​What is Medicine – Stable Angina

​What is Medicine – Stable Angina ​

Stable Angina is a narrowing of the coronary arteries. The narrowing of the coronary arteries may lead to the reduction of blood flow to the heart muscle / myocardium. 

In times of high demand, such as physical exertion, there is insufficiency blood supply to meet the demand. Angina may be presented with chest pain with or without radiation to arms or jaw.

Stable angina is different from unstable angina as stable angina’s symptoms are relieved by rest or the intake of glyceryl trinitrate while unstable angina / acute coronary syndrome may present on randomly whilst at rest. 

Physical examination is needed for patient with stable angina to look for any signs of abnormalities in heart sound, or signs of heart failure. 

ECG, full blood count for anemia, urea and electrolytes ( prior to starting an ACE inhibitor) and liver function test ( prior to starting statins), lipid profile, thyroid function test( hypo or hyperthyroid) or HbA1C and fasting glucose ( diabetes) are needed for patient with stable angina. 

The investigation needed for stable angina include CT coronary angiography which is considered as a gold standard of diagnostic investigation. CT coronary angiography includes the injection of contrast and taking CT images timed with the heart beat to give detailed view of the coronary arteries. Any narrowing of the coronary arteries will be highlighted. 

The management of stable angina include referral to cardiology, advise the patient about the diagnosis, management and when to call for ambulance, medical treatment and procedural as well as surgical intervention. 

The medical treatment for stable angina include immediate symptomatic relief, long term symptomatic relief and secondary prevention of cardiovascular disease. 

Immediate symptomatic relief will focus on GTN spray which causes vasodilation and help to relieve the symptoms. 

Long term symptomatic relief include beta blocker or / and calcium channel blocker. Long acting nitrates such as isosorbide mononitrate, ivabradine, nicorandil and ranolazine are considered. 

The secondary prevention includes, aspirin, atorvastatin and ACE inhibitor.

Surgical / procedural intervention may include percutaneous coronary intervention with coronary angioplasty. This involves dilating the blood vessel with a balloon and or inserting a stent. This intervention is considered in patient who based on CT coronary angiography  reveals a proximal or extensive disease. The procedure involves the catheter being put into the patient’s brachial or femoral artery, feeding that up to the coronary arteries under the guidance of the x ray and injecting contrast so that any stenosis of the coronary arteries can be highlighted on the image of the x ray. Later balloon dilation is considered and followed by stent insertion.

Coronary Artery Bypass Graft surgery is considered in severe cases of stenosis (recovery is slower and complication rate is higher than percutaneous coronary intervention The chest along the sternum is opened, a graft vein from the patient’s leg such as the great saphenous vein is taken and sewed it on the affected part of the coronary artery to bypass the stenosis.