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Angina is pain or constricting discomfort that typically occurs in the front of the chest (but may radiate to the neck, shoulders, jaw or arms) and is brought on by physical exertion or emotional stress.
Diagnose stable angina according to NICE guidance on chest pain of recent onset (CG95).
Patients with chest pain of recent onset should be referred to the rapid access chest pain clinic for assessment. Assessment will include appropriate investigation to confirm diagnosis, provide risk stratification and guide appropriate revascularisation for symptomatic or prognostic disease.
Patients should be considered for the same treatment regardless of age (taking co-morbidity into account).
If beta blockers and calcium channel blockers are contraindicated or not tolerated
Consider monotherapy with either:
With addition of:
Add or change to amlodipine or nifedipine MR (Adalat LA®)
Change calcium channel blocker to amlodipine or nifedipine MR (Adalat LA®)
Consider one of the following as an additional drug:
Consider specialist referral
If symptoms are not satisfactorily controlled consider adding or change to:
Only add a third drug if:
Local cardiologists advise that:
All patients with angina, controlled or otherwise, who, considering co-morbidity, are sufficiently robust so as to be considered for revascularisation and who after discussion with their doctor wish to be referred, should be referred to a cardiologist at least once for risk stratification and consideration of revascularisation. This will normally be at diagnosis. Those who are not considered fit enough for revascularisation could reasonably be managed symptomatically.