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How to Treat Angina Pectoris?


Things to note:
Lifestyle modification
All persons with risk factors for ischaemic heart disease should be encouraged to make the following lifestyle changes as appropriate:
  • Smoking cessation.
  • Weight reduction in the overweight patients, i.e. BMI > 25 kg/m2.
  • Maintain ideal weight, i.e. BMI < 25 kg/m2.
  • Reduce alcohol intake to no more than 2 standard drinks/day.
  • Follow a prudent eating plan i.e. low saturated fat, high fibre and unrefined carbohydrates, with adequate fresh fruit and vegetables.
  • Moderate aerobic exercise, e.g. 30 minutes brisk walking at least 3 times a week.

Medical Treatment:
Long-term prophylaxis for thrombosis:
  • Aspirin, oral, 75-150 mg daily with food.
PLUS
Relief of angina:
Nitrates, short acting e.g:
  • Isosorbide dinitrate, SL, 5 mg.
    • Repeat at 5-minute intervals for 3 or 4 doses if required.
PLUS
Step 1
  • Atenolol, oral, 50-100 mg daily.
    • Titrate of approximately 60 beats per minute to resting heart rate.
Consider the long - acting calcium channel blocker if beta-blocker can not be tolerated or is contraindicated.
Step 2
ADD
  • Long acting calcium channel blocker e.g:
    • Amlodipine, oral, 5 mg.
Step 3
ADD
  • Isosorbide mononitrate, oral, 10-20 mg.
    • To provide a nitrate-free period to prevent tolerance, take at 8:00 and 14:00.
    • Change for night shift workers.
OR
  • Isosorbide dinitrate, oral, 20-40 mg.
    • To provide a nitrate-free period to prevent tolerance, take at 8:00 and 14:00.
    • Change for night shift workers.
HMGCoA reductase inhibitors, e.g:
  • Simvastatin, oral, 10 mg daily.


When to refer:
  • When diagnosis is in doubt.
  • Failed medical therapy.