Angina Pectoris, Stable

Description

General Measures

Medicine Treatment

Referral

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ICD 10 code: I20.20

DESCRIPTION

Characteristic chest pain (burning or heavy discomfort behind the sternum), of duration < 15 minutes, due to myocardial ischaemia, usually occurring on exercise and relieved by rest.

GENERAL MEASURES

Lifestyle modification. See: Prevention of ischaemic heart disease and atherosclerosis

MEDICINE TREATMENT (doctor initiated)

Long-term prophylaxis for thrombosis:

• Aspirin, oral, 150 mg daily

LoE:Ia⁸

AND

Relief of angina

• Nitrates, short acting e.g.:
• Isosorbide dinitrate, sublingual, 5 mg
  • May be repeated if required at 5– minute intervals for 3 or 4 doses
  • Instruct patients to keep the tablets in the airtight and lightproof container in which they are supplied
  • Instruct patients that nitrates are not addictive
  • Instruct patients to use prophylactically, before activities which may provoke angina

LoE:IVb⁹

AND

Step 1

• Beta-blocker
• Atenolol, oral, 50–100 mg daily
  • Titrate to resting heart rate of approximately 60 beats/ minute

If beta-blocker cannot be tolerated or is contraindicated, consider long acting calcium channel blocker.

Step 2

ADD

• Long-acting calcium channel blocker e.g.:
• Amlodipine, oral, 5 mg daily

Step 3

ADD

• Isosorbide mononitrate, oral, 10–20 mg twice daily

LoE:IIIb¹⁰

OR

• Isosorbide dinitrate, oral, 20–30 mg twice daily
  • Take either medicine at 8:00 and 14:00 in order to provide a nitrate-free period to prevent tolerance
  • Modify for night shift workers

LoE:IIIb¹¹

Angina is a high-risk condition for cardiovascular disease and is an indication for a statin.

• HMGCoA reductase inhibitors (statins), e.g.:
• Rosuvastatin, oral, 10 mg at night

LoE:Ia¹²

Patients on protease inhibitor:

• Atorvastatin, oral, 10 mg at night

LoE:Ia¹³

Patients on amlodipine (and not on a protease inhibitor):

• Simvastatin, oral, 10-20 mg at night

LoE:IVb¹⁴

If patient complains of muscle pain:

Reduce dose e.g.:

• If simvastatin 20 mg not tolerated, reduce to 10 mg

OR

Refer for further management

LoE:IIb¹⁵

REFERRAL

• When diagnosis is in doubt
• Failed medical therapy

Click here for the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_1 November 2024

Chapter 4: Cardiovascular Conditions_4.2 Angina Pectoris, Stable