INVESTIGATIONS

Blood tests

• Haemoglobin
• Blood glucose
• Thyroid function
• Cholesterol - see risk factor modification

12 lead ECG

• a normal ECG does not exclude angina

RISK FACTOR MODIFICATION

Cholesterol

• all patients should have their serum cholesterol measured
• if raised, manage in line with local guidelines

Blood pressure

• all patients should have their blood pressure measured
• if raised, manage in line with local guidelines

Smoking

• all patients who smoke should be advised to stop
• stopping strategies should be tailored to individuals
• nicotine patches can be used in patients with angina
• nicotine patches can help but should not be used alone

Exercise

• patients should take moderate exercise within their capabilities to improve fitness and well-being

Weight reduction

• encourage patients to reduce their weight until their BMI is normal

DRUG TREATMENT

Check all agents for doses, contra-indications and side-effects in the

British National Formulary

Secondary prophylaxis

• treat all patients with aspirin 75-300mg daily

Symptomatic treatment

• sublingual GTN
• add a beta-blocker
• add an oral nitrate

EXERCISE TESTING

• Refer for an exercise test all patients with clinically certain angina
• if open access service not available then refer to a cardiologist
• Do not refer for an exercise test
  • patients in whom the diagnosis is unclear
  • patients who are physically incapable of performing the test for reasons other than their angina
  • patients with co-morbidities that are currently more important
  • patients who decline to have the test
  • patients whose symptoms are uncontrolled on maximal medical treatment - they should be referred to a cardiologist for angiography

REFERRAL TO A CARDIOLOGIST

Refer to a cardiologist:

• patients in whom the diagnosis is unclear
• patients with clinically certain angina for exercise testing if open access service is not available
• patients whose symptoms are uncontrolled on maximum medical therapy
• patients with a positive exercise test from open access testing

Do not refer:

• patients who currently have a more significant condition
• patients who decline referral