Cardiology
Chronic Stable Angina
Cardiology

Chronic Stable Angina

ASA + statin + BB + nitrate PRN; stress test pathway.

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◆Pharmacotherapy

  • •Foundation: aspirin + high-intensity statin
  • •First-line antianginal: beta-blocker (↓ contractility + HR)
  • •Add: long-acting nitrate or CCB
  • •Refractory: ranolazine (no major hemodynamic effects)
  • •AVOID beta-blockers in Prinzmetal (use CCB)
  • •Nicotine patches OK in stable angina

◆Risk factor modification

  • •Smoking cessation (most important)
  • •Mediterranean diet ↓ CV mortality
  • •Aerobic exercise program

◆Diagnostic triage

  • •Stress test: intermediate pretest probability + interpretable ECG + can exercise = exercise treadmill
  • •Pharmacologic stress (adenosine, dipyridamole, dobutamine): cannot exercise OR ECG uninterpretable (LBBB, paced, ST↓)
  • •Dobutamine if vasodilators contraindicated; AVOID adenosine/dipyridamole in severe asthma/COPD
  • •Coronary angiography: high-risk stress findings or refractory symptoms

High-yield pearls

  • ◆Nitrates + PDE5 inhibitor (sildenafil) → dangerous hypotension
  • ◆Add ranolazine when BB + nitrates fail and BP/HR limits further therapy
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