Overview
Stable Angina
1. Clinical Overview
Summary
Stable angina is chest discomfort due to myocardial ischaemia with exertion or stress, relieved by rest or GTN. Caused by fixed coronary artery stenosis limiting blood flow during increased demand. Diagnosis is confirmed with functional testing (exercise ECG, stress echo, CT coronary angiography). Management includes risk factor modification, antiplatelet therapy, antianginal drugs (GTN, beta-blocker, CCB), and revascularisation for refractory symptoms or high-risk disease.
Key Facts
- Definition: Predictable chest tightness with exertion, relieved by rest/GTN
- Pathophysiology: Fixed coronary stenosis → demand-supply mismatch
- First-line treatment: GTN (acute), beta-blocker or CCB, aspirin, statin
2. Diagnosis
- Clinical history (typicality)
- CT coronary angiography (NICE first-line if suspected CAD)
- Exercise stress ECG / stress echo / MPI
3. Management
Medical
| Class | Drug | Notes |
|---|---|---|
| Short-acting nitrate | GTN spray | For acute symptoms |
| Beta-blocker | Bisoprolol | First-line antianginal |
| CCB | Amlodipine or diltiazem | Alternative/addition |
| Aspirin | 75mg OD | Secondary prevention |
| Statin | Atorvastatin 80mg | Secondary prevention |
| ACEi | Consider | Especially if HF, DM, HTN |
Revascularisation
- PCI or CABG if refractory symptoms or prognostically significant disease
4. References
- NICE Guideline CG126. Stable angina: management. 2011 (updated 2016).
Last Reviewed: 2026-01-01 | MedVellum Editorial Team