Stable Angina

• A new S4 may be heard, suggesting a stiff ventricle due to ischemia
• Most with angina have ECG changes DURING an attack. Most commonly, ST depression is seen.
• ST elevation occurs in variant angina (Prinzmetal angina) and some cases of stable angina with atherosclerotic disease

Dx

Baseline ECG

Exercise stress test - positive if large (>2mm) ST depression or hypotension (SBP drops >10mmHg) or both

exercise stress test can predict severity of IHD; assess effectiveness of treatment & recovery (after MI)

contraindications:

AMI, unstable angina, aortic dissection, severe CCF, uncontrolled sustained ventricular arrthythmias, symptomatic SVT, significant aortic stenosis, HOCM or severe uncontrolled HTN

• alpha- and beta blockers, nitroglycerin and digoxin should be withheld prior to test

For the patients with baseline ECG abnormalities, such as BBB, LVH, or with a pacemaker and taking digoxin can be evaluated by nuclear stress imaging

Dobutamine or adenosine stress test: for those unable to exercise

Stress ECho - can detect abnormal wall motion abnormalities

(Invasive) Cardiac catheterization is used in stable angina for (1) diagnosis and (2) prognosis/risk stratification

Finally angiography

Tx

Nitroglycerin S/L

Risk factor modification

Nicorandil acts as both a nitric oxide donor and a sarcolemmal K+-adenosine triphosphate (K-ATP)-dependant channel opener, causing K+efflux and subsequent hyperpolarisation and inhibition of L-type Ca2+channels, leading to systemic and coronary vasodilatation. The beneficial effects of nicorandil monotherapy are similar to those of metoprolol, amlodipine, diltiazem and nitrates