Stable Angina, Guidelines & RACPC

Posted by e-Medical PPT
Promoting Assessment & Treatment which is
Structured, Systematic, Objective
Evidence-based
Appropriate
In keeping with the patient’s wishes

Risk stratification
At presentation (“pre-test”)
After non-invasive assessment (“post-test”)
After Coronary Angiography

Angina : NSF Standards
Standard 8
    People with symptoms of angina or suspected angina should receive appropriate investigation and treatment to relieve their pain and reduce their risk of coronary events.
Standard 9
    People with angina that is increasing in frequency or severity should be referred to a cardiologist urgently or, for those at greatest risk, as an emergency.

Standard 10
    NHS Trusts should put in place hospital-wide systems of care so that patients with suspected or confirmed coronary heart disease receive timely and appropriate investigation and treatment to relieve their symptoms and reduce their risk of subsequent coronary events.


Evaluation and Diagnosis
In patients presenting with chest pain
detailed symptom history
focused physical examination
directed risk-factor assessment
Estimate the probability of significant CHD
if intermediate or high: refer to RACPC
Objective assessment (eg ExECG) is for:
Diagnosis of myocardial ischaemia
Assessment of severity & pathophysiology
Assessment of prognosis

Rapid Access Chest Pain Clinics
One-stop” assessment of stable patients
Recent (<6 months) onset of exertional chest pain, intermediate-high risk of angina
Known CHD which was stable (eg after PTCA or CABG) now symptomatic again
< 2 week wait to clinic

Classification of Chest Pain
Estimating the Probability of CHD from History of Chest Pain
Precipitated by exercise
Brief duration (<15 minutes)
Relieved promptly by rest or GTN
Central chest location
Radiates to Jaw, Throat, or L Arm
Absence of other causes for pain

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