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CHRONIC STABLE ANGINA
Chronic stable angina is a clinical syndrome characterized by squeezing, heaviness or pressure discomfort in the chest, neck, jaw, shoulder, back, or arms which is usually precipitated by exertion and/or emotional stress and relieved by rest and/or Nitroglycerin.
It is caused by myocardial ischemia that is commonly associated with narrowing of the coronary arteries.
Angina is stable when it is not a new symptom and when there is no deterioration in frequency, duration or severity of episodes.

Prevention

Influenza Vaccination

  • Annual influenza vaccination is recommended for patients with ischemic heart disease (IHD) especially the elderly
    • Decreases exacerbation of underlying medical condition and risk for mortality in patients with chronic illnesses such as cardiovascular (CV) disease

Follow Up

  • Patients with stable ischemic heart disease (SIHD) should have regular follow-up every 4-6 months during the first year of therapy and 6-12 months after the first year if the patient is stable and reliable to know when symptoms or functional capacity becomes worse
  • Evaluation includes:
    • Assessment of symptoms and clinical function
    • Surveillance for complications such as arrhythmias and heart failure
    • Monitoring of cardiac risk factors
    • Assessment of the adequacy and compliance to lifestyle modifications and medical therapy
  • Periodic screening of comorbidities that are prevalent in patients with SIHD such as diabetes mellitus (DM), depression and chronic renal disease
  • Reinforce therapies that help control risk factors such as dyslipidemia, hypertension and DM
  • Patients at risk (eg recent acute coronary syndrome or revascularization, heart failure) should have medically-supervised programs (cardiac rehabilitation) and physician-directed home-based exercise programs 
  • Resting electrocardiogram (ECG) at 1-year or longer intervals between studies in patients with stable symptoms can also be performed
    • Additional ECG is suggested if patient experiences arrhythmia, anginal symptoms or if therapy has been modified
  • Exercise ECG or stress imaging is recommended if there are changes in frequency of symptoms or new symptoms occur
    • Repeat exercise ECG may be done after 2 years if stable
    • Stress test may be done for reference 1-3 months post revascularization and/or periodically for ischemia reassessment 
  • Reassessment of prognosis via stress test every 3-5 years for low-risk/asymptomatic patients after warranty of previous stress test
  • Assessment of left ventricular ejection fraction (LVEF) and segmental wall motion by echocardiography or radionuclide imaging is recommended in patients with new or worsening heart failure or evidence of intervening myocardial infarction (MI) by history or ECG
  • For patients with debilitating angina unresponsive to optimal medical therapy and revascularization, consider using a reducer device for coronary sinus constriction to improve symptoms 
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