ManagementofStableAnginaSIGN96：稳定型心绞痛标志96管理.pptVIP

Management of Stable Angina SIGN 96  Care of patients with suspected angina Alleviation of angina symptoms Prevention of new vascular events Consider for revascularisation Revascularisation by CABG Psychological issues Patients with CHD undergoing non-cardiac surgery (1) Patients with CHD undergoing non-cardiac surgery (2) Patients with CHD undergoing non-cardiac surgery (3) Long term follow up * Angina Patient Journey Diagnosis and Assessment Pharmacological management Interventional cardiology and cardiac surgery Patient issues and follow up Presentation Chest pain evaluation service Drug intervention to prevent new vascular events Stable angina and non-cardiac surgery Psychological and cognitive issues Patient presents with chest pain likely to be due to stable angina Consider characteristics of pain and associated features Detailed clinical examination ? Consider need for early referral ? Refer for confirmation of diagnosis to chest pain service Coronary angiography ? Exercise tolerance test or Myocardial perfusion scintigraphy if unable to exercise or pre existing ECG abnormalities 12 Lead ECG Measure Hb, TSH, TC, RBS ? C B C B Confirm diagnosis and assess severity of CHD Use chest pain evaluation service with earliest appointment B Early access to angiography and coronary artery bypass surgery may reduce the risk of adverse cardiac events and impaired quality of life C Beta blockers first line therapy Inadequate control of symptoms – add a calcium channel blocker Sublingual GTN tablets or spray for immediate relief before activities known to bring on angina A A A If intolerant of beta blockers treat with a rate limiting calcium channel blocker, long acting nitrates or nicorandil A Consider referral to a cardiologist if symptoms not controlled on maximum therapeutic doses of two drugs ? Consider ACEI in all patients with stable angina Meta-analysis of 6 RCTs – 33,500 patients – CHD and preserved LVSD Meta-analysis of HOPE, EUROPA