THE CONTEXT
Management of angina aims to relieve symptoms and improve prognosis through education, lifestyle measures, risk-factor treatment and medication.
Education and reassurance
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Begin with a careful explanation of the problem and a discussion of lifestyle and medical interventions.
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Anxiety and misconceptions can contribute to disability. Some patients avoid all exertion because they believe every angina attack causes permanent damage.
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Education and reassurance can dispel these misconceptions and substantially improve quality of life.
Core management principles
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Advise smoking cessation and healthier lifestyles.
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Identify and treat risk factors, and introduce drug treatment for symptom control.
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Assess the extent and severity of coronary artery disease and identify high-risk patients for treatment that improves life expectancy.
Antiplatelet and statin treatment
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All patients with angina secondary to coronary artery disease should receive antiplatelet therapy.
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Low-dose aspirin, 75 mg, should be prescribed indefinitely because it reduces MI risk.
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Clopidogrel 75 mg daily is an equally effective alternative if aspirin causes dyspepsia or other side-effects.
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All patients should receive a statin, even if their serum cholesterol concentration is normal.