Predictable exertional chest pain relieved by rest / GTN, due to fixed coronary stenosis.
Risk factors
- • Age, male, smoking, DM, HTN, dyslipidaemia, family hx CAD
History taking
- • Central tight chest pain on exertion, <10 min, relieved by rest
- • Radiation to jaw/arm, dyspnoea
Examination
- • General: vitals, pallor, icterus, oedema, lymphadenopathy
- • Focused system examination
- • Look for red-flag findings
Red flags
- • Haemodynamic instability
- • Rapid deterioration
- • Severe pain or new neurological deficit
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • ECG (often normal at rest)
- • Lipids, HbA1c, FBC, TFT
- • CT coronary angiography (NICE 1st line) or stress imaging
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Treat underlying cause
- • Symptomatic relief
- • Patient education
Drug therapy
- • Aspirin 75 mg OD
- • High-intensity statin (atorvastatin 80 mg)
- • GTN spray PRN
- • β-blocker (bisoprolol 2.5–10 mg) or CCB (amlodipine 5–10 mg) first line
- • Add long-acting nitrate / ivabradine / ranolazine if needed
Lifestyle advice
- • Smoking cessation, BP/lipid control, exercise
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Explain diagnosis and natural course in lay terms
- • Red-flag symptoms warranting urgent return
- • Adherence to medications and follow-up
Referral criteria
- • Refer if diagnostic uncertainty, complications, or failure of first-line therapy
Clinical pearls
- • Sublingual GTN: sit down, repeat after 5 min; call ambulance if pain persists 15 min total
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
