Definition
Stable angina is chest pain or discomfort due to transient myocardial ischaemia, typically triggered by exertion or emotional stress and relieved by rest or nitrates. It reflects underlying coronary artery disease (CAD).
Clinical Features
Mnemonic: SAP
Substernal chest discomfort
Aggravated by exertion or stress
Promptly relieved by rest or GTN (glyceryl trinitrate)
Atypical angina meets 2 of 3; non-anginal chest pain meets 0–1.
Risk Factors
Smoking
Hypertension
Diabetes mellitus
Hyperlipidaemia
Family history of IHD
Physical inactivity
Investigations
Clinical assessment: history and risk factors
Resting ECG: may be normal; could show ischaemic changes
Functional imaging (stress echo, myocardial perfusion scan)
CT coronary angiography: preferred first-line diagnostic test
Blood tests: FBC, lipids, HbA1c/glucose, renal function
💊 MANAGEMENT
🧠 Mnemonic: ABCD-GTN
Aspirin 75 mg daily (unless contraindicated)
Beta-blocker or calcium channel blocker (1st line symptom relief)
Cholesterol control – statin (e.g. atorvastatin)
Diabetes and BP control
GTN for symptom relief (short-acting nitrate)
Nitro spray for acute episodes
💊 2nd line anti-anginals: long-acting nitrates, ivabradine, nicorandil, ranolazine
🛠️ Consider revascularisation (PCI or CABG) if symptoms persist despite medical therapy or high-risk anatomy.
Complications
Progression to unstable angina or MI
Heart failure
Arrhythmias
🧐 Differentials
Acute coronary syndrome
Pericarditis
Aortic dissection
GORD
Musculoskeletal chest pain
🩺 Monitoring
Long-term medical therapy to reduce symptoms and CV risk
Lifestyle advice: smoking cessation, diet, exercise
Monitor symptom progression and control of comorbidities
Last updated in line with NICE CG126 (July 2016)
Last reviewed: July 2025
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