Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Angina - stable - Management
How should I treat a person with suspected angina while waiting for specialist referral?

  • Provide the person with sublingual glyceryl trinitrate to use for the relief of symptoms while they are waiting for specialist referral.
    • Instruct the person that if they experience chest pain they should:
      • Stop what they are doing and rest.
      • Use their glyceryl trinitrate spray or tablets as instructed.
      • Take a second dose after 5 minutes if the pain has not eased.
      • Take a third dose after another 5 minutes if the pain still has not eased.
      • Call 999 for an ambulance if the pain has not eased after another 5 minutes, or earlier if the pain is intensifying or the person is unwell.
  • If clinically confident of the diagnosis, start aspirin.
Basis for recommendation
  • CKS found no evidence or guidelines regarding what treatment to start whilst the person is waiting for specialist assessment. The recommendation to prescribe sublingual glyceryl trinitrate is based on the assumption that the working diagnosis of angina is correct.
    • The recommendation for instructions on how to use glyceryl trinitrate (GTN) is based on expert opinion and local guidelines.
  • CKS expert reviewers suggested that aspirin can also be started if angina is likely on the basis of clinical assessment. Opinion was divided on whether to start a beta-blocker, so this has not been recommended in primary care before the diagnosis is confirmed.

© NHS Institute for Innovation and Improvement