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Angina - stable - Management
When should I refer someone with newly diagnosed angina?
- Consider hospital admission for people with the following symptoms, as they may have unstable angina:
- Pain at rest (which may occur at night).
- Pain on minimal exertion.
- Angina that seems to be progressing rapidly despite increasing medical treatment.
- Indications for early referral to a cardiologist include:
- Previous myocardial infarction, coronary artery bypass graft, or percutaneous transluminal coronary angioplasty and development of angina.
- Electrocardiographic evidence of previous myocardial infarction or other significant abnormality.
- Newly diagnosed atrial fibrillation.
- Heart failure and angina.
- An ejection systolic murmur suggesting aortic stenosis.
- Any suggestion of hypertrophic cardiomyopathy (for example by family history, physical examination, or electrocardiographic abnormality).
- Refer for prognostic exercise testing if this has not been done as part of the diagnostic process.
- Further reasons to refer people to a cardiologist include:
- Doubt about the diagnosis.
- The presence of several risk factors or a strong family history.
- The person's preference for referral.
- Problems with employment, life insurance, or unacceptable interference with lifestyle.
- Significant comorbidity (such as diabetes).
In depth
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