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Angina - stable - Management
When should I refer someone whose symptoms are poorly controlled on treatment?
- 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:
- No previous stress test (such as exercise tolerance test).
- Failure to respond to medical treatment (maximum therapeutic doses of two drugs).
- A highly abnormal exercise tolerance test.
- Previous myocardial infarction, coronary artery bypass graft, or percutaneous transluminal coronary angioplasty.
- Newly diagnosed or uncontrolled atrial fibrillation.
- Electrocardiographic evidence of a previous myocardial infarction or other significant abnormality.
- Ejection systolic murmur suggesting aortic stenosis.
- Further reasons to refer to a cardiologist include:
- 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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