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Angina - stable - Management
View full scenario

When should I refer someone with suspected 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.
  • Refer urgently all people with suspected angina to a chest pain evaluation service, for confirmation of the diagnosis and assessment of the severity of coronary heart disease.

In depth

How should I treat a person with suspected angina while waiting for specialist referral?

  • Provide the person with glyceryl trinitrate (sublingual spray or tablets) 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.

In depth

Prescriptions

Sublingual glyceryl trinitrate

Age from 16 years onwards
GTN 400microgram spray: spray once under the tongue when required
Glyceryl trinitrate 400micrograms/actuation sublingual spray
Spray one puff under the tongue when required for chest pain.
Supply 1 200-dose pump spray.
Age: from 16 years onwards
NHS cost: £3.13
OTC cost: £5.52
Licensed use: yes
Patient information: The dose can be repeated up to three times per attack. If your chest pain persists after three doses of GTN seek urgent medical help.
GTN 500microgram tabs: place one under the tongue when required
Glyceryl trinitrate 500microgram sublingual tablets
Place one tablet under the tongue when required for chest pain.
Supply 100 tablets.
Age: from 16 years onwards
NHS cost: £2.70
OTC cost: £4.76
Licensed use: yes
Patient information: The dose can be repeated up to three times per attack. If your chest pain persists after three doses of GTN seek urgent medical help. Discard any remaining tablets 8 weeks after opening.

© NHS Institute for Innovation and Improvement