Medical management and evaluations of stable angina patients in tertiary care centre without invasive treatment

Abstract

Background: Ischemic heart disease is the important cause of morbidity and mortality in the community, it may present with wide variety of clinical entities. Chronic stable angina is a common condition and results in a considerable burden for both the individual and society. There are two approaches to the management of stable angina - percutaneous coronary intervention (PCI) and optimising medical therapy (OMT). Our study is focused on management of stable angina in tertiary care centre without invasive investigation.Methods: This study carried out in Medicine Department, SIMS, Shimoga for 7 months from January 2017 to July 2017. 100 patients of chronic Stable Angina attending OPD of Mc Gann Hospital. A detailed history was taken in all the patients and a through physical examination was done. ECG, Blood investigations, 2D- Echocardiography and TMT is done.Results: The mean age was (54.67±8.56) years. With male to female ratio being 1.2:1. ECG was normal in majority of patients (39%), followed by ST, T changes (33%), LVH (35%) and Hemiblock (36%). Hyperlipidemia (48%), Hypertension (42%) and Diabetes mellitus (37%) are major diseases associated with stable angina. Most of the patients are taking clopidogrel (96%) and aspirin (88%). Followed by ACE/ARB’s (70%) and statins (72%). Normal 2D-Echo is seen in 82% of cases. Diastolic dysfunction in 69%. Decreased ejection fraction in 23%. TMT is done in only 75 patients out of whom 9 could not complete the test. Inducible ischemia is positive in 48 patients.Conclusions: Our study showed ECG changes, 2D Echo findings, TMT results and medication usage similar to other studies. However, there is less compliance with medication and risk factors are under controlled. Stable Angina is a common initial manifestation of coronary heart disease. It needs to be treated more aggressively to prevent complications. Increasing education regarding stable angina both among patients and physicians is need of the hour.