Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Contents Key priorities for implementation 6 Guidance 9 1.2 Information and support for people with stable angina 9 1.3 General principles for treating people with stable angina 10 1.4 Anti-anginal drug treatment 12 1.5 Investigation and revascularisation 15 1.7 Stable angina that has not responded to treatment 19 1.8 Cardiac syndrome X 19 Recommendations for research 21 1 Adding a newer anti-anginal drug to a calcium channel blocker 21 2 Management of stable angina in people with evidence of ischaemia on non-invasive functional testing 21 3 Early revascularisation strategy for people with angina and multivessel disease 22 4 Cardiac rehabilitation 23 5 Patient self-management plans 23 Finding more information and committee details 25 Update information 26 This guideline partially replaces TA73. This guideline is the basis of QS21 and QS181. Introduction Angina is pain or constricting discomfort that typically occurs in the front of the chest (but may radiate to the neck, shoulders, jaw or arms) and is brought on by physical exertion or emotional stress. Some people can have atypical symptoms, such as gastrointestinal discomfort, breathlessness or nausea. Angina is the main symptom of myocardial ischaemia and is usually caused by atherosclerotic obstructive coronary artery disease restricting blood flow and therefore oxygen delivery to the heart muscle. The Health Survey for England (2006) reported that around 8% of men and 3% of women aged between 55 and 64 years currently have or have had angina. The figures for men and women aged between 65 and 74 years are around 14% and 8% respectively. It is estimated that almost 2 million people in England currently have or have had angina. 