KEY INFORMATION, EXTRA’S
KEY INFORMATION
- Consider PCI/CABG if medical therapy is ineffective (failure to control symptoms with two maximum dose drug therapies)
- No nitrates with sildenafil (24-hour gap required) – avoid concomitant use
- No beta-blockers with rate-limiting calcium channel blockers – No rate-limiting calcium channel blockers with ivabradine
- Contraindications for rate-limiting calcium channel blockers:
- heart failure, bradycardia, AV block
- Contraindications for dihydropyridine calcium channel blockers:
- severe hypertension, aortic stenosis
- Side effects of calcium channel blockers: headaches, facial flushing, lower limb oedema, dizziness, postural drop
- contraindications for beta blockers: asthma, severe COPD, heart rate less than 60, AV block, severe hypotension (< 90 systolic), PAD, Raynaud’s, severe/uncontrolled heart failure – contraindications of long-acting nitrates: acute MI, HOCM, increased intracranial pressure, anaemia, closed-angle glaucoma
- Adverse effects of nitrates: transient decrease in blood pressure and headaches
- Monitor heart rate with ivabradine (stop if there is no improvement at 3 months). Adverse effects: blurring & flashes of light in the eyes, bradycardia, AF & headaches. – Ranolazine contraindicated if egfr <30
EXTRA’S
Driving advice:
- Type 1 licence: cease if symptomatic, DVLA notification not required
- Type 2 licence: cease driving, inform DVLA, must be symptom-free for 6 weeks + pass exercise test
Air travel:
- Mild/moderate cases: generally safe
- Severe cases: defer until stable/consider in-flight oxygen.