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Page 2 of 3 Treatment and Follow-up
• To achieve and maintain patients’ BP at or less than 140/85 mmHg
• To achieve and maintain optimum control of blood pressure and glucose for
diabetic patients
• To achieve and maintain patients’ total cholesterol level at or less than 5.0 mmol/l
– refer to Guidelines for the Management of Hypercholesterolaemia
• To achieve and maintain 100% of patients not smoking
• To advise on lifestyle modification, egg. Diet, management of obesity, alcohol
consumption, exercise, and community physical activity programs, reinforced
with appropriate literature
• To make referrals to specialist services where appropriate, egg. Dietitian, smoking
cessation clinics
• To check compliance and patients’ understanding of current pharmacological
intervention (see recommendations below)
• To check and discuss general health issues with patients
Pharmacological Intervention for patients with CHD
• Aspirin should be given routinely to and continued for life in patients A
with CHD – a dose of 75-150 mg aspirin per day is recommended in
post MI patients
• Clopidogrel (75 mg/day) is an effective alternative in patients A
with contraindications to aspirin, or who are intolerant of aspirin.
• Caution should be exercised in the use of Clopidogrel, which can A
cause GI upset in some patients.
• β-blocker therapy should be given to patients following myocardial
infarction unless there are contraindications
• Long term ACE inhibitor therapy should be given to patients A
following MI with or without left ventricular dysfunction, unless there
are contraindications
• In post MI patients with left ventricular dysfunction, ACE inhibitor A
therapy should be considered within 48 hours of the onset of
symptoms – refer to guidelines for the management of heart failure
• Caution should be exercised in the use of ACE inhibitors in patients
who are hypotensive, who have moderate renal failure, or who are
known to have renal artery stenosis.
• The initiation of Statin therapy
Criteria for Specialist referral
1. Patients who have had a recent onset chest pain in the last 2 – 4 weeks
should be referred to the Rapid Access Chest Pain clinic
2. Patients who have had previous assessment of chest pain in either the
Cardiology clinic, A & E department or as an inpatient or outpatient, should be
referred to the Cardiology Outpatient clinic in the normal way.
3. Patients suspected of having acute and severe pain in the background of
stable angina should be referred to the A & E department as they could be
suffering from MI/unstable angina.
4. Except under exceptional circumstances, women under 40 and men under 30
should not be referred to the Rapid Access Chest Pain clinic, because the
probability of coronary heart disease in these groups is extremely low.
5. Patients with abnormal ECG’s are at greatest risk and should be considered
for specialist referral.
6. Patients with chest pain and murmurs suggesting aortic stenosis should be
considered for specialist referral.
7. Patients where clinical condition gives rise for concern, e.g. failure to respond to management/treatment outlined in this guideline, pain at rest or at night, concurrent illnesses, particularly diabetes, should be considered for specialist referral.
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Research 
