Picture quiz: Stable angina
A 60 year old woman presented to her general practitioner with nine months' history of chest pain. The pain was worse on exertion and temporarily relieved by glyceryl trinitrate spray. She had a long standing history of hypertension treated with bendrofluazide and hypercholesterolaemia treated with a statin. She was also on aspirin.
An exercise test was arranged which showed sinus tachycardia segment depression in leads I, II, III, and V1-V6, accompanied by chest pain. Following this the investigation shown in figs 1 and 2 was performed. Fig 3 is a graphical representation of the outline of the heart and the major coronary arteries.
Lifestyle changes may contribute to management as recognised in the national service framework for coronary heart disease. Patients with ischaemic heart disease should be advised to stop smoking as a priority. A low cholesterol, Mediterranean-type diet, including more fruit, green vegetables, fish, poultry, bread, and cereals, and