You review a 65-year-old male on the post-take ward round who has been referred by his GP with a 2-week history of exertional chest pain. There have been no episodes at rest and he has improved since the GP started him on bisoprolol 2.5 mg od. His resting ECG shows no ischaemia and troponin tests are negative. He has a family history of ischaemic heart disease but no other risk factors.
Which investigation would you recommend?
The history is very suggestive of stable angina and so the patient has a high likelihood of coronary disease (>90%). Therefore he should go directly to invasive coronary angiography. Exercise treadmill testing is no longer recommended by NICE for stratification of stable angina.