Specialist angina and complex coronary disease service

Heart health

Dr Ranil de Silva has taken over leadership of the specialist angina and complex coronary disease service at Royal Brompton Hospital.

Specialist angina service

The service treats patients who suffer from persistent angina, despite having had treatment with medication, stents, and coronary artery bypass surgery. This can also include patients who may have previously been considered unsuitable for revascularisation and those who suffer from chest pain despite a normal coronary angiogram.

The specialist multidisciplinary team of healthcare professionals is dedicated to the investigation and treatment of such patients. This includes providing a full clinical assessment and access to a comprehensive range of advanced scanning techniques for diagnosis, performed by leading imaging specialists. 

A holistic approach to management is used with access to an angina nurse specialist who can advise on approaches to limiting the impact on daily life.

Evaluation of patients

Patients who are referred to the service undergo a comprehensive clinical evaluation to identify any cognitive and lifestyle issues related to their symptoms of chest pain and underlying diagnosis. They may have non-invasive imaging, and coronary angiography and intracoronary physiology or imaging as required. 

All the cases are then discussed in a multidisciplinary team meeting during which a tailored management plan is developed for each patient.


Patients with persistent angina are treated by a consultant who discusses the diagnosis and treatment options. Also, the patient has ongoing contact with a dedicated angina nurse specialist to address any concerns.

The treatment could also include:

  • optimisation of drug treatment
  • advanced coronary angioplasty/stenting where appropriate
  • high risk or redo CABG
  • a home-based rehabilitation programme
  • pain management delivered by a consultant with a specialist interest in cardiac pain
  • psychological support.

We are also active in a number of clinical trials of novel treatments.

GP education

The specialist angina service team run a popular annual meeting for GPs and allied health care professionals with an emphasis on the case-based discussion on diagnosis and treatment of angina. 


Dr Ranil de Silva

Consultant interventional cardiologist