title: Choice of therapy in chronic ischemic heart disease.
abstract: The choice of therapy in chronic ischemic heart disease depends on identifying the underlying mechanism. Ambulatory monitoring provides a means of identifying those patients in whom increased myocardial oxygen demand is the most important mechanism and who will respond to a beta blocker. In contrast, those patients with coronary spasm are best treated with a calcium antagonist. The history of angina pectoris and the time of onset may, in itself, be misleading. Detailed ambulatory monitoring studies show that nocturnal angina is frequently due to increased myocardial oxygen demand and in such circumstances should be treated by careful control of the heart rate using a beta blocker without intrinsic sympathomimetic activity. Other factors that will influence the choice of medical therapy must be considered. Smoking is particularly important because it not only acts detrimentally in terms of increased myocardial oxygen demand, but may also interfere with the metabolism of those antianginal agents that are metabolized in the liver. The importance of silent myocardial ischemia has been emphasized recently, and studies using ambulatory pulmonary artery monitoring have shown that silent ischemic episodes have the same significance in terms of hemodynamic effects as painful ischemic episodes. The therapeutic and prognostic implications of these findings need to be explored.
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000787:Angina Pectoris / Q000188:drug therapy / Q000517:prevention & control; D003327:Coronary Disease / Q000188:drug therapy* / Q000517:prevention & control; D004562:Electrocardiography; D006339:Heart Rate; D006801:Humans; D008991:Monitoring, Physiologic; D012890:Sleep / Q000502:physiology; D000074606:Smoking Prevention
chemical_list: D000319:Adrenergic beta-Antagonists