Treatment options for refractory angina in patients who are not candidates for revascularization.
Patients with refractory angina are those for whom medical therapy has failed to eradicate the angina completely and who have persistent symptoms that are stable but limit their activities of daily living. Approach to management must include the elimination of the secondary causes of this condition and maximum medical therapy, and if angina persists, the consideration of other strategies. Controversy exists regarding the value of transmural myocardial laser revascularization. Enhanced external counterpulsation is clinically effective in approximately 70% of patients. Spinal cord stimulation is not being used clinically in the United States. In the United States, it is still an investigational procedure that is currently being evaluated prospectively in a randomized trial. Ranolazine, an inhibitor of sodium-dependent calcium overload, may prove to be useful in patients with refractory angina.
Conti
C Richard
CR
University of Florida, Health Science Center, Room M-438, 1600 SW Archer Road, Gainesville, 32610-0277, USA. conticr@medicine.ufl.edu
D000083:Acetanilides; D000787:Angina Pectoris / Q000628:therapy*; D003131:Combined Modality Therapy; D015908:Counterpulsation; D004599:Electric Stimulation Therapy; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D006801:Humans; D009204:Myocardial Revascularization; D010879:Piperazines / Q000627:therapeutic use; D000069458:Ranolazine; D013116:Spinal Cord
D000083:Acetanilides; D004791:Enzyme Inhibitors; D010879:Piperazines; D000069458:Ranolazine