Management of chronic stable angina pectoris.
Agina pectoris is a discomfort in the chest or adjacent areas caused by myocardial ischemia. It is most commonly caused by the inability of narrowed atherosclerotic coronary arteries to supply adequate oxygen to the heart under conditions of increase demand. This review article will focus in the medical treatment of chronic stable angina, with a focus in new strategies or medications. Treatment by revascularization techniques will not be discussed in this article. The goal of treatment is to improve quality of life, decrease cardiovascular events and mortality. All patients should be evaluated for reversible causes of their angina, such as anemia, hyperthyroidism, sympathomimetic drugs and hypertension. Sublingual nitroglycerin should be used for immediate relief of symptoms. In general, all patients should be on aspirin (ASA) unless they are allergic or other contraindications, if so; clopidogrel should be added to the therapy. In addition to the antiplatelet therapy, which decreases mortality, patients should be started on beta blockers and nitrates. If there is no improvement in symptoms then a calcium channel blockers of the dihydropyridine family should be added. Patients with Diabetes Mellitus and/or left ventricular systolic dysfunction should be also started on angiotensin converting enzyme inhibitors. If the patient continues with limiting angina, ranolazine should be started and finally enhanced external counterpulsation should be considered in those patients who have not responded to maximal drug therapy.
Rodríguez-Ospina
Luis
L
Cardiology Section, Department of Medicine, Veterans Administration Caribbean Healthcare System, San Juan, Puerto Rico, USA. Luis.rodriguez-ospina@va.gov
Montano-Soto
Luarde
L
D000083:Acetanilides / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use; D000286:Administration, Sublingual; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D000465:Algorithms; D000787:Angina Pectoris / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D000788:Angina Pectoris, Variant / Q000188:drug therapy; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000627:therapeutic use; D002908:Chronic Disease; D000075202:Contraindications; D015908:Counterpulsation; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use; D006801:Humans; D000960:Hypolipidemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005996:Nitroglycerin / Q000008:administration & dosage / Q000627:therapeutic use; D010879:Piperazines / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D000069458:Ranolazine; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use
D000083:Acetanilides; D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D004791:Enzyme Inhibitors; D000960:Hypolipidemic Agents; D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D014665:Vasodilator Agents; D000069458:Ranolazine; D005996:Nitroglycerin; D001241:Aspirin