Chronic stable angina treatment: Difference between revisions
No edit summary |
No edit summary |
||
Line 1: | Line 1: | ||
{{Chronic stable angina}} | {{Chronic stable angina}} | ||
'''Editor-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; '''Associate Editor(s)-In-Chief:''' {{CZ}}; [[John Fani Srour, M.D.]]; Jinhui Wu, M.D. | |||
== | ==Overview== | ||
Treatment of chronic stable angina aims at minimizing symptoms, reducing recurrent [[ischemia]], improving the quality of life and improving prognosis by preventing [[MI]] and death. Treatment options include lifestyle modification, pharmacotherapy and revascularization that help in slowing the disease progression, preserving the endothelial function and preventing thrombosis. | |||
==Precipitating factors== | |||
*While chronic stable angina may be due to underlying [[atherosclerosis]], other factors may either precipitate or exacerbate angina. | *While chronic stable angina may be due to underlying [[atherosclerosis]], other factors may either precipitate or exacerbate angina. | ||
*Identification and management of these conditions may reduce the frequency and intesity of anginal episodes. These conditions include: | *Identification and management of these conditions may reduce the frequency and intesity of anginal episodes. These conditions include: | ||
:*[[Anemia]], | :*[[Anemia]], | ||
:* | :*[[Hypertension|Uncontrolled hypertension]], | ||
:*Thyroid disorders ([[thyrotoxicosis]]), | :*Thyroid disorders ([[thyrotoxicosis]]), | ||
:*Heart rhythm abnormalities ([[tachyarrhythmias]]), | :*Heart rhythm abnormalities ([[tachyarrhythmias]]), | ||
:* | :*[[congestive heart failure|Decompensated congestive heart failure]] and | ||
:* | :*[[valvular heart disease|Concomitant valvular heart disease]]. | ||
==Risk factor modification== | ==Risk factor modification== | ||
Line 28: | Line 29: | ||
Alphabet of chronic stable angina management: elements listed below are the most important components of stable angina management. | Alphabet of chronic stable angina management: elements listed below are the most important components of stable angina management. | ||
*A | *'''A:''' [[Aspirin]] use | ||
*A | *'''A:''' Anti anginal therapy | ||
*B | *'''B:''' [[Beta blocker]] use | ||
*B | *'''B:''' [[Blood pressure]] control | ||
*C | *'''C:''' Cholesterol lowering therapy | ||
*C | *'''C:''' Cigarette smoking cessation | ||
*D | *'''D:''' [[Diabetes Mellitus]] control | ||
*D | *'''D:''' Diet | ||
*E | *'''E:''' Exercise | ||
*E | *'''E:''' Education | ||
==Pharmacotherapy== | ==Pharmacotherapy== | ||
You can read in greater detail about each of the pharmacotherapy for chronic stable angina below by clicking on the link for that topic | You can read in greater detail about each of the pharmacotherapy for chronic stable angina below by clicking on the link for that topic | ||
*[[Chronic stable angina pharmacotherapy overview|Pharmacotherapy overview]] | |||
*'''Antiplatelet agents:''' [[Chronic stable angina treatment aspirin|Aspirin]] | [[Chronic stable angina treatment dipyridamole|Dipyridamole]] | [[Chronic stable angina treatment clopidogrel|Clopidogrel]] | |||
*'''Antianginal agents:''' [[Chronic stable angina nitrate therapy|Nitrates]] | [[Chronic stable angina beta blocker therapy|Beta Blockers]] | [[Chronic stable angina calcium channel blocker therapy|Calcium Channel Blockers]] | [[Chronic stable angina newer antianginal agents|Newer Anti-anginal Agents]] | |||
*'''[[Chronic stable angina treatment angiotensin converting enzyme inhibitors (ACEI) and renin angiotensin aldosterone system blockers (RAAS blockers)|ACEI/RAAS blockers]]''' | |||
*'''[[Chronic stable angina treatment anti-lipid agents|Anti-lipid agents]]''' | |||
*[[Chronic stable angina ACC/AHA guidelines for pharmacotherapy to prevent MI, death and reduce symptoms|ACC/AHA Guidelines for Pharmacotherapy]] | |||
==Revascularization== | ==Revascularization== | ||
Line 67: | Line 68: | ||
==Alternative therapies for refractory angina== | ==Alternative therapies for refractory angina== | ||
You can read in greater detail about each of the alternative therapies for refractory angina below by clicking on the link for that topic. | |||
[[Chronic stable angina transmyocardial revascularization(TMR)|Transmyocardial Revascularization]] | [[Chronic stable angina spinal cord stimulation(SCS)|Spinal Cord Stimulation]] | [[Chronic stable angina enhanced external counter pulsation(EECP)|Enhanced External Counter Pulsation (EECP)]] | [[Chronic stable angina ACC/AHA guidelines for alternative therapies in patients with refractory angina|ACC/AHA Guidelines for Alternative Therapies in patients with Refractory Angina]] | [[Chronic stable angina transmyocardial revascularization(TMR)|Transmyocardial Revascularization]] | [[Chronic stable angina spinal cord stimulation(SCS)|Spinal Cord Stimulation]] | [[Chronic stable angina enhanced external counter pulsation(EECP)|Enhanced External Counter Pulsation (EECP)]] | [[Chronic stable angina ACC/AHA guidelines for alternative therapies in patients with refractory angina|ACC/AHA Guidelines for Alternative Therapies in patients with Refractory Angina]] | ||
== | ==Vote on and Suggest Revisions to the Current Guidelines== | ||
*[[The Living Guidelines: Chronic Stable Angina Pectoris | The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]] | *[[The Living Guidelines: Chronic Stable Angina Pectoris | The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]] | ||
==Sources== | ==Sources== | ||
*The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. PMID: [http://pubmed.gov/10351980 10351980]</ref> | *Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology <ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= |url=url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367 [http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-angina-FT.pdf]}} </ref> | ||
*The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. [http://circ.ahajournals.org/content/99/21/2829.full.pdf] PMID: [http://pubmed.gov/10351980 10351980]</ref> | |||
*TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina <ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58. PMID: [http://pubmed.gov/12515758 12515758]</ref> | *TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina <ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58.[http://content.onlinejacc.org/cgi/reprint/41/1/159.pdf] PMID: [http://pubmed.gov/12515758 12515758]</ref> | ||
*The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72. [http:// | *The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72.[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf] PMID: [http://pubmed.gov/17998462 17998462]</ref> | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category: | [[Category:Ischemic heart diseases]] | ||
[[Category: | [[Category:Disease state]] | ||
[[Category: Cardiology]] | [[Category:Cardiology]] | ||
[[Category: Emergency medicine]] | [[Category:Emergency medicine]] | ||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} |
Revision as of 16:23, 18 August 2011
Chronic stable angina Microchapters | ||
Classification | ||
---|---|---|
| ||
| ||
Differentiating Chronic Stable Angina from Acute Coronary Syndromes | ||
Diagnosis | ||
Alternative Therapies for Refractory Angina | ||
Discharge Care | ||
Guidelines for Asymptomatic Patients | ||
Case Studies | ||
Chronic stable angina treatment On the Web | ||
Risk calculators and risk factors for Chronic stable angina treatment | ||
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [5] Phone:617-632-7753; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [6]; John Fani Srour, M.D.; Jinhui Wu, M.D.
Overview
Treatment of chronic stable angina aims at minimizing symptoms, reducing recurrent ischemia, improving the quality of life and improving prognosis by preventing MI and death. Treatment options include lifestyle modification, pharmacotherapy and revascularization that help in slowing the disease progression, preserving the endothelial function and preventing thrombosis.
Precipitating factors
- While chronic stable angina may be due to underlying atherosclerosis, other factors may either precipitate or exacerbate angina.
- Identification and management of these conditions may reduce the frequency and intesity of anginal episodes. These conditions include:
- Anemia,
- Uncontrolled hypertension,
- Thyroid disorders (thyrotoxicosis),
- Heart rhythm abnormalities (tachyarrhythmias),
- Decompensated congestive heart failure and
- Concomitant valvular heart disease.
Risk factor modification
- Initiation of intensive modification of risk factors is urgent and an essential part of the main therapy in chronic stable angina.
- Initiate risk factor modification, promote regular physical exercise (all patients should be encouraged to obtain 30 to 60 minutes/day of regular aerobic activity), low fat diet, and lifestyle modification.
- You can read in greater detail about each of the risk factor modification topic below by clicking on the link for that topic
Smoking Cessation | Weight Management | Physical Activity | Lipid management | BP control | Diabetes control | ACC/AHA Guidelines for Cardiovascular Risk Factor Reduction
The treatment essentials
Alphabet of chronic stable angina management: elements listed below are the most important components of stable angina management.
- A: Aspirin use
- A: Anti anginal therapy
- B: Beta blocker use
- B: Blood pressure control
- C: Cholesterol lowering therapy
- C: Cigarette smoking cessation
- D: Diabetes Mellitus control
- D: Diet
- E: Exercise
- E: Education
Pharmacotherapy
You can read in greater detail about each of the pharmacotherapy for chronic stable angina below by clicking on the link for that topic
- Antiplatelet agents: Aspirin | Dipyridamole | Clopidogrel
- Antianginal agents: Nitrates | Beta Blockers | Calcium Channel Blockers | Newer Anti-anginal Agents
Revascularization
- Revascularization is used only for select patients specially those who have uncontrolled symptoms with optimal medical therapy.
- This can be achieved with either percutaneous coronary intervention(PCI) with stent placement or coronary artery bypass surgery.
- With the availability of drug-eluting stents, PCI is increasingly being performed for many lesions including more complex ones.
- You can read in greater detail about specific revascularization approaches for the treatment of chronic stable angina by clicking on the link below for that topic.
PCI | CABG | PCI vs CABG | ACC/AHA Guidelines for Revascularization
Alternative therapies for refractory angina
You can read in greater detail about each of the alternative therapies for refractory angina below by clicking on the link for that topic. Transmyocardial Revascularization | Spinal Cord Stimulation | Enhanced External Counter Pulsation (EECP) | ACC/AHA Guidelines for Alternative Therapies in patients with Refractory Angina
Vote on and Suggest Revisions to the Current Guidelines
Sources
- Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology [1]
- The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina [2]
- TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina [3]
- The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina [4]
References
- ↑ Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). [url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367 [1] "Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology"] Check
|url=
value (help). Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367. - ↑ Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). Circulation 99 (21):2829-48. [2] PMID: 10351980
- ↑ Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 107 (1):149-58.[3] PMID: 12515758
- ↑ Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation 116 (23):2762-72.[4] PMID: 17998462