Chronic stable angina treatment

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Transmyocardial Revascularization (TMR)
Spinal Cord Stimulation (SCS)
Enhanced External Counter Pulsation (EECP)
ACC/AHA Guidelines for Alternative Therapies in patients with Refractory Angina
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Editors-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Cafer Zorkun, M.D., Ph.D. [2]; Associate Editors-In-Chief: John Fani Srour, M.D.; Jinhui Wu, MD.

Identification and treatment of exacerbating conditions

• 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

• Overview of pharmacotherapy in patients with chronic stable angina

• Antiplatelet agents: Aspirin | Dipyridamole | Clopidogrel

• Antianginal agents: Nitrates | Beta Blockers | Calcium Channel Blockers | Newer Anti-anginal Agents

• ACEI/RAAS blockers

• Anti-lipid agents

• ACC/AHA Guidelines for Pharmacotherapy to prevent MI, Death and Reduce symptoms

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

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.

• In general, PCI is reserved for single or some cases of two vessel disease, and
• CABG is reserved for patients with two or three vessel disease or left main disease.

• With the availability of drug-eluting stents, PCI is increasingly being performed for many lesions including more complex ones.

See Also

• The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines

Sources

• The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina

• TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina

• The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina

References

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