Chronic stable angina medical therapy
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Chronic stable angina Microchapters | ||
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Classification | ||
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Differentiating Chronic Stable Angina from Acute Coronary Syndromes | ||
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Diagnosis | ||
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Alternative Therapies for Refractory Angina | ||
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Discharge Care | ||
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Guidelines for Asymptomatic Patients | ||
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Case Studies | ||
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Chronic stable angina medical therapy On the Web | ||
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Risk calculators and risk factors for Chronic stable angina medical therapy | ||
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
Pharmacologic agents for Angina
- First line therapy in the patient with chronic stable angina includes:
- Aspirin to minimize the risk of thrombosis superimposed on the chronic fixed obstruction and
- Beta blockade to reduce heart rate and myocardial oxygen demands, as well as reduce the risk of fatal arrhythmias should plaque rupture occur. These agents also reduce or prevent ischemia with a single daily dose and their known long term prognostic benefit may also be generalized to other patients with ischemic heart disease.
- Strong consideration should be given to initiaion of ACE inhibition as potential disease modifying therapy.
- Calcium channel blockers should be considered in patients who cannot tolerate beta blockers or nitrates or who respond inadequately to these drugs. However, CCBs are not preferred initial therapy for the management of patients with stable exertional angina. Extended release nifedipine, second generation vasoselective calcium channel blockers, and extended-release verapamil or diltiazem are the calcium blockers of choice.
- All patients should also be given nitroglycerin and instructions about its therapeutic and prophylactic use.
- For most patients, the initial therapy should consist of use of beta blockers, and nitrates should be added if the response to beta blocker therapy is inadequate.
- If angina episodes occur >2-3 times in a week, consider adding a calcium channel blocker drug or a long acting nitrate. Regardless of the frequency and severity of angina symptoms, adding a calcium antagonists and/or long lasting nitrates to the main treatment regimen may help to reduce blood pressure and therefore treat ventricular function abnormalities.
- In patients with special circumstances or concomitant diseases, specific medications, or combinations of medications are preferable.
- Consider adding a third agent if angina persists despite of two anti-anginal drugs.
- Evaluate fasting lipid profile and initiate proper lipid lowering drug therapy when necessary. Ideally start with HMG-CoA reductase inhibitor to reduce LDL cholesterol level below 100 mg/dl (<70 mg/dl in high risk patients).
- Coronary angiography is indicated in patients with refractory symptoms or ischemia if administration of optimal medical therapy has failed to control the symptoms or ischemia. It should also be carried out in "high-risk" patients with non invasive test results, and in those with special occupations or sedentary life styles that require a more aggressive approach.
Individual pharmacologic agents used in Chronic stable angina
- You can read in greater detail about each of the risk factor modification topic 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
- ACEI/RAAS blockers: Overview |
- Anti-lipid agents: Anti-lipid agents |
See Also
Sources
- The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina [1]
- TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina [2]
- The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina [3]
References
- ↑ 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. 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. 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. DOI:10.1161/CIRCULATIONAHA.107.187930 PMID: 17998462