Chronic stable angina treatment

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Chronic stable angina Microchapters

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Overview

Historical Perspective

Classification

Classic
Chronic Stable Angina
Atypical
Walk through Angina
Mixed Angina
Nocturnal Angina
Postprandial Angina
Cardiac Syndrome X
Vasospastic Angina

Differentiating Chronic Stable Angina from Acute Coronary Syndromes

Pathophysiology

Epidemiology and Demographics

Risk Stratification

Pretest Probability of CAD in a Patient with Angina

Prognosis

Diagnosis

History and Symptoms

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Test Selection Guideline for the Individual Basis

Laboratory Findings

Electrocardiogram

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Chest X Ray

Myocardial Perfusion Scintigraphy with Pharmacologic Stress

Myocardial Perfusion Scintigraphy with Thallium

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Exercise Echocardiography

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Positron Emission Tomography

Ambulatory ST Segment Monitoring

Electron Beam Tomography

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Coronary Angiography

Treatment

Medical Therapy

Revascularization

PCI
CABG
Hybrid Coronary Revascularization

Alternative Therapies for Refractory Angina

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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Noninvasive Testing in Asymptomatic Patients
Risk Stratification by Coronary Angiography
Pharmacotherapy to Prevent MI and Death in Asymptomatic Patients

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; John Fani Srour, M.D.; Jinhui Wu, M.D.; Lakshmi Gopalakrishnan. M.B.B.S.

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.

Patients with single-vessel CAD may be started on initial pharmacologic therapy and if non-responsive or symptomatic despite on therapy, PCI may be a preferred alternative.

Patients with double-vessel CAD and with normal LV function may be started on initial medical management and in non-responders, PCI may be considered. However, the decision of PCI versus CABG depends on the coronary anatomy, LV function and the need for complete revascularization.

Patients with triple-vessel CAD or left main disease or reduced left ventricular function, CABG is the mainstay of management. However, in cases of mild symptoms or preserved LVEF in patients with triple-vessel disease, initial pharmacologic therapy or PCI may be tried.

Treatment

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 intensity of anginal episodes. These conditions include:

Risk Factor Modification

  • Initiation of intensive modification of risk factors is an urgent and 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 topics below:
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.

Pharmacotherapy

  • The role of pharmacotherapy in the management of chronic stable angina is to reduce the severity and frequency of symptoms and to provide a bettered overall prognosis.
  • You can read in greater detail about each of the pharmacotherapies for chronic stable angina below by clicking on the link for that topic:

Revascularization

  • Revascularization is only used for select patients specially those who have uncontrolled symptoms with optimal medical therapy.
  • 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.
  • 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:

References


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