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__NOTOC__
{{Chronic stable angina}}
{{Chronic stable angina}}
'''Editors-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; {{CZ}}; '''Associate Editors-In-Chief:''' [[John Fani Srour, M.D.]]; Jinhui Wu, MD


==Overview==
'''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.
'''Mechanism of benefit:'''
 
==Mechanisms of benefit==
*Beta blocking drugs decrease [[heart rate]], [[blood pressure]], and contractility and, as a result, reduce myocardial oxygen consumption.
*Beta blocking drugs decrease [[heart rate]], [[blood pressure]], and contractility and, as a result, reduce myocardial oxygen consumption.
*A slowing of heart rate is associated with an increased left ventricular perfusion time.
*A slowing of heart rate is associated with an increased left ventricular perfusion time.
*Exercise induced increases in heart rate and blood pressure are also blunted. In patients with stable angina, beta adrenergic blocking agents increase exercise duration and the time to the onset of [[angina]] and of [[ST segment depression]], although the double product threshold (heart rate multiplied by blood pressure) at which [[ischemia]] occurs remains unchanged.
*Exercise induced increases in heart rate and blood pressure are also blunted. In patients with stable angina, beta adrenergic blocking agents increase exercise duration and the time to the onset of [[angina]] and of [[ST segment depression]], although the double product threshold (heart rate multiplied by blood pressure) at which [[ischemia]] occurs remains unchanged.


'''Indications:'''
==Indications==
*It is beneficial to start and continue beta blocker drug therapy indefinitely in all patients who have had [[myocardial infarction]], [[acute coronary syndrome]] (ACS) or left ventricular dysfunction with or without [[heart failure]] symptoms, unless contraindicated.
*It is beneficial to start and continue beta blocker drug therapy indefinitely in all patients who have had [[myocardial infarction]], [[acute coronary syndrome]] (ACS) or left ventricular dysfunction with or without [[heart failure]] symptoms, unless contraindicated.
*Beta blocking agents with beta selectivity (such as [[metoprolol]] and [[atenolol]]) are preferable in patients with mild [[asthma]], [[chronic obstructive pulmonary disease]] (COPD), [[insulin dependent diabetes mellitus]] (IDDM) or intermittent [[claudication]]. However, with increased doses of beta blockers, selectivity is lost and both types of beta receptors are blocked.
*Beta blocking agents with beta selectivity (such as [[metoprolol]] and [[atenolol]]) are preferable in patients with mild [[asthma]], [[chronic obstructive pulmonary disease]] (COPD), [[insulin dependent diabetes mellitus]] (IDDM) or intermittent [[claudication]]. However, with increased doses of beta blockers, selectivity is lost and both types of beta receptors are blocked.


'''Beta blocker dosing:'''
==Contra-indications==
*The effective dose of any beta blocker drug varies considerably from patient to patient.
*For an effective treatment, resting heart rate should be reduced to between 45 and 60 bpm (beats per minute) and heart rate should be below 90 beats per minute during moderate exercise, such as climbing two stairs at a normal pace.
*For maintenance therapy of stable angina, beta blocking drugs with a relatively long half-life are preferable.
 
'''Contraindications:'''
*If administration of beta blockers induces symptomatic [[heart failure]], they should be discontinued or the dose reduced.
*If administration of beta blockers induces symptomatic [[heart failure]], they should be discontinued or the dose reduced.
*The sudden withdrawal of beta blocker therapy may result in worsening of angina (rebound effect) and precipitation of acute ischemic episodes; it is preferable to taper these medications gradually over 2 to 3 weeks.
*The sudden withdrawal of beta blocker therapy may result in worsening of angina (rebound effect) and precipitation of acute ischemic episodes; it is preferable to taper these medications gradually over 2 to 3 weeks.
Line 25: Line 19:
*Severe [[peripheral vascular disease]]
*Severe [[peripheral vascular disease]]


'''Side Effects:'''
==Dosage==
*The effective dose of any beta blocker drug varies considerably from patient to patient.
*For an effective treatment, resting heart rate should be reduced to between 45 and 60 bpm (beats per minute) and heart rate should be below 90 beats per minute during moderate exercise, such as climbing two stairs at a normal pace.
*For maintenance therapy of stable angina, beta blocking drugs with a relatively long half-life are preferable.
 
==Adverse effects==
*Major side effects of beta blocker therapy include fatigue, impaired exercise tolerance, [[depression]], [[insomnia]], nightmares, and worsening [[claudication]] and [[bronchospasm]].
*Major side effects of beta blocker therapy include fatigue, impaired exercise tolerance, [[depression]], [[insomnia]], nightmares, and worsening [[claudication]] and [[bronchospasm]].
*Beta blockers may increase the blood sugar level and impair insulin sensitivity, particularly when used concurrently with [[diuretics]]. They may decrease the reaction to hypoglycemia in patients with [[insulin dependent diabetes mellitus]] (IDDM).
*Beta blockers may increase the blood sugar level and impair insulin sensitivity, particularly when used concurrently with [[diuretics]]. They may decrease the reaction to hypoglycemia in patients with [[insulin dependent diabetes mellitus]] (IDDM).
*Beta blockers also may exert unfavorable effects on the blood lipid profile with an increase in [[triglycerides]] and reduction in high density lipoprotein ([[HDL]]-C). However, the clinical significance of these adverse changes in the lipid profile with beta blockers has not yet been defined.
*Beta blockers also may exert unfavorable effects on the blood lipid profile with an increase in [[triglycerides]] and reduction in high density lipoprotein ([[HDL]]-C). However, the clinical significance of these adverse changes in the lipid profile with beta blockers has not yet been defined.


 
==ACC/AHA Guidelines- Pharmacotherapy to Prevent MI and Death and Reduce Symptoms (DO NOT EDIT) <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><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>==
==ACC/AHA Guidelines- Pharmacotherapy to Prevent MI and Death and Reduce Symptoms (DO NOT EDIT)<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=10351980ACC/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><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>==
{{cquote|
{{cquote|
===Class I===
===Class I===
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'''2.''' [[Beta-blockers]] as initial therapy in the absence of contraindications in patients without prior [[MI]]. ''(Level of Evidence: B)''}}
'''2.''' [[Beta-blockers]] as initial therapy in the absence of contraindications in patients without prior [[MI]]. ''(Level of Evidence: B)''}}


==See Also==
==ESC Guidelines- Pharmacological therapy to improve symptoms and/or reduce ischaemia in patients with stable angina (DO NOT EDIT) <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=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367}}</ref>==
{{cquote|
===Class I===
'''1.''' Test the effects of a beta-1 blocker, and titrate to full dose; consider the need for 24 h protection against [[ischemia]]. ''(Level of Evidence: A)''
 
'''2.''' In case of beta-blocker intolerance or poor efficacy attempt monotherapy with a [[Chronic stable angina calcium channel blocker therapy|CCB]] ''(Level of evidence: A)'', [[Chronic stable angina nitrate therapy|long-acting nitrate]] ''(Level of evidence: C)'', or [[nicorandil]]. ''(Level of evidence: C)''
 
'''3.''' If the effects of beta-blocker monotherapy are insufficient, add a [[Chronic stable angina calcium channel blocker therapy|dihydropyridine CCB]]. ''(Level of evidence: B)''
 
===Class IIa===
'''1.''' In case of beta-blocker intolerance try sinus node inhibitor. ''(Level of evidence: B)''
 
'''2.''' If [[Chronic stable angina calcium channel blocker therapy|CCB]] monotherapy or combination therapy (CCB with beta-blocker) is unsuccessful, substitute the CCB with a [[Chronic stable angina nitrate therapy|long-acting nitrate]] or [[nicorandil]]. Be careful to avoid [[Chronic stable angina nitrate therapy#Nitrate Tolerance|nitrate tolerance]]. ''(Level of evidence: C)''}}
 
==ESC Guidelines- Pharmacological therapy to improve prognosis in patients with stable angina (DO NOT EDIT) <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=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367}}</ref>==
{{cquote|
===Class I===
'''1.''' Oral beta-blocker therapy in patients [[MI|post-MI]] or with [[heart failure]]. ''(Level of Evidence: A)''}}
 
==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>
*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://dx.doi.org/10.1161/CIRCULATIONAHA.107.187930 DOI:10.1161/CIRCULATIONAHA.107.187930] PMID: [http://pubmed.gov/17998462 17998462]</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 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: Disease state]]  
[[Category:Ischemic heart diseases]]
[[Category: Ischemic heart diseases]]
 
[[Category: Cardiology]]
[[Category:Disease state]]
[[Category: Emergency medicine]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]


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Revision as of 20:44, 21 August 2011

Chronic stable angina Microchapters

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Differentiating Chronic Stable Angina from Acute Coronary Syndromes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [4] Phone:617-632-7753; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [5]; John Fani Srour, M.D.; Jinhui Wu, M.D.

Mechanisms of benefit

  • Beta blocking drugs decrease heart rate, blood pressure, and contractility and, as a result, reduce myocardial oxygen consumption.
  • A slowing of heart rate is associated with an increased left ventricular perfusion time.
  • Exercise induced increases in heart rate and blood pressure are also blunted. In patients with stable angina, beta adrenergic blocking agents increase exercise duration and the time to the onset of angina and of ST segment depression, although the double product threshold (heart rate multiplied by blood pressure) at which ischemia occurs remains unchanged.

Indications

Contra-indications

  • If administration of beta blockers induces symptomatic heart failure, they should be discontinued or the dose reduced.
  • The sudden withdrawal of beta blocker therapy may result in worsening of angina (rebound effect) and precipitation of acute ischemic episodes; it is preferable to taper these medications gradually over 2 to 3 weeks.
  • Severe bradycardia,
  • Episodes of second or third degree atrioventricular (AV) blocks,
  • Severe peripheral vascular disease

Dosage

  • The effective dose of any beta blocker drug varies considerably from patient to patient.
  • For an effective treatment, resting heart rate should be reduced to between 45 and 60 bpm (beats per minute) and heart rate should be below 90 beats per minute during moderate exercise, such as climbing two stairs at a normal pace.
  • For maintenance therapy of stable angina, beta blocking drugs with a relatively long half-life are preferable.

Adverse effects

  • Major side effects of beta blocker therapy include fatigue, impaired exercise tolerance, depression, insomnia, nightmares, and worsening claudication and bronchospasm.
  • Beta blockers may increase the blood sugar level and impair insulin sensitivity, particularly when used concurrently with diuretics. They may decrease the reaction to hypoglycemia in patients with insulin dependent diabetes mellitus (IDDM).
  • Beta blockers also may exert unfavorable effects on the blood lipid profile with an increase in triglycerides and reduction in high density lipoprotein (HDL-C). However, the clinical significance of these adverse changes in the lipid profile with beta blockers has not yet been defined.

ACC/AHA Guidelines- Pharmacotherapy to Prevent MI and Death and Reduce Symptoms (DO NOT EDIT) [1][2]

Class I

1. Beta-blockers should be started and continued indefinitely in all patients who have had MI, acute coronary syndrome, or left ventricular dysfunction with or without heart failure symptoms, unless contraindicated. (Level of Evidence: A)

2. Beta-blockers as initial therapy in the absence of contraindications in patients without prior MI. (Level of Evidence: B)

ESC Guidelines- Pharmacological therapy to improve symptoms and/or reduce ischaemia in patients with stable angina (DO NOT EDIT) [3]

Class I

1. Test the effects of a beta-1 blocker, and titrate to full dose; consider the need for 24 h protection against ischemia. (Level of Evidence: A)

2. In case of beta-blocker intolerance or poor efficacy attempt monotherapy with a CCB (Level of evidence: A), long-acting nitrate (Level of evidence: C), or nicorandil. (Level of evidence: C)

3. If the effects of beta-blocker monotherapy are insufficient, add a dihydropyridine CCB. (Level of evidence: B)

Class IIa

1. In case of beta-blocker intolerance try sinus node inhibitor. (Level of evidence: B)

2. If CCB monotherapy or combination therapy (CCB with beta-blocker) is unsuccessful, substitute the CCB with a long-acting nitrate or nicorandil. Be careful to avoid nitrate tolerance. (Level of evidence: C)

ESC Guidelines- Pharmacological therapy to improve prognosis in patients with stable angina (DO NOT EDIT) [3]

Class I

1. Oral beta-blocker therapy in patients post-MI or with heart failure. (Level of Evidence: A)

Vote on and Suggest Revisions to the Current Guidelines

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]
  • Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology [3]
  • The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina [4]

References

  1. 1.0 1.1 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. [1] PMID: 10351980
  2. 2.0 2.1 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.[2] PMID: 12515758
  3. 3.0 3.1 3.2 Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). "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". Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367.
  4. 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.[3] PMID: 17998462


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