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{{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 of the management of 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.


==Identification and treatment of exacerbating conditions==
==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]],  
:*Uncontrolled [[hypertension]],  
:*[[Hypertension|Uncontrolled hypertension]],  
:*Thyroid disorders ([[thyrotoxicosis]]),  
:*Thyroid disorders ([[thyrotoxicosis]]),  
:*Heart rhythm abnormalities ([[tachyarrhythmias]]),  
:*Heart rhythm abnormalities ([[tachyarrhythmias]]),  
:*Decompensated [[congestive heart failure]] and  
:*[[congestive heart failure|Decompensated congestive heart failure]] and  
:*Concomitant [[valvular heart disease]].
:*[[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=[[Aspirin]] use  
*'''A:''' [[Aspirin]] use  
*A=Anti anginal therapy
*'''A:''' Anti anginal therapy
*B=[[Beta blocker]] use  
*'''B:''' [[Beta blocker]] use  
*B=[[Blood pressure]] control
*'''B:''' [[Blood pressure]] control
*C=Cholesterol lowering therapy
*'''C:''' Cholesterol lowering therapy
*C=Cigarette smoking cessation  
*'''C:''' Cigarette smoking cessation  
*D=[[Diabetes Mellitus]] control
*'''D:''' [[Diabetes Mellitus]] control
*D=Diet
*'''D:''' Diet
*E=Exercise
*'''E:''' Exercise
*E=Education
*'''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|Overview of pharmacotherapy in patients with chronic stable angina]]
*[[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]]
*'''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]]
*'''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 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 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 to prevent MI, Death and Reduce symptoms]]
*[[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.
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]]


==See Also==
==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://dx.doi.org/10.1161/CIRCULATIONAHA.107.187930 DOI:10.1161/CIRCULATIONAHA.107.187930] PMID: [http://pubmed.gov/17998462 17998462]</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:Disease state]]
[[Category: Cardiology]]
[[Category:Cardiology]]
[[Category: Emergency medicine]]
[[Category:Emergency medicine]]


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Revision as of 16:23, 18 August 2011

Chronic stable angina Microchapters

Acute Coronary Syndrome Main Page

Home

Patient Information

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

Physical Examination

Test Selection Guideline for the Individual Basis

Laboratory Findings

Electrocardiogram

Exercise ECG

Chest X Ray

Myocardial Perfusion Scintigraphy with Pharmacologic Stress

Myocardial Perfusion Scintigraphy with Thallium

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Exercise Echocardiography

Computed coronary tomography angiography(CCTA)

Positron Emission Tomography

Ambulatory ST Segment Monitoring

Electron Beam Tomography

Cardiac Magnetic Resonance Imaging

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

Discharge Care

Patient Follow-Up
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Secondary Prevention

Guidelines for Asymptomatic Patients

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

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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:

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.

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

Revascularization

  • Revascularization is used only 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. 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

  1. ↑ 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.
  2. ↑ 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
  3. ↑ 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
  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.[4] PMID: 17998462


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