Chronic stable angina treatment: Difference between revisions
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*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 | *Identification and management of these conditions may reduce the frequency and intensity of anginal episodes. These conditions include: | ||
:*[[Anemia]], | :*[[Anemia]], | ||
:*[[Hypertension|Uncontrolled hypertension]], | :*[[Hypertension|Uncontrolled hypertension]], | ||
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==Risk factor modification== | ==Risk factor modification== | ||
*Initiation of intensive modification of risk factors is '''urgent and | *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. | *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 | *You can read in greater detail about each of the risk factor modification topics below. | ||
[[Chronic stable angina treatment smoking cessation|Smoking Cessation]] | [[Chronic stable angina treatment weight management|Weight Management]] | [[Chronic stable angina treatment physical activity|Physical Activity]] | [[Chronic stable angina treatment lipid management|Lipid | [[Chronic stable angina treatment smoking cessation|Smoking Cessation]] | [[Chronic stable angina treatment weight management|Weight Management]] | [[Chronic stable angina treatment physical activity|Physical Activity]] | [[Chronic stable angina treatment lipid management|Lipid Management]] | [[Chronic stable angina treatment blood pressure control|BP Control]] | [[Chronic stable angina treatment diabetes control|Diabetes Control]] | [[Chronic stable angina treatment ACC/AHA guidelines for cardiovascular risk factor reduction|ACC/AHA Guidelines for Cardiovascular Risk Factor Reduction]] | ||
==The treatment essentials== | ==The treatment essentials== | ||
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 | ||
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==Pharmacotherapy== | ==Pharmacotherapy== | ||
*The role of pharmacotherapy in the management of chronic stable angina is to reduce the severity and frequency of symptoms and to provide | *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. | ||
*In patients with chronic stable angina, immediate '''symptomatic relief''' is achieved with [[Chronic stable angina nitrate therapy|short-acting sublingual nitrates]] and long term relief of symptoms is achieved with [[Chronic stable angina beta blocker therapy|beta blockers]], [[Chronic stable angina treatment calcium channel blockers|calcium channel blockers]] and [[Chronic stable angina nitrate therapy|long-acting nitrates]]. | *In patients with chronic stable angina, immediate '''symptomatic relief''' is achieved with [[Chronic stable angina nitrate therapy|short-acting sublingual nitrates]] and long term relief of symptoms is achieved with [[Chronic stable angina beta blocker therapy|beta blockers]], [[Chronic stable angina treatment calcium channel blockers|calcium channel blockers]] and [[Chronic stable angina nitrate therapy|long-acting nitrates]]. | ||
*Drugs that improve quality of life and associated with '''better prognosis''' include: [[Chronic stable angina treatment aspirin|low dose aspirin]], [[Chronic stable angina treatment angiotensin converting enzyme inhibitors (ACEI) and renin angiotensin aldosterone system blockers (RAAS blockers)|ACEIs]], [[Chronic stable angina beta blocker therapy|beta-blockers]]. | *Drugs that improve quality of life and are associated with '''better prognosis''' include: [[Chronic stable angina treatment aspirin|low dose aspirin]], [[Chronic stable angina treatment angiotensin converting enzyme inhibitors (ACEI) and renin angiotensin aldosterone system blockers (RAAS blockers)|ACEIs]], [[Chronic stable angina beta blocker therapy|beta-blockers]]. | ||
*You can read in greater detail about each of the | *You can read in greater detail about each of the pharmacotherapies for chronic stable angina below by clicking on the link for that topic | ||
:*[[Chronic stable angina pharmacotherapy overview|Overview]] | :*[[Chronic stable angina pharmacotherapy overview|Overview]] | ||
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==Revascularization== | ==Revascularization== | ||
*[[Revascularization]] is used | *[[Revascularization]] is only used 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]]. | *This can be achieved with either percutaneous coronary intervention([[PCI]]) with stent placement or [[coronary artery bypass surgery]]. | ||
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*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. | *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. | ||
[[Chronic stable angina revascularization percutaneous coronary intervention(PCI)|PCI]] | [[Chronic stable angina revascularization coronary artery bypass grafting(CABG)|CABG]] | [[Chronic stable angina percutaneous coronary intervention versus coronary artery bypass grafting|PCI vs CABG]] | [[Chronic stable angina ACC/AHA guidelines for revascularization|ACC/AHA Guidelines for Revascularization]] | [[Chronic stable angina revascularization percutaneous coronary intervention(PCI)|PCI]] | [[Chronic stable angina revascularization coronary artery bypass grafting(CABG)|CABG]] | [[Chronic stable angina percutaneous coronary intervention versus coronary artery bypass grafting|PCI vs CABG]] | [[Chronic stable angina ACC/AHA guidelines for revascularization|ACC/AHA Guidelines for Revascularization]] | ||
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*[[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]] | ||
== | ==Guidelines Resources== | ||
*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> | *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> | ||
Revision as of 18:19, 28 October 2011
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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 treatment On the Web | ||
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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.; 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.
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:
- 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 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.
- 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
- 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.
- In patients with chronic stable angina, immediate symptomatic relief is achieved with short-acting sublingual nitrates and long term relief of symptoms is achieved with beta blockers, calcium channel blockers and long-acting nitrates.
- Drugs that improve quality of life and are associated with better prognosis include: low dose aspirin, ACEIs, beta-blockers.
- You can read in greater detail about each of the pharmacotherapies for chronic stable angina below by clicking on the link for that topic
- Antiplatelet agents: Aspirin | Dipyridamole | Clopidogrel
- Antianginal agents: Nitrates | Beta Blockers | Calcium Channel Blockers | Potassium channel openers | Newer Anti-anginal Agents
Revascularization
- Revascularization is only used 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.
- 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
Guidelines Resources
- 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
- ↑ 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. - ↑ 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
- ↑ 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
- ↑ 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