Angina and Its Management
J Cardiovasc Pharmacol Ther. 2017 May;22(3):199-209. doi: 10.1177/1074248416679733. Epub 2016 Dec 14.
Robert A Kloner 1 2 , Bernard Chaitman 3
1 1 Huntington Medical Research Institutes, Pasadena, CA, USA.
2 2 Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.
3 3 Saint Louis University School of Medicine, St. Louis, MO, USA.
Angina pectoris is defined as substernal chest pain, pressure, or discomfort that is typically exacerbated by exertion and/or emotional stress, lasts greater than 30 to 60 seconds, and is relieved by rest and nitroglycerin. There are approximately 10 million people in the United States who have angina, and there are over 500 000 cases diagnosed per year. Several studies now show that angina itself is a predictor of major adverse cardiac events. In addition, angina is a serious morbidity that impedes quality of life and should be treated. In the United States, pharmacologic therapy for angina includes β-blockers, nitrates, calcium channel blockers, and the late sodium current blocker ranolazine. In other countries, additional pharmacologic agents include trimetazidine, ivabradine, nicorandil, fasudil, and others. Revascularization is indicated in certain high-risk individuals and also has been shown to improve angina. However, even after revascularization, a substantial percentage of patients return with recurrent or continued angina, requiring newer and better therapies. Treatment for refractory angina not amenable to usual pharmacologic therapies or revascularization procedures, includes enhanced external counterpulsation, transmyocardial revascularization, and stem cell therapy. Angina continues to be a significant cause of morbidity. Therapy should be geared not only to treating the risk factors for atherosclerotic disease and improving survival but should also be aimed at eliminating or reducing the occurrence of angina and improving the ability of patients to be active.
Keywords: angina pectoris; calcium channel blockers; coronary artery disease; nitrates; revascularization.; β-blockers.
Angina Pectoris / diagnosis
Angina Pectoris / epidemiology
Angina Pectoris / physiopathology
Angina Pectoris / therapy*
Counterpulsation
Myocardial Revascularization* / adverse effects
Recovery of Function
Vasodilator Agents / adverse effects
Vasodilator Agents / therapeutic use*
Vasodilator Agents