Document Detail


Management of chronic stable angina pectoris.
MedLine Citation:
PMID:  19400528     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Agina pectoris is a discomfort in the chest or adjacent areas caused by myocardial ischemia. It is most commonly caused by the inability of narrowed atherosclerotic coronary arteries to supply adequate oxygen to the heart under conditions of increase demand. This review article will focus in the medical treatment of chronic stable angina, with a focus in new strategies or medications. Treatment by revascularization techniques will not be discussed in this article. The goal of treatment is to improve quality of life, decrease cardiovascular events and mortality. All patients should be evaluated for reversible causes of their angina, such as anemia, hyperthyroidism, sympathomimetic drugs and hypertension. Sublingual nitroglycerin should be used for immediate relief of symptoms. In general, all patients should be on aspirin (ASA) unless they are allergic or other contraindications, if so; clopidogrel should be added to the therapy. In addition to the antiplatelet therapy, which decreases mortality, patients should be started on beta blockers and nitrates. If there is no improvement in symptoms then a calcium channel blockers of the dihydropyridine family should be added. Patients with Diabetes Mellitus and/or left ventricular systolic dysfunction should be also started on angiotensin converting enzyme inhibitors. If the patient continues with limiting angina, ranolazine should be started and finally enhanced external counterpulsation should be considered in those patients who have not responded to maximal drug therapy.
Authors:
Luis Rodríguez-Ospina; Luarde Montano-Soto
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Publication Detail:
Type:  Comparative Study; Journal Article; Review    
Journal Detail:
Title:  Boletín de la Asociación Médica de Puerto Rico     Volume:  100     ISSN:  0004-4849     ISO Abbreviation:  Bol Asoc Med P R     Publication Date:    2008 Oct-Dec
Date Detail:
Created Date:  2009-04-29     Completed Date:  2009-05-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7505267     Medline TA:  Bol Asoc Med P R     Country:  Puerto Rico    
Other Details:
Languages:  eng     Pagination:  39-47     Citation Subset:  IM    
Affiliation:
Cardiology Section, Department of Medicine, Veterans Administration Caribbean Healthcare System, San Juan, Puerto Rico, USA. Luis.rodriguez-ospina@va.gov
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MeSH Terms
Descriptor/Qualifier:
Acetanilides / administration & dosage,  blood,  therapeutic use
Administration, Sublingual
Adrenergic beta-Antagonists / administration & dosage,  therapeutic use
Algorithms
Angina Pectoris / drug therapy*,  mortality,  therapy
Angina Pectoris, Variant / drug therapy
Angiotensin-Converting Enzyme Inhibitors / administration & dosage,  therapeutic use
Antilipemic Agents / administration & dosage,  therapeutic use
Aspirin / administration & dosage,  therapeutic use
Calcium Channel Blockers / administration & dosage,  contraindications,  therapeutic use
Chronic Disease
Counterpulsation
Dose-Response Relationship, Drug
Drug Therapy, Combination
Enzyme Inhibitors / administration & dosage,  blood,  therapeutic use
Humans
Nitroglycerin / administration & dosage,  therapeutic use
Piperazines / administration & dosage,  blood,  therapeutic use
Platelet Aggregation Inhibitors / administration & dosage,  therapeutic use
Practice Guidelines as Topic
Randomized Controlled Trials as Topic
Vasodilator Agents / administration & dosage,  therapeutic use
Chemical
Reg. No./Substance:
0/Acetanilides; 0/Adrenergic beta-Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Antilipemic Agents; 0/Calcium Channel Blockers; 0/Enzyme Inhibitors; 0/Piperazines; 0/Platelet Aggregation Inhibitors; 0/Vasodilator Agents; 110445-25-5/ranolazine; 50-78-2/Aspirin; 55-63-0/Nitroglycerin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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