Management of Angina

Abstract

Chronic stable angina caused by coronary artery disease is not only a very frequent condition, but it is also associated with an increased risk of major cardiovascular events. There are other important mechanisms of angina pectoris involving coronary microvascular dysfunction and reduced coronary blood flow reserve. Once the diagnosis of angina is confirmed, and the mechanisms responsible for myocardial ischaemia identified, treatment should be started without delay. The key objectives of the treatment of angina pectoris in both coronary disease patients and patients with microvascular angina include improve symptoms and quality of life as well as clinical outcomes such as mortality and major cardiovascular events. The bulk of the evidence regarding the effects of risk factor management, lifestyle changes and preventative pharmacological therapy in angina pectoris, has been gathered in patients suffering from obstructive coronary artery disease. Lesser information, however, is available regarding interventions that affect prognosis in microvascular angina. International guidelines recommend lifestyle changes, aggressive risk factor management and the use of pharmacological agents as well as coronary intervention when indicated. This chapter discusses the various options available for management of this common condition.