Treatment strategies for chronic stable angina

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Introduction: Stable angina pectoris – generally the expression of an imbalance between myocardial oxygen demand and supply – is often the first manifestation of ischemic heart disease. The effective management of this highly prevalent condition is largely dependent on the identification of the prevailing pathogenic mechanism, the implementation of lifestyle changes and the appropriate use of pharmacological agents and revascularization techniques. There is abundant literature on management of chronic stable angina, but publications are generally devoted to focused areas. There is a need for a comprehensive review that addresses both the different types of angina and their pathogenic mechanisms, as well as rational approaches to patient management.Areas covered: This paper reviews the pathogenesis and pathophysiological mechanisms of myocardial ischemia, along with its consequences and current treatment options. Relevant papers in the English literature were identified via PubMed, using the following keywords relating to chronic stable angina: ischemic heart disease, coronary artery disease and antianginal therapy.Expert opinion: The treatment of chronic stable angina has improved in recent years as a result of a better understanding of its pathogenic mechanisms, the implementation of lifestyle changes and aggressive management of risk factors, as well as pharmacological advances and better revascularization techniques. Understanding the pathogenesis of the disease is important to identify effective treatment strategies. A careful clinical history, the implementation of appropriate diagnostic tests and a rational use of antianginal drugs and revascularization protocols often ensure the successful control of the patient's symptoms.