Traditional Management of Chronic Stable Angina

Abstract

The clinical syndrome of chronic stable angina is an age-related condition that is one common manifestation of coronary artery disease (CAD). The presence of angina significantly affects quality of life when patients must limit their activities of daily living in an effort to prevent the occurrence of anginal attacks. In addition, patients are at risk for significant complications of CAD such as myocardial infarction, heart failure, stroke, and death. Therefore, treatment should focus not only on relief of symptoms and improvements in quality of life, but also on preventing disease progression and reducing the risk of complications from CAD. All patients should be instructed on the appropriate use of sublingual nitroglycerin for the immediate treatment of anginal episodes. Beta-blockers, calcium channel blockers, long-acting nitrate therapy, and ranolazine can prevent anginal symptoms. In addition, aggressive risk factor management, healthy lifestyle changes, antiplatelet agents such as aspirin, and angiotensin-converting enzyme inhibitors all should be used to prevent disease progression and occurrence of myocardial infarction or death. Many patients will be candidates for revascularization of the myocardium with either percutaneous coronary intervention or coronary artery bypass grafting for relief of symptoms as well as improvement in prognosis. Even after revascularization, patients may still require antianginal drug therapy. All patients undergoing revascularization should be guided to make appropriate lifestyle changes and to make concerted efforts to manage risk factors for CAD.

Prevalence of Sarcopenia among Nursing Home Older Residents in Cairo, Egypt

“…This may be due to the reported association between sedentary life style and the two diseases either IHD [29] or sarcopenia [26]. As well as, in IHD patients there is limitation in carrying out physical activities due to fear of ischemic chest pain or anticipation of pain [30]. This lack of physical activity will lead to sarcopenia.…”

Tolerability and Pharmacokinetics of ACT-280778, a Novel Nondihydropyridine Dual L/T-type Calcium Channel Blocker

“…8 Such a differentiated pattern of expression of T-type versus L-type calcium channels also occurs in other arterioles and venules. [12][13][14][15] However, their tolerability is limited by unwanted, dose-related cardiovascular properties, such as negative inotropism (verapamil) or reflex tachycardia (short-acting dihydropyridines), and side effects such as constipation (verapamil) or peripheral edema (dihydropyridines). 9 Similarly, blockade of T-type calcium channels in the microvasculature on a background of L-type calcium channel blockade provided additional inhibition of the constrictor response to endothelin-1.…”

Extended-release ranolazine: critical evaluation of its use in stable angina

“…About 16.3 million people in the US have coronary heart disease and an estimated 8.9 million people have chronic stable angina 2,3. Coronary heart disease is responsible for approximately one of every six deaths in the US,3 and based on data from 2007, the estimated direct and indirect cost of coronary heart disease in the US annually exceeds $177.5 billion 3,4…”

“…Angina pectoris is a clinical syndrome characterized by discomfort, typically in the chest, neck, chin, or left arm, induced by physical exertion, emotional stress, or cold, and is relieved by rest or nitroglycerin 2. It is present symptomatically in only 18% of coronary artery disease 3.…”

“…The general management of chronic stable angina is directed at medical therapy to reduce coronary heart disease progression, as well as therapies and lifestyle modification to control or eliminate coronary heart disease risk factors (smoking, high blood pressure, diabetes mellitus, hyperlipidemia, physical inactivity, weight management, and influenza vaccination) 2,6…”