Angina: Treatment Goals

Treatment Strategy Of Chronic Stable AnginaAngina: Treatment GoalsFeel betterLive longerThe Goals of Therapy in CADTo improve quality of life (symptoms)To reduce mortalityTo reduce morbidityTo reduce progression of disease and induce regression.3Angina: PrognosisLeft ventricular functionNumber of coronary arteries with significant stenosisExtent of jeoporized myocardiumStable AnginaRisk stratificationNoninvasive testing Cardiac catheterizationStable AnginaEvaluation of LV FunctionPhysical examCXREchocardiogram

Stable AnginaEvaluation of IschemiaHistoryBaseline ElectrocardiogramExercise TestingCCSC Angina ClassificationClass I

Class II

Class III

Class IVAngina only with extreme exertionAngina with walking 1 to 2 blocksAngina with walking1 blockAngina with minimal activityStable AnginaNon-Invasive Evaluation

Cardiac CatheterizationIndications

Risk Factor ModificationHypertensionSmokingDyslipidemiaDiabetes MellitusObesityStressHomocysteineTreatment of Chronic Stable AnginaMedicalRevascularizationPCIACBG13Stable AnginaTreatment OptionsMedical Treatment

MEDICAL THERAPYANTIPLATELETSBETA BLOCKERSNITRATESCALCIUM ANTAGONISTACEISTATINSNEW THERAPIES

16Stable AnginaConsiderations when Choosing a DrugEffect on myocardiumEffect on cardiac conduction systemEffect on coronary/systemic arteriesEffect on venous capitance systemCircadian rhytm

Pharmacotherapy for Chronic Stable Angina (class I)1. Aspirin in the absence of contraindications A2. Beta-blockers as initial therapy in the absence of contraindications in patients with prior myocardial infarction or without prior myocardial infarction A,B3. ACE inhibitor in all patients with CAD who also have diabetes and/or LV systolic dysfunction A4. LDL-lowering therapy in patients with documented or suspected CAD and LDL cholesterol >130 mg/dl, with a target LDL of