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Angina pectoris: evaluation in the office.

Mark D Kelemen1

  • 1Division of Cardiology, University of Maryland School of Medicine, Baltimore, MD 21201-1734, USA. mkelemen@medicine.umaryland.edu

The Medical Clinics of North America
|February 14, 2006
PubMed
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Angina pectoris, chest pain due to reduced blood flow to the heart, is diagnosed through risk factor review, history, and stress testing. Management includes lifestyle changes, medications, and possibly revascularization to improve outcomes.

Area of Science:

  • Cardiology
  • Internal Medicine

Background:

  • Angina pectoris signifies myocardial ischemia, necessitating thorough evaluation.
  • Risk factor assessment, detailed patient history, and provocative testing are crucial diagnostic steps.

Purpose of the Study:

  • To outline the comprehensive evaluation and management strategies for patients presenting with angina pectoris.
  • To highlight the role of stress testing and coronary angiography in diagnosis and treatment planning.

Main Methods:

  • Evaluation involves reviewing risk factors, taking a detailed history, and performing provocative stress tests (exercise or pharmacologic).
  • High-risk patients identified via clinical assessment or stress testing are referred for coronary angiography and potential revascularization.
  • Management encompasses lifestyle modifications (smoking cessation, diet, weight control), vasculoprotective drugs (aspirin, statins, ACE inhibitors), and antianginal medications (nitrates, beta-blockers, calcium channel blockers).

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Main Results:

  • Stress testing utilizes exercise (treadmill, bicycle, arm ergometry) or pharmacologic agents (dobutamine, adenosine, dipyridamole) to assess cardiac function.
  • Referral for coronary angiography and revascularization is indicated for patients with high-risk features.
  • Integrated management strategies have significantly reduced morbidity and mortality over the last two decades.

Conclusions:

  • Current management guidelines for angina pectoris, including lifestyle changes, pharmacotherapy, and revascularization, have demonstrably improved patient outcomes.
  • Continued focus on guideline implementation for undertreated populations is expected to further enhance cardiovascular health and reduce disease burden.