[Therapy of chronic stable angina]

Chronic stable angina is a common clinical problem limiting the quality of life. Patients with suspected stable angina require prompt cardiological investigation to ensure that the diagnosis is correct and that the prognosis is evaluated. An initial non-invasive strategy using an exercise test is most appropriate. All patients should be advised regarding life-style modifications to correct risk factors. In the absence of contraindications or intolerance acetylsalicylic acid and statins should be given. ACE-inhibitors are indicated in patients with left ventricular dysfunction, hypertension or diabetes and patients with other high-risk features. Beta blockers are used in all patients after myocardial infarction and those with left ventricular dysfunction. Anti-anginal therapy is based on the use of short-acting nitrates. Beta blockers, calcium antagonists and long-acting nitrates reduce the frequency and intensity of angina. In patients with high-risk features and those whose symptoms cannot be adequately controlled by medications coronary angiography should be considered. Both percutaneous coronary intervention and coronary artery bypass graft operation (CABG) are effective measures to control anginal symptoms. However, only CABG has been shown to improve prognosis in some high-risk patients.