Current perspectives in treatment of angina pectoris

The most appropriate treatment for a patient with angina pectoris depends on the underlying pathophysiologic process and whether any associated illness is present. Each patient's clinical history must be carefully reviewed so the hemodynamic process responsible for the clinical picture is understood. If symptoms are produced mostly by an increase in myocardial oxygen demand, efforts should be directed toward reducing the demand or improving coronary blood flow to meet the demand. If symptoms appear to occur secondary to vasospasm, treatment should be directed toward relief of spasm with potent vasodilating agents, such as calcium channel blockers. Most patients have a clinical picture consistent with mixed angina and may require combination therapy. Treatment of associated illnesses and the safety of pharmacologic agents used in their presence should be carefully considered. Finally, if treatment is to successfully reduce the incidence of serious cardiac events and prolong life, the goal of therapy should be relief of the total ischemic burden on the heart.