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Angina IV: Management

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Acetylcholine Re-Challenge After Intracoronary Nitroglycerine Administration

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Non-PCI/CABG therapies for refractory angina.

Ki E Park¹, C Richard Conti²

¹Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL; Department of Cardiology, Malcom Randall VA Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL.

Trends in Cardiovascular Medicine

|November 22, 2017

Summary

Refractory angina persists despite treatment. Management includes aggressive risk factor modification, optimized medical therapy with multiple agents, and novel treatments like ranolazine or enhanced external counterpulsation.

Keywords:

Cardiac rehabilitation Enhanced external counterpulsation Non-pharmacologic therapy Novel agents Pharmacologic therapy Refractory angina

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Area of Science:

Cardiology
Internal Medicine

Background:

Refractory angina affects many patients despite current therapies.
Persistent angina symptoms significantly impact quality of life.

Purpose of the Study:

To outline comprehensive management strategies for refractory angina.
To highlight the importance of aggressive risk factor modification and optimized medical therapy.

Main Methods:

Review of current medical literature and treatment guidelines.
Discussion of pharmacologic and non-pharmacologic therapeutic options.

Main Results:

Optimized medical management is crucial, often requiring multiple medications.
Novel agents like ranolazine and ivabradine show potential.
Non-pharmacologic therapies including enhanced external counterpulsation and cardiac rehabilitation offer relief.

Conclusions:

Aggressive risk factor modification and optimized medical management are essential for refractory angina.
A multimodal approach combining pharmacologic and non-pharmacologic strategies is recommended for symptom control.