[Drug therapy of angina pectoris]

In patients without heart failure and with exercise-induced angina pectoris, betablockers are still the treatment of choice. The pharmacological differences within the betablockers are of minor importance clinically. Patients with angina at rest, or with a considerably changing effort threshold, are suspect for additional coronary spasms. Here calcium antagonists, and possibly nitrates, should be given first. A combination of these three treatments often proves beneficial. Amiodarone, which in the beginning was only rarely used because of its complex pharmacokinetics, is now generally accepted as an effective and well-tolerated drug for angina. In unstable angina, medical treatment varies according to the differing clinical symptoms. In addition to immobilization and anticoagulation, prolonged pain attacks are treated with intravenous nitrates. If the symptoms persist, combination of antianginal drugs as described above, sometimes in high doses, is necessary in order to postpone selective coronary angiography and bypass operation by one to two weeks. Otherwise these procedures must be performed after intraaortic balloon pumping has been instituted.