open access

Vol 18, No 4 (2011)
Review articles
Published online: 2011-07-15
Submitted: 2013-01-14
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Management of refractory angina pectoris

Aarush Manchanda, Ashim Aggarwal, Nupur Aggarwal, Ozlem Soran
Cardiol J 2011;18(4):343-351.

open access

Vol 18, No 4 (2011)
Review articles
Published online: 2011-07-15
Submitted: 2013-01-14

Abstract

Despite significant advances in revascularization techniques and medical therapy, there remains a significant population of patients who continue to have intractable angina symptoms. This review aims to define the patients with refractory angina pectoris (RAP) and to present the therapeutic options currently available for this condition.
RAP itself is defined and the pharmacological treatment options other than traditional medical therapies are discussed. The latest therapeutic options for this patient population are extensively reviewed. Among the multitude of pharmacological and non-invasive therapeutic options for patients with RAP, ranolazine is a new drug indicated for the treatment of chronic angina, in combination with amlodipine, beta-blockers or nitrates. Enhanced external counterpulsation has not only been shown to improve symptoms, but also to improve long-term ventricular function in these patients. In randomized trials, neurostimulation has been shown to be effective in reducing angina symptoms. Transmyocardial laser revascularization has emerged as an invasive treatment for RAP over the last two decades. Extracorporeal shockwave myocardial revascularization gene therapy and percutaneous in situ coronary venous arterialization are still under investigation. (Cardiol J 2011; 18, 4: 343–351)

Abstract

Despite significant advances in revascularization techniques and medical therapy, there remains a significant population of patients who continue to have intractable angina symptoms. This review aims to define the patients with refractory angina pectoris (RAP) and to present the therapeutic options currently available for this condition.
RAP itself is defined and the pharmacological treatment options other than traditional medical therapies are discussed. The latest therapeutic options for this patient population are extensively reviewed. Among the multitude of pharmacological and non-invasive therapeutic options for patients with RAP, ranolazine is a new drug indicated for the treatment of chronic angina, in combination with amlodipine, beta-blockers or nitrates. Enhanced external counterpulsation has not only been shown to improve symptoms, but also to improve long-term ventricular function in these patients. In randomized trials, neurostimulation has been shown to be effective in reducing angina symptoms. Transmyocardial laser revascularization has emerged as an invasive treatment for RAP over the last two decades. Extracorporeal shockwave myocardial revascularization gene therapy and percutaneous in situ coronary venous arterialization are still under investigation. (Cardiol J 2011; 18, 4: 343–351)
Get Citation

Keywords

refractory angina; coronary artery disease

About this article
Title

Management of refractory angina pectoris

Journal

Cardiology Journal

Issue

Vol 18, No 4 (2011)

Pages

343-351

Published online

2011-07-15

Bibliographic record

Cardiol J 2011;18(4):343-351.

Keywords

refractory angina
coronary artery disease

Authors

Aarush Manchanda
Ashim Aggarwal
Nupur Aggarwal
Ozlem Soran

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