Optimal medical management of angina.

Coronary artery disease remains one of the principal causes of disability worldwide. Its most common manifestation is angina pectoris. Angina occurs due to an imbalance between myocardial oxygen demand and supply; it is classically precipitated by physical activity, emotion, eating, or cold weather. It is defined as stable when its frequency, severity, duration, time of appearance, and precipitating factors remain unchanged for 60 days. Treatment of patients with stable angina targets a number of factors that underlie its pathophysiology: aspirin as an antiplatelet agent, b-blockade to reduce myocardial oxygen demand, and additional antianginal drugs when symptoms are incompletely controlled by b-blockers alone. Furthermore, aggressive treatment of risk factors for the development of coronary artery disease confers a significant mortality benefit. Unstable angina is defined as symptoms developing at rest, on minimal exertion, and of increasing severity, duration, or frequency. It is associated with significant mortality; consequently, early assessment and intervention is essential to prevent worsening ischemia. Treatment includes close in-patient monitoring, administration of antiplatelet and antithrombotic drugs, and a combination of b-blockers, calcium antagonists, and intravenous nitrates where appropriate. Coronary revascularization should be considered in high-risk patients, and when conservative management strategies fail.