Advertisement

Stable Angina

  • Steven HollenbergEmail author
  • Stephen Heitner
Chapter
Part of the Current Clinical Practice book series (CCP, volume 1)

Abstract

Myocardial ischemia results from an imbalance of oxygen supply and oxygen demand. Traditionally, myocardial ischemia has been differentiated in terms of the acuity and stability of the symptoms. Typical angina is exertional, and is relieved promptly by rest or nitroglycerin. Stable angina occurs reproducibly with a similar level of exertion, in a pattern that is unchanged over the last 6 months. In 2006, despite therapeutic advances, 9.8 million patients had angina in the United States [1]. New, worsening, or rest symptoms, and chest pain associated with elevated cardiac enzymes, fall under the category of the acute coronary syndromes (unstable angina, ST- and non-ST-segment elevation myocardial infarction) and is discussed in the appropriate chapter.

Keywords

Percutaneous Coronary Intervention Smoking Cessation Acute Coronary Syndrome Coronary Artery Bypass Grafting Stable Angina 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics – 2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;119:480–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Braunwald E. Control of myocardial oxygen consumption. Physiologic and clinical considerations. Am J Cardiol. 1971;27:416–32.PubMedCrossRefGoogle Scholar
  3. 3.
    DeWood MA, Stifter WF, Simpson CS, et al. Coronary arteriographic findings soon after non-Q-wave myocardial infarction. N Engl J Med. 1986;315:417–23.PubMedCrossRefGoogle Scholar
  4. 4.
    Heberden N. Some account of a disorder of the breast. Med Transactions. 1772;2:59–67.Google Scholar
  5. 5.
    Swap CJ, Nagurney JT. Value and limitations of chest pain history in the evaluation of patients with suspected acute coronary syndromes. JAMA. 2005;294:2623–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Diamond GA. A clinically relevant classification of chest discomfort. J Am Coll Cardiol. 1983;1:574–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Voskuil JH, Cramer MJ, Breumelhof R, Timmer R, Smout AJ. Prevalence of esophageal ­disorders in patients with chest pain newly referred to the cardiologist. Chest. 1996;109:1210–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Douglas PS, Khandheria B, Stainback RF, et al. ACCF/ASE/ACEP/AHA/ASNC/SCAI/SCCT/SCMR 2008 appropriateness criteria for stress echocardiography: a report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, American Society of Echocardiography, American College of Emergency Physicians, American Heart Association, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance endorsed by the Heart Rhythm Society and the Society of Critical Care Medicine. J Am Coll Cardiol. 2008;51:1127–47.PubMedCrossRefGoogle Scholar
  9. 9.
    Hendel RC, Berman DS, Di Carli MF, et al. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 Appropriate Use Criteria for Cardiac Radionuclide Imaging: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine. J Am Coll Cardiol. 2009;53:2201–29.PubMedCrossRefGoogle Scholar
  10. 10.
    Craven L. Experience with aspirin (acetysalicylic acid) in the non-specific prophylaxis of coronary thrombosis. Miss Vlly Med J. 1953;75:38–44.Google Scholar
  11. 11.
    Lewis Jr HD, Davis JW, Archibald DG, et al. Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. Results of a Veterans Administration cooperative study. N Engl J Med. 1983;309:396–403.PubMedCrossRefGoogle Scholar
  12. 12.
    Theroux P, Ouimet H, McCans J, et al. Aspirin, heparin, or both to treat acute unstable angina. N Engl J Med. 1988;319:1105–11.PubMedCrossRefGoogle Scholar
  13. 13.
    Steering Committee of the Physicians’ Health Study Research Group. Final report on the aspirin component of the ongoing physicians’ health study. N Engl J Med. 1989;321:129–35.CrossRefGoogle Scholar
  14. 14.
    Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) Study Investigators. Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable angina and non-Q-wave myocardial infarction. N Engl J Med. 1998;338:1488–97.CrossRefGoogle Scholar
  15. 15.
    Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med. 1997;336:973–9.PubMedCrossRefGoogle Scholar
  16. 16.
    CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996;348:1329–39.CrossRefGoogle Scholar
  17. 17.
    Cohn PF, Gorlin R. Physiologic and clinical actions of nitroglycerin. Med Clin North Am. 1974;58:407–15.PubMedGoogle Scholar
  18. 18.
    Lacoste LL, Theroux P, Lidon RM, Colucci R, Lam JY. Antithrombotic properties of transdermal nitroglycerin in stable angina pectoris. Am J Cardiol. 1994;73:1058–62.PubMedCrossRefGoogle Scholar
  19. 19.
    Silber S. Nitrates: why and how should they be used today? Current status of the clinical usefulness of nitroglycerin, isosorbide dinitrate and isosorbide-5-mononitrate. Eur J Clin Pharmacol. 1990;38 Suppl 1:S35–51.PubMedCrossRefGoogle Scholar
  20. 20.
    Frishman WH. Multifactorial actions of beta-adrenergic blocking drugs in ischemic heart disease: current concepts. Circulation. 1983;67:I11–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Oliva PB, Potts DE, Pluss RG. Coronary arterial spasm in Prinzmetal angina. Documentation by coronary arteriography. N Engl J Med. 1973;288:745–51.PubMedCrossRefGoogle Scholar
  22. 22.
    Stason WB, Schmid CH, Niedzwiecki D, et al. Safety of nifedipine in angina pectoris: a meta-analysis. Hypertension. 1999;33:24–31.PubMedGoogle Scholar
  23. 23.
    Wilson SR, Scirica BM, Braunwald E, et al. Efficacy of ranolazine in patients with chronic angina observations from the randomized, double-blind, placebo-controlled MERLIN-TIMI (metabolic efficiency with ranolazine for less ischemia in non-ST-segment elevation acute coronary syndromes) 36 trial. J Am Coll Cardiol. 2009;53:1510–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Neal B, MacMahon S, Chapman N. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists’ Collaboration. Lancet. 2000;356:1955–64.PubMedCrossRefGoogle Scholar
  25. 25.
    Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–52.PubMedCrossRefGoogle Scholar
  26. 26.
    Lloyd-Jones DM, Hong Y, Labarthe D, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation. 2010;121:586–613.PubMedCrossRefGoogle Scholar
  27. 27.
    Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342:145–53.PubMedCrossRefGoogle Scholar
  28. 28.
    Fox KM. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet. 2003;362:782–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Braunwald E, Domanski MJ, Fowler SE, et al. Angiotensin-converting-enzyme inhibition in stable coronary artery disease. N Engl J Med. 2004;351:2058–68.PubMedCrossRefGoogle Scholar
  30. 30.
    Lipid Research Clinics Program. The lipid research clinics coronary primary prevention trial results. II. The relationship of reduction in incidence of coronary heart disease to cholesterol lowering. JAMA. 1984;251:365–74.CrossRefGoogle Scholar
  31. 31.
    Frick MH, Elo O, Haapa K, et al. Helsinki heart study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease. N Engl J Med. 1987;317:1237–45.PubMedCrossRefGoogle Scholar
  32. 32.
    Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344:1383–9.Google Scholar
  33. 33.
    Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med. 1996;335:1001–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med. 1998;339:1349–57.CrossRefGoogle Scholar
  35. 35.
    Gibbons RJ, Abrams J, Chatterjee K, et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina–summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation. 2003;107:149–58.PubMedCrossRefGoogle Scholar
  36. 36.
    Grundy SM, Cleeman JI, Merz CN, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004;110:227–39.PubMedCrossRefGoogle Scholar
  37. 37.
    Cannon CP, Braunwald E, McCabe CH, et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med. 2004;350:1495–504.PubMedCrossRefGoogle Scholar
  38. 38.
    Nissen SE, Tuzcu EM, Schoenhagen P, et al. Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial. JAMA. 2004;291:1071–80.PubMedCrossRefGoogle Scholar
  39. 39.
    Fraker Jr TD, Fihn SD, Gibbons RJ, et al. 2007 chronic angina focused update of the ACC/AHA 2002 guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 guidelines for the management of patients with chronic stable angina. J Am Coll Cardiol. 2007;50:2264–74.PubMedCrossRefGoogle Scholar
  40. 40.
    Ockene IS, Miller NH. Cigarette smoking, cardiovascular disease, and stroke: a statement for healthcare professionals from the American Heart Association. American Heart Association Task Force on Risk Reduction. Circulation. 1997;96:3243–7.PubMedGoogle Scholar
  41. 41.
    Krauss RM, Eckel RH, Howard B, et al. AHA Dietary Guidelines: revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation. 2000;102:2284–99.PubMedGoogle Scholar
  42. 42.
    Lichtenstein AH, Appel LJ, Brands M, et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation. 2006;114:82–96.PubMedCrossRefGoogle Scholar
  43. 43.
    Cushman WC, Evans GW, Byington RP, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362:1575–85.PubMedCrossRefGoogle Scholar
  44. 44.
    Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86.CrossRefGoogle Scholar
  45. 45.
    UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet. 1998;352:837–53.CrossRefGoogle Scholar
  46. 46.
    Thompson PD, Buchner D, Pina IL, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation. 2003;107:3109–16.PubMedCrossRefGoogle Scholar
  47. 47.
    Hambrecht R, Walther C, Mobius-Winkler S, et al. Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial. Circulation. 2004;109:1371–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Patel MR, Dehmer GJ, Hirshfeld JW, Smith PK, Spertus JA. ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization: a report by the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology Endorsed by the American Society of Echocardiography, the Heart Failure Society of America, and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol. 2009;53:530–53.PubMedCrossRefGoogle Scholar
  49. 49.
    CASS Principal Investigators. Coronary artery surgery study (CASS): a randomized trial of coronary artery bypass surgery. Survival data. Circulation. 1983;68:939–50.CrossRefGoogle Scholar
  50. 50.
    European Coronary Surgery Study Group. Prospective randomised study of coronary artery bypass surgery in stable angina pectoris. Lancet. 1980;2:491–5.Google Scholar
  51. 51.
    Frye RL, August P, Brooks MM, et al. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009;360:2503–15.PubMedCrossRefGoogle Scholar
  52. 52.
    BARI Investigators. The final 10-year follow-up results from the BARI randomized trial. J Am Coll Cardiol. 2007;49:1600–6.CrossRefGoogle Scholar
  53. 53.
    Serruys PW, Morice MC, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009;360:961–72.PubMedCrossRefGoogle Scholar
  54. 54.
    Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. The Bypass Angioplasty Revascularization Investigation (BARI) Investigators. N Engl J Med 1996;335:217–25.Google Scholar
  55. 55.
    Katritsis DG, Ioannidis JP. Percutaneous coronary intervention versus conservative therapy in nonacute coronary artery disease: a meta-analysis. Circulation. 2005;111:2906–12.PubMedCrossRefGoogle Scholar
  56. 56.
    Trikalinos TA, Alsheikh-Ali AA, Tatsioni A, Nallamothu BK, Kent DM. Percutaneous coronary interventions for non-acute coronary artery disease: a quantitative 20-year synopsis and a network meta-analysis. Lancet. 2009;373:911–8.PubMedCrossRefGoogle Scholar
  57. 57.
    Boden WE, O’Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503–16.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Cooper University HospitalCamdenUSA
  2. 2.Robert Wood Johnson Medical SchoolUniversity of Medicine and Dentistry of Section of Cardiology Cooper University HospitalCamdenUSA

Personalised recommendations