cardiovascular disorders
Angina Pectoris
Key Points
Angina pectoris occurs when cardiac workload exceeds the ability of coronary arteries to supply an adequate amount of oxygenated blood. Symptoms of stable angina pectoris range from a vague, barely troublesome ache to a severe, intense precordial crushing sensation; they are typically precipitated by exertion, last no more than a few minutes, and subside with rest. Do stress testing with ECG for patients with normal resting ECG or with myocardial imaging (eg, echocardiography, radionuclide imaging, PET, MRI) for patients with abnormal resting ECG. Do coronary angiography when revascularization (percutaneous intervention or coronary artery bypass grafting) is being considered. Givenitroglycerinfor immediate relief of angina. Maintain patients on an antiplatelet drug, a beta-blocker, and a statin, and add a calcium channel blocker for further symptom prevention if needed. Consider revascularization if significant angina persists despite drug therapy or if lesions noted during angiography indicate high risk of mortality. 