Abstract
Treatment of stable angina pectoris (AP) has to be complex. It consists of necessary preventive measures, pharmacological therapy, and invasive myocardial revascularization procedures, either catheterization or surgery.
Pharmacological therapy and invasive revascularizatíon procedures are not competitive but complementary. The article presents an overview of pharmacological treatment of stable AP as outlined in the 2010 guidelines of the Czech Society of Cardiology on the díagnosis and treatment of stable AP in all patients, secondary prevention measures, non-pharmacological as well as pharrnacological, need to be systematically taken.
The actual pharmacological treatment of stable AP can be divided into prognosis-modifying treatment and symptom-modifying treatment. The former uses drugs preventing coronary artery occlusíon (antiplatelet drugs), controlling endothelial dysfunction, stabilizing atherosclerotic plaque or inducing regression of atherosclerosis (statins, ACE inhibitors and sartans), and reducing arrhythmia risk (beta-blockers).
The symptom-modifying therapies are heart rate-modifyíng drugs (beta-blockers, heart rale lowering calcium channel blockers and ivabradine), drugs controlling coronary perfusion by coronary vascular relaxation (calcium channel blockers, long-acting nitrates and molsidomine), and metabolic modulators (trimetazidine and ranolazine). Beta-blockers as the on prognosis- and symptom-modifying drugs are antianginal drugs of the fírst choice.
Short acting nitrates (nitroglycerin and isosorbide dinitrate) administered intraorally in tablet or aerosol dosage form are effective in preventing and treating acute episodes of AP