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Titolo:
Guidelines for the management of patients with chronic stable angina: Treatment
Autore:
Fihn, SD; Williams, SV; Daley, J; Gibbons, RJ;
Indirizzi:
VA Puget Sound Hlth Care Syst, NW Hlth Serv Res & Dev Ctr Excellence, Seattle, WA 98108 USA VA Puget Sound Hlth Care Syst Seattle WA USA 98108 Seattle, WA 98108 USA Massachusetts Gen Hosp, Partners Hlth Care Syst, Boston, MA 02114 USA Massachusetts Gen Hosp Boston MA USA 02114 are Syst, Boston, MA 02114 USA Univ Penn, Philadelphia, PA 19104 USA Univ Penn Philadelphia PA USA 19104Univ Penn, Philadelphia, PA 19104 USA Mayo Clin & Mayo Fdn, Rochester, MN 55905 USA Mayo Clin & Mayo Fdn Rochester MN USA 55905 Fdn, Rochester, MN 55905 USA
Titolo Testata:
ANNALS OF INTERNAL MEDICINE
fascicolo: 8, volume: 135, anno: 2001,
parte:, 1
pagine: 616 - 632
SICI:
0003-4819(20011016)135:8<616:GFTMOP>2.0.ZU;2-T
Fonte:
ISI
Lingua:
ENG
Soggetto:
CORONARY-ARTERY DISEASE; ACUTE MYOCARDIAL-INFARCTION; AMERICAN-HEART-ASSOCIATION; TOTAL ISCHEMIC BURDEN; RANDOMIZED CONTROLLED TRIAL; DENSITY-LIPOPROTEIN CHOLESTEROL; PATIENTS RECEIVING PROPRANOLOL; ESTROGEN REPLACEMENT THERAPY; ACC/AHA/ACP-ASIM GUIDELINES; BETA-ADRENERGIC-BLOCKADE;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
191
Recensione:
Indirizzi per estratti:
Indirizzo: Fihn, SD VA Puget Sound Hlth Care Syst, NW Hlth Serv Res & Dev Ctr Excellence, 152,1660 S Columbian Way, Seattle, WA 98108 USA VA Puget Sound Hlth Care Syst 152,1660 S Columbian Way Seattle WA USA 98108
Citazione:
S.D. Fihn et al., "Guidelines for the management of patients with chronic stable angina: Treatment", ANN INT MED, 135(8), 2001, pp. 616-632

Abstract

The dual alms of treating patients with chronic stable angina are 1) to reduce morbidity and mortality and 2) to eliminate angina with minimal adverse effects and allow the patient to return to normal activities. In the absence of contraindications, is-blockers are recommended as initial therapy. All beta -blockers seem to be equally effective. If the patient has serious contraindications to beta -blockers, unacceptable side effects, or persistent angina, calcium antagonists should be administered. Long-acting dihydropyridine and nondihydropyridine agents are generally as effective as beta -blockers in relieving angina. Long-acting nitrates are considered third-linetherapy because a nitrate-free interval is required to avoid developing tolerance. All long-acting nitrates seem to be equally effective. Patients with angina should take 75 to 325 mg of aspirin daily unless theyhave contraindications. Such risk factors as, smoking, elevated low-density lipoprotein cholesterol level, diabetes, and hypertension should be treated appropriately. Coronary revascularization has not been shown to improve survival for mostpatients with chronic angina but may be required to control symptoms. However, coronary artery bypass grafting (CABG) is often indicated for symptomatic patients with left-main disease, three-vessel disease, or two-vessel disease including proximal stenosis of the left anterior descending coronary artery; it improves their survival. Percutaneous transluminal coronary angioplasty is an alternative to CABG for patients with normal left ventricularfunction and favorable angiographic features. Coronary artery bypass grafting is initially more effective in relieving angina than medical therapy, but the two procedures yield similar results after 5 to 10 years. Eighty percent of patients who undergo CABG remain angina-free 5 years after surgery. In low-risk patients, percutaneous transluminal coronary angioplasty seemsto control angina better than medical therapy, but recurrent angina and repeated procedures are more likely than with CABG. Patient education is an important component of. management. Long-term follow-up should be individualized to ascertain clinical stability at regular intervals and to reassess prognosis when warranted.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 08/04/20 alle ore 11:39:24