Which of the following results is the primary treatment goal for angina?
A. Reversal of ischemia.
B. Reversal of infarction.
C. Reduction of stress and anxiety.
D. Reduction of associated risk factors.
Correct Answer: A. Reversal of ischemia.
Reversal of the ischemia is the primary goal, achieved by reducing oxygen consumption and increasing oxygen supply. As heart rate is the main influencer of oxygen consumption, most anginal events are initiated by an increase in heart rate. Three classes of drugs used for angina reduce symptoms by way of heart rate reduction— beta-blockers, ivabradine, and non-dihydropyridine calcium channel blockers.
Option B: An infarction is permanent and can’t be reversed. Another mechanism by which anginal symptoms can be treated is with vascular smooth muscle relaxation. This leads to coronary artery dilatation, thereby increasing perfusion ability. The drugs that work on this mechanism are dihydropyridine calcium channel blockers, nitrates, and nicorandil.
Option C: Lifestyle modifications include regular exercise, weight control, and smoking cessation and should be encouraged. Risk factor modification includes controlling blood pressure, cholesterol, and blood sugar. Medications for risk factor modification and to prevent disease progression include aspirin, statins, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers.
Option D: Prognosis of chronic stable angina progression to cardiac events varies among patients. Factors affecting prognosis include cardiovascular comorbidities as well as compliance with lifestyle modifications and medical treatment plans. Long-term prognosis is also affected by left ventricular systolic function, the degree of exercise the patient can tolerate, and the extent of CAD present.
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