General principles of treatment of stable angina pectoris are represented by the need to reduce the frequency of myocardial ischemia and angina manifestations in order to increase quality of life, as well as preventive measures to control the cardiovascular risk factors and halt the progression of coronary atherosclerosis.
These objectives can be achieved through the following therapeutic means:
– Hygienic-dietary measures and lifestyle changes;
– Medical treatment that acts by modifying cardiovascular risk factors of age, or preventive effects through other mechanisms;
– Medical treatment which prevents the painful symptoms of angina and which represents practically the conventional anti-angina medical therapy, to which is added a new medical treatment option and with anti-ischemic role;
– Myocardial revascularization.
Hygienic-dietary measures and lifestyle changes
Hygienic-dietary measures and lifestyle changes are part of the genes of primary and secondary prevention of the coronary heart disease. They have mainly the vessel-protective role, which means that under certain conditions they can favorably influence the evolution of the phenomenon of atherosclerosis, are additional to the medical treatment and require much more attention than at the given time. Exercise, along with the changes in eating habits and smoking cessation are the essential elements of non-medical management of patients with stable angina. Together with them enters in discussion the information given to the patient and family entourage about the risk factors and about sub-start morphological of the stable coronary heart disease, the implications of the diagnosis and treatment, as well as the evaluating with the purpose of removing physical and psychological factors that may be involved in triggering painful symptoms.
The importance of vigorous exercise has been shown experimentally and clinically improving the performance of ischemic myocardium. In the experimental mode has been observed the increase of myocardial perfusion and optimization of endothelial dysfunction and clinical performance improvement was evidenced during exercise. Increasing angina threshold and significant prolongation of periods free of angina is comparable with the clinical effect resulting from the application to PCI techniques. The results of a clinical study published in 2008, have shown that the combined recommendations of daily achievement to some exercise, to have an appropriate management of occupational stress and to follow a diet low in fat, leading to a significant reduction the frequency of angina episodes, to improve exercise capacity and improved quality of life.
Current guidelines recommend that patients with stable coronary artery damage, tp achieve 30-60min of exercise daily with moderate-intensity aerobic. Physical activity is within the tolerance of the patient (minimum-maximum 60min 30 minutes, preferably daily, but at least 5 times / week) and recommendations must take into account the type, duration, frequency and intensity of exercise.
At intermediate and high risk patients will be indicated individualized programs according to preliminary testing exercise capacity and will not overcome the threshold of 1.000Kcal / week. In patients with significant limitation of the exercise capacity (for example those who have heart failure), it is recommended short sessions and repeated several times throughout the day in order to maintain the possibility of independence in daily activities, reducing depression. Exercise can reduce the need for antihypertensive medications, particularly evident effect on the administration of angiotensin converting enzyme inhibitors and diuretics, but less pronounced in the case of B-blocker therapy. Regular exercise lowers the systolic and diastolic values with 5-10mmHg, this effect is independent to weight loss to Na intake.
Physical activity promotes weight loss and lowers the serum lipids, restores insulin sensitivity and improves glucose metabolism and last but not least has favorable psychological effects. Sexual activity can trigger angina. Nitroglycerin administered prior to intercourse may be helpful, but it does not have to be physically demanding and emotionally.