All patients should be treated for acute attacks and maintained on prophylactic treatment for 6 to 12 months after the initial episode. Aggravating factors such as alcohol or cocaine use and cigarette smoking should be stopped.
Nitrates are the mainstay of therapy, and most patients respond rapidly to sublingual nitroglycerin or ISDN. Intravenous (IV) and intracoronary nitroglycerin may be useful for patients not responding to sublingual.
Because of calcium channel antagonists may be more effective, have few serious adverse effects, and can be given less frequently than nitrates, some authorities consider them the agents of choice for variant angina. Nifedipine, Verapamil, and Diltiazem are all equally effective as single agents for initial management. Patients unresponsive to calcium channel antagonists alone may have nitrates added. Combination therapy with nifedipine plus diltiazem or nifedipine plus verapamil has been reported to be useful in patients unresponsive to single-drug regimens.
Beta blockers have little or no role in the management of variant angina as they may induce coronary vasoconstriction and prolong ischemia.
Nitrates are the mainstay of therapy, and most patients respond rapidly to sublingual nitroglycerin or ISDN. Intravenous (IV) and intracoronary nitroglycerin may be useful for patients not responding to sublingual.
Because of calcium channel antagonists may be more effective, have few serious adverse effects, and can be given less frequently than nitrates, some authorities consider them the agents of choice for variant angina. Nifedipine, Verapamil, and Diltiazem are all equally effective as single agents for initial management. Patients unresponsive to calcium channel antagonists alone may have nitrates added. Combination therapy with nifedipine plus diltiazem or nifedipine plus verapamil has been reported to be useful in patients unresponsive to single-drug regimens.
Beta blockers have little or no role in the management of variant angina as they may induce coronary vasoconstriction and prolong ischemia.
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