What is optimal drug therapy in angina pectoris?

The treatment of classic angina pectoris must be carefully individualized, taking into account factors such as age, degree of disability, anatomic location and extent of lesions, ventricular function, and psychologic makeup of the patient. In some instances, early coronary bypass surgery is indicated. In other cases, a trial with full medical therapy is indicated and, if successful, medical management should be continued with careful, ongoing monitoring of the clinical course. Medical treatment should be considered a failure only if maximal dosage of nitrates and beta blockers is attained without satisfactory control of symptoms. The advent of calcium-channel blockers appears to add a new dimension in the treatment of variant angina, and these drugs may be useful also in certain patients with fixed coronary lesions and concomitant coronary artery spasm.