Refractory angina

Patients who have optimal therapy but continue to have angina and are not candidates for revascularization.

Approximately 5-15% of angina patients have refractory angina.

Estimated to be 300-900,000 patients in the U.S. at present with 25-75,000 new cases per year.

Two kinds: acute and chronic.

Acutely symptomatic patients with ongoing chest pain or angina equivalent with EKG changes such as transient ST-segment depression while the patient is receiving maximum medical therapy with oral beta-blockers, oral calcium channel blockers, nitrates, antiplatelet agents, and statins.

The use of heparin or low molecular weight heparin and clopidigrel should be considered as adjunctive therapy.

No classic presentation as patients may have different electrocardiographic changes during symptoms, may have elevated cardiac enzymes or not, may have elevated CRP or not, the left ventricular function may be abnormal or normal and coronary pathology may be variable significantly among patients.

Patients more likely to have multiple coronary artery disease, and left ventricular dysfunction.

Patients with left main coronary artery disease, with prior angioplasty or coronary artery bypass are candidates for this presentation.

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