Abstract: . . .  should lose weight, smokers should quit, sedentary patients should get aerobic exercise, and patients with hypertension or hyperlipidemia should receive appropriate therapy. VARIANT ANGINA PECTORIS Treatment of vasospastic angina can proceed in three steps. For initial therapy, either a calcium channel blocker or a nitrate is selected. If either drug alone is inadequate, then combined therapy with a calcium channel blocker plus a nitrate should be tried. If this combination fails to control anginal attacks, CABG may be indicated. Table 5. Effects of nitrates, beta-blockers and calcium channel blockers on determinants of cardiac oxygen supply and demand Determinant Nitrates . . .
. . .  sedentary patients should get aerobic exercise, and patients with hypertension or hyperlipidemia should receive appropriate therapy. VARIANT ANGINA PECTORIS Treatment of vasospastic angina can proceed in three steps. For initial therapy, either a calcium channel blocker or a nitrate is selected. If either drug alone is inadequate, then combined therapy with a calcium channel blocker plus a nitrate should be tried. If this combination fails to control anginal attacks, CABG may be indicated. Table 5. Effects of nitrates, beta-blockers and calcium channel blockers on determinants of cardiac oxygen supply and demand Determinant Nitrates Beta-blockers Calcium Blockers . . .
. . .  appropriate therapy. VARIANT ANGINA PECTORIS Treatment of vasospastic angina can proceed in three steps. For initial therapy, either a calcium channel blocker or a nitrate is selected. If either drug alone is inadequate, then combined therapy with a calcium channel blocker plus a nitrate should be tried. If this combination fails to control anginal attacks, CABG may be indicated. Table 5. Effects of nitrates, beta-blockers and calcium channel blockers on determinants of cardiac oxygen supply and demand Determinant Nitrates Beta-blockers Calcium Blockers Heart Rate ? ? Contractility ? ? Preload  . . .
. . .  + calcium channel blocker Step 4: CABG or PTCA At all stages, the treatment program should encourage reduction of angina risk factors: obese patients should lose weight, smokers should quit, sedentary patients should get aerobic exercise, and patients with hypertension or hyperlipidemia should receive appropriate therapy. VARIANT ANGINA PECTORIS Treatment of vasospastic angina can proceed in three steps. For initial therapy, either a calcium channel blocker or a nitrate is selected. If either drug alone is inadequate, then combined therapy with a calcium channel blocker plus a nitrate should be tried. If this combination fails to control anginal attacks, CABG may be indicated.  . . .
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