Management of angina pectoris. Modern concepts.

While William Heberden gave us an excellent clinical description of angina pectoris more than 200 years ago, the understanding and management of this disorder have undergone major development since then, and especially so in recent years. The pathological basis for the disease was established shortly after Heberden's account. The concept of the imbalance between supply and demand was postulated in the nineteenth century. Recent progress has been made in mainly three areas: the better definition of prognosis, new insights into pathophysiology, and newer management modalities and aims. Today, the combination of the patient's functional state (exercise test), his heart (ventricular function) and coronary anatomy (angiography) enables us to accurately define the prognosis of the disease. Sophisticated studies have now demonstrated that during an exercise-induced angina attack there is a reduction in coronary blood flow and an increase in coronary resistance. Mechanisms associated with the angina attack involve the sclerotic epicardial arteries and the microcirculation. Further major advances in the medical management of angina pectoris now depend on our ability to improve prognosis and retard the development of the atherosclerotic process.