The role of optimal medical therapy in patients with refractory angina

The management of patients with refractory angina poses a major clinical challenge. Optimal medical therapy (OMT) is of paramount importance to improving quality of life by reducing (as much as possible) the number of angina attacks with a correspondent increase in exercise tolerance. For that, a judicious use of a combination of all agents currently approved in the management of patients with stable angina should be implemented. Guidelines usually recommend a combination of hemodynamic agents, such as β-blockers, calcium-channel blockers, and/or long-acting nitrates, at maximally tolerated doses, followed by the addition (as needed) of antianginal agents with different modes of action, such as trimetazidine, ivabradine, ranolazine, nicorandil, perhexiline, allopurinol, and/or fasudil (where available). Here, we describe the case of a patient who initially received a diagnosis of refractory angina and in whom OMT greatly helped to improve symptoms. L Heart Metab. 2017;72:32-36