Stable angina
ICD-10 I20.8 · ICD-11 BA40.1

Treatment of Stable Angina in Vasospastic Angina

Vasospastic angina — also referred to as variant angina — is a distinct presentation of stable angina characterised by coronary artery spasm. Because the underlying mechanism differs from obstructive coronary disease, the treatment approach is specifically tailored to address spasm.

Clinical scenario: Stable angina occurring in the setting of vasospastic (variant) angina with episodic coronary artery spasm.

Treatment approach: First-line management centres on a particular class of calcium channel blocker. Additional agents targeting coronary artery spasm form part of the evidence-based regimen — the complete combination strategy and sequencing are in the full protocol.

Clinical goal: Control and relief of angina symptoms.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/eurheartj/ehae177

The schematic shows useful combinations (green lines), combinations that are not recommended (red lines), possible combinations (solid blue lines), and drugs with similar effects (blue dashed lines), which can be combined in selected indications: HFrEF (ivabradine and beta-blocker), atrial fibrillation (diltiazem/verapamil and beta-blocker), vasospastic angina (dihydropyridine CCB and nitrates).

Consideration for initial therapy: ivabradine, nicorandil, long-acting nitrates, ranolazine, or trimetazidine for patients with intolerance or contraindications to beta-blockers and/or CCBs; ranolazine and trimetazidine for patients with microvascular angina; nicorandil or nitrates for patients with coronary artery spasm.

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