3．不同类型心绞痛的药物治疗
（1)慢性稳定型心绞痛：属劳力型心绞痛；由氧耗量增加引起。运动时，血中儿茶酚胺增高，通过α受体使冠状动态收缩。所以在治疗上除考虑除低氧耗量外，应同时加用冠状动脉扩张药，以阻止狭窄的冠状动脉进一步狭窄。常用硝酸酯类、钙拮抗制，可单独或联合β阻滞剂。
（2)不稳定型心绞痛：属混合型心绞痛，增加氧耗量和自发性血管痉挛均可诱发，根据临床表现和预后分为低危组和高危组。①低危组：包括新近出现的进行性心绞痛或慢性稳定型心绞痛突然加重，但无心电图改变。这类患者预后较好，应口服多种抗心绞痛药物，硝酸酯、钙拮抗剂或（和)β阻滞剂，并用阿司匹林。预防休息时心绞痛复发，可给硝酸甘油长效制剂或经皮肤吸收的贴剂。②高危组：包括静息心绞痛伴有或原有ST段改变。剧烈心绞痛持续时间较长的中间型急性冠状动脉缺血综合征，其预后差，心肌梗死发生率和病死率高，应入院积极治疗。仅用钙拮抗剂是不够的，可加用静脉滴注硝酸甘油和肝素，有主张用阿司匹林100～150mg/d，加用肝素钙皮下给药7500IU，每12h一次。有人报告用氨酰心安和肝素静脉用药治疗不稳型心绞痛，心肌梗死发生率和病死率显著降低。
（3)变异型心绞痛：血管痉挛型心绞痛，钙拮抗剂疗效好。多中心研究硝苯吡啶或硫氮
酮较维拉帕米疗效佳。硝酸酯与钙拮抗剂合用比分别单用疗效好。理论上β阻滞剂抑制β受体后，α受体兴奋性加强，可使冠状动脉进一步收缩，因此可加重变异型心绞痛的发作，有时α受体阻滞对变异型心绞痛有效。
有些冠状动脉痉挛患者，舌下含硝酸甘油或静脉用硝酸甘油不能缓解，多见于冠状动脉造影时导管刺激或激发试验引起。可经导管将小剂量硝酸甘油（25～200μg)直接注入痉挛的冠状动脉内。
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