Treatment and Prevention
There are three complementary approaches to treating angina. One is to reduce angina pain with medications. Another is to treat the narrowed arteries with operations such as coronary artery bypass graft surgery or angioplasty/stenting. The third is to eliminate the risk factors that are causing coronary artery disease, of which angina is a symptom.
Several types of medications are available for managing angina: beta-blockers, nitrates, calcium channel blockers and antiplatelet medications.
- Beta-blockers and some calcium channel blockers reduce the demands put on the heart by decreasing the heart rate and by lowering the blood pressure.
- Nitrates, such as nitroglycerin*, help to open the coronary arteries which then supply more blood to the heart. A tablet or spray of fast-acting nitroglycerin, also called sublingual nitroglycerin, can be placed under the tongue to provide rapid relief of angina pain. Longer-acting nitrates can be given in tablet form from one to three times a day to help control and prevent angina attacks. Nitroglycerin is also available in patches and ointment that can be applied to the skin for continuous control. With longer-acting nitrates, most physicians advise an 8- to 12-hour period where no nitrates are used or taken, as continuous use causes the nitrates to be less effective at the same dose.
- Antiplatelet medications such as aspirin or clopidogrel are given as blood thinners to prevent blood clots from forming and blocking the coronary arteries.
In addition to these medications, cholesterol-lowering medication may also be recommended for people with angina. A family of cholesterol-lowering medications, referred to as "statins", has been shown to best reduce the occurrence of heart attacks in people with angina even if their cholesterol profile is normal. Similarly, a group of blood pressure-lowering medications, the ACE-inhibitors, has also been shown to reduce the risk of heart attacks in people with angina, even if their blood pressure is normal.
Sometimes, narrowed arteries can be fixed with invasive procedures such as angioplasty (stenting) or bypass surgery. The artery may be opened with angioplasty, a procedure which can directly open the narrowing by inflating a tiny balloon under high pressure. After the balloon is deflated and removed, a metal mesh called a stent is usually left in place to prevent the widened artery from narrowing again. Bypass surgery improves blood flow to the heart by removing blood vessels from elsewhere in the body (usually leg veins or arteries from the inside of the chest) and attaching them to the narrowed coronary arteries. However, angioplasty and bypass surgery do not get rid of the plaques entirely. If the risk factors which caused the plaques in the first place are not eliminated, the arteries may clog up again. People with coronary artery disease should quit smoking, drink alcohol in moderation, maintain a low salt intake, and control high blood pressure with lifestyle modifications and medications.
Exercise fitness can go a long way in treating angina. Angina can discourage exercise because it's painful, but this is the wrong response to the problem. Exercise can encourage the growth of new blood vessels to compensate for existing blockages. Some people whose angina didn't improve with medications and even bypass operations have become pain-free after a sensible exercise program.
People with angina should begin an exercise program only under medical supervision. It's important to start slowly, especially if someone has previously had unstable angina or a heart attack. Exercise has additional benefits to relieving the pain of angina - it will also reduce the risk of heart attacks and strokes.
*All medications have both common (generic) and brand names. The brand name
is what a specific manufacturer calls the product (e.g., Tylenol®).
The common name is the medical name for the medication (e.g., acetaminophen).
A medication may have many brand names, but only one common name. This article
lists medications by their common names. For more information on brand names,
speak with your doctor or pharmacist.