|How Is Angina Treated?
Once an angina diagnosis has been made, the doctor will need to confirm the type of angina present because this will influence the sort of treatment offered. Stable angina (where symptoms have been predictable for at least 3 months) is usually treated with medications and lifestyle changes. Unstable angina (where symptoms have become erratic) signifies a serious worsening of the condition and indicates a heart attack could be imminent. It may need treating with immediate surgery to widen blocked arteries before blood supply to the heart is completely stopped. Non-emergency surgical intervention (in other words, planned elective surgery) may also be considered for patients with stable angina whose symptoms are not completely relieved by medications alone.
How Is Stable Angina Treated?
The aim of treatment is twofold:
1. To stop or minimize symptoms and thus improve quality of life.
2. To prevent further worsening of coronary heart disease (the underlying cause of the condition).
To do this, management options include treatment with drugs, lifestyle advice (see natural treatment for angina) and in severe cases, surgical intervention. Most people will initially be treated with one or two anti-anginal drugs which act both as a method of reducing symptoms and for prevention of coronary heart disease. If symptoms are not satisfactorily controlled by medications, then heart bypass surgery or coronary angioplasty may be recommended. At all times your doctor should provide balanced information about your condition and treatment options. Your doctor should:
1. Clearly explain the causes of angina (including exertion, eating a heavy meal, emotional stress and exposure to cold); the risk factors for angina (including smoking) and how it is likely to develop or be managed.
2. Encourage you to ask questions about the condition and voice any fears you may have about heart attack risk factors and life expectancy.
3. Explain which symptoms of angina require immediate medical attention.
4. Assess your need for lifestyle advice (weight loss, exercise and stopping smoking).
5. Answer any specific questions you may have about physical exertion (including sex) or the impact of depression or stress on angina.
6. At no point treat the symptoms of angina differently in women than in men. Although coronary heart disease in women can present differently, it still requires the same level of care and treatment.
Anti-Anginal Drug Treatment
The main drugs used to treat angina are nitrate medications, beta blockers and calcium channel blockers. The primary aim of these drugs is to prevent angina attacks and the secondary aim is to prevent cardiovascular events such as a heart attack or stroke. The dosage of medication will differ from patient to patient, and the doctor will organize a follow-up appointment within 2 to 4 weeks of the first prescription to monitor the effectiveness of the drugs and any possible side effects. The first line of treatment for stable angina is usually calcium channel blockers or beta blockers. If these cause unwelcome side effects or fail to reduce symptoms, nitrates or a newer drug called ranolazine may be prescribed.
Beta Blockers: These cause the heart to beat more slowly and with less force which reduces blood pressure. They also help blood vessels to relax and open up improving blood flow. They are very effective for treating angina. However some people find they cause cold feet and hands, or lead to low energy levels. Some men who take the drugs report difficulties maintaining erections while those with asthma say it makes their condition worse. As there are a number of different beta blockers your doctor will know which is most suitable for your needs. He may also adjust the dosage so you experience fewer problems.
Calcium Channel Blockers: These drugs help prevent angina attacks by relaxing and widening the blood vessels and by reducing the workload of the heart (depending on which one you are prescribed).
Nitrates: Short acting nitrates are often prescribed to patients who despite taking beta or calcium blockers still experience angina attacks. They are taken before doing something that usually triggers an attack (such as exercise) or during an attack to stop symptoms. The most common form of nitrate in this instance is nitroglycerin tablets which you put under your tongue. They also come in the form of a spray which can be sprayed under the tongue. Nitroglycerines take effect very quickly, usually within 5 minutes and last between 5 to 10 minutes.
Ranolazine: This is a new medication and is usually prescribed where blockers or nitrates fail to adequately treat symptoms of chest pain. It is a slow release tablet which is taken twice a day and helps to prevent angina attacks occurring in the first place.
Preventing Coronary Heart Disease
In order to prevent a worsening of symptoms of coronary heart disease, the following medications may also be prescribed:
Aspirin: A daily dose of aspirin (called aspirin therapy) can prevent blood clots which reduces the risk of heart attacks in women and men.
Angiotensin-Converting Enzyme (ACE) Inhibitors: ACE inhibitors help prevent long term high blood pressure (hypertension).
Statins: Cholesterol drugs which help to prevent further blockages in the arteries.
Questions To Ask Your Doctor About Medications
When you receive a prescription for angina medications, ask your doctor to clarify:
1. What the medicine is.
2. How it is likely to affect your condition (the benefits)
3. If there are likely to be any side effects and what to do if there are.
4. How to take the medicine.
5. What to do if you miss a dose.
6. How long you will need to take the medication after the first prescription.
7. How to get further supplies.
If treatment with anti-anginal drugs fail to bring relief of symptoms, then surgical intervention may be considered:
Coronary Angiography: A procedure which tests for signs of coronary heart disease and blockages (atherosclerosis) in the arteries (image). This test will help to determine if surgical intervention to unblock arteries is necessary.
Coronary Angioplasty: Also known as percutaneous coronary intervention (PCI - see image), this is a medical procedure which unblocks arteries and restores blood flow to the heart. A metal stent may be placed in the area of blockage to keep the artery permanently open.
Heart Bypass Surgery: Coronary artery bypass graft (CABG - image) is a serious operation which is usually only considered if angioplasty is not appropriate. It involves grafting a piece of artery from one part of the body onto the coronary artery to permanently circumvent the blocked artery.
How Is Unstable Angina Treated?
Unstable angina is considered a medical emergency. An angiography (sometimes referred to as cardiac catheterization) is usually performed on admittance to hospital (or at chest pain clinics) to determine the extent of clots in the arteries and the immediate risk of heart attack. If risks are high the patient will be recommended either angioplasty or heart bypass. In the meantime thrombolytic therapy may also be administered which is a powerful drug that breaks up any clots in the blood. Patients may be admitted to ICU for close monitoring. Once discharged the patient will be recommended cardiac rehabilitation. If lifestyle adjustments need to be made, this will also be discussed. This includes a home cardiac exercise program for those who need to achieve a healthier weight for their height (body mass index, BMI).
How Is Prinzmetal's Angina Treated?
Typically it responds to nitrates and calcium channel blockers. Recent research shows that satins (used for treating high cholesterol) may also be beneficial in treating this condition. Beta blockers which can cause the arteries to spasm should be avoided. If you have any other queries, visit our section on womens health questions.
How Is Microvascular Angina Treated?
Also known as Cardiac Syndrome X, it is treated much in the same was as stable angina with medications and lifestyle changes.
Next: Living with Angina