Treatment

Treatment for angina includes lifestyle changes, medicine, special procedures, and cardiac rehabilitation. The main goals of treatment are to:

• Reduce the frequency and severity of symptoms
• Prevent or lower the risk of heart attack and death

Lifestyle changes and medicine may be the only treatments needed if your symptoms are mild and are not getting worse. Unstable angina is an emergency condition that requires treatment in the hospital.

Lifestyle Changes

The first thing that you need to do is change your living habits to avoid bringing on an episode of angina.

• Slow down or take rest breaks, if angina comes on with exertion.
• Avoid large meals and rich foods that leave you feeling stuffed, if angina comes on after a heavy meal.
• Try to avoid situations that make you upset or stressed, if angina comes on with stress. Learn techniques to handle stress that can't be avoided.

You can also make other lifestyle changes, for example:

• Eat a healthy diet to prevent or reduce high blood pressure, high blood cholesterol, and obesity
• Quit smoking, If you smoke
• Be physically active, as directed by your doctor
• Lose weight, if you are overweight or obese.
• Follow your doctor's orders and take all medicines as directed, especially if you have diabetes

Medications

Nitrates are the most commonly used medicines to treat angina. Fast-acting preparations are taken when angina occurs or is expected to occur. Nitrates relax and widen blood vessels, allowing more blood to flow to the heart while reducing its workload.

You can use nitrates in different forms to:

• Relieve an episode that is occurring by using the medicine when the pain begins
• Prevent an episode from occurring by using the medicine just before pain or discomfort is expected to occur
• Reduce the number of episodes that occur by using the medicine regularly on a long-term basis

Nitroglycerin is the most commonly used nitrate for angina. Nitroglycerin that dissolves under your tongue or between your cheeks and gum is used to relieve an angina episode. Nitroglycerin in the form of pills and skin patches is used to prevent attacks of angina. These forms of nitroglycerin act too slowly to relieve pain during an angina attack.

Other medicines can be used to treat angina:

• Beta blockers slow the heart rate and lower blood pressure. They can delay or prevent the onset of angina.
• Calcium channel blockers relax blood vessels so that more blood flows to the heart, reducing pain from angina. Calcium channel blockers also lower blood pressure.
• ACE (angiotensin-converting enzyme) inhibitors lower blood pressure and reduce the strain on the heart. They also reduce the risk of a future heart attack and heart failure.

People who have angina may also use:

• Medicines to lower cholesterol levels.
• Medicines to lower high blood pressure.
• Oral antiplatelet medicines (such as aspirin and clopidigrel), taken daily, to stop platelets from clumping together to form blood clots. Platelets are small blood cells that circulate through your blood vessels and help stop bleeding by sticking together to seal small cuts or breaks in tiny blood vessels. Antiplatelet medicines may not be appropriate for some people because they increase the risk of bleeding. Discuss the benefits and risks with your doctor before starting therapy with aspirin or the other antiplatelet medicines.
• Glycoprotein IIb-IIIa inhibitors are potent antiplatelet medicines that prevent clots from forming in your arteries. They are given intravenously in hospitals for the treatment of angina or during and after angioplasty.
• Anticoagulants to prevent clots from forming in your arteries and blocking blood flow.

Special Procedures

When medicines and other treatments do not control angina, special (invasive) procedures may be needed. Two commonly used procedures are:

• Angioplasty. This procedure opens blocked or narrowed coronary arteries. It can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack. Sometimes a stent is placed in the artery to keep it propped open after the procedure.
• Coronary artery bypass surgery. This procedure uses arteries or veins from other areas in your body to bypass your blocked coronary arteries. Bypass surgery improves blood flow to your heart, relieves chest pain, and can prevent a heart attack.

Cardiac Rehabilitation

Your doctor may prescribe cardiac rehabilitation (rehab) for angina or after bypass surgery, angioplasty, or a heart attack.

The cardiac rehab team may include:

• Doctors
  • Your family doctor
  • A heart specialist
  • A surgeon
• Nurses
• Exercise specialists
• Physical therapists and occupational therapists
• Dietitians
• Psychologists or other behavior therapists

Rehab has two parts:

• Exercise training. This helps you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your exercise plan will be based on your individual ability, needs, and interests.
• Education, counseling, and training. This helps you understand your heart condition and find ways to reduce your risk of future heart problems. The cardiac rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and to deal with your fears about the future.

Reference:

National Heart, Lung, and Blood Institute, USA.