Treatments for Angina

Drug treatment of angina

Anti-platelet drugs

There are two anti-platelet drugs of which aspirin is the most common.

• Aspirin:  Aspirin thins the blood making it less likely to form clots, reducing the risk of heart attack or stroke.  It occasionally upsets the stomach so take your tablet with or after meals.

• Clopidogrel:  Clopidogrel also thins the blood and may be prescribed if you are allergic to aspirin.  It may also be given along with aspirin for short periods especially after an angioplasty. 
  

Beta-blockers:  Beta-blockers reduce the work the heart has to do by slowing down the heart rate and lowering the blood pressure.  They also help prevent future heart attacks and reduce the frequency of angina.  They may not be suitable for you if you have asthma or other lung conditions.

Calcium channel blockers:  These help to relax the arteries, lowering blood pressure and reducing the work the heart has to do.  Sometimes they are used for people who are not able to take beta-blockers.

ACE inhibitors:  These also help to relax the arteries lowering blood pressure and reducing the work the heart has to do.  They are also known to act preventatively in reducing the risk of heart attacks and stroke in people who have coronary heart disease.  They can cause an annoying cough.

Angiotensin II inhibitors:  These are sometimes used when ACE inhibitors are not suitable.

Cholesterol lowering drugs:  Even if your cholesterol is not especially high your doctor may prescribe cholesterol lowering tablets as they reduce your risk of a heart attack.  These drugs are usually taken at night.  They can sometimes cause muscle pains which if they occur, should be reported to the doctor.

Nitrates:  Nitrates work by widening (dilating) the blood vessels and therefore reduces the work of the heart.  Nitrates come in a number of forms:

GTN spray can be taken under the tongue to relieve the symptoms of angina or to prevent the pain from coming on e.g. before climbing a hill.  GTN also comes in tablet form.  For more information visit "How to take your GTN"

• Nitrate Tablets (e.g. Isosorbide Mononitrate or Isosorbide Dinitrate):  Taken on a regular basis they reduce the number of angina attacks and improve your ability to take exercise. Nitrates should be taken at the times prescribed for them to work effectively.

Nitrate Patches:  With nitrate patches the medicine is absorbed through the skin by direct contact.  They should be applied on the chest or back and not directly over the heart.  Only one patch should be used a day, which should be removed at night unless specifically being used to combat night time angina.  You should apply the patch to a different area of skin every time and should not apply the patch to inflamed or cracked skin as the medicine can be absorbed too rapidly.

Interventions

It should be remembered that the purpose of interventions is to relieve the symptoms of angina. They will not cure angina or the cause of it.  So it is important to remember that drug treatment and working on reducing risk factors will still be necessary to prevent symptoms recurring.

Angioplasty or Percutaneous Coronary Intervention (PCI)

PCI involves stretching narrowed areas of coronary arteries to improve the blood flow.  It is performed in a similar way to an angiogram using a local anesthetic, then stretching the narrowed coronary artery with a tiny balloon which is at the tip of the catheter.

In the majority of cases a metal stent will also be placed in the artery.  A stent is a cylinder of metal mesh which acts like a scaffold to keep the artery open and prevents the narrowing coming back.  The artery heals around the stent making it a permanent part of the artery.  You will not be aware that it is there. 

Sometimes stents can be used which slowly release drugs directly to the narrowed area to help prevent the problem recurring.  These are called drug eluting stents and are only used when the risk of re-narrowing is high.  You would normally stay in hospital for 24 hours after angioplasty.

Surgery to treat angina

Coronary Artery Bypass Graft (CABG)

This is what is commonly referred to as a ‘Bypass’.  Not everyone with angina will be suitable for surgery.  Your cardiologist will discuss the options with you.

Bypass surgery can be performed on more than one narrowed coronary artery hence ‘double’ and ‘triple’ bypass surgery.  It is carried out under a general anesthetic. 

Beating Heart Surgery

This name refers to a bypass operation that can be done while the heart is still beating.  Sometimes the wound can be smaller than usual.  There are a small number of surgeons who are doing this procedure and it is only suitable for a small number of people.  You would need to stay in hospital for 5-7 days following bypass surgery. 

Last updated: 09/09/2010