What’s the best treatment for your angina?

Blocked heart arteries are causing your chest pain (angina), keeping an area of your heart from getting enough oxygen. Your doctor says you need to treat the blockages to avoid a heart attack and other complications.

There are several options for treating angina, which might depend on the type of angina you have. How do you choose? Here’s information to help.

Types of angina

Angina is pain, discomfort or pressure in the chest. The most common types are chronic stable angina and unstable angina.

• Chronic stable angina. Chest pain occurs when your heart is working hard enough to need more oxygen, such as during exercise. The pain can go away when you rest. The pattern of pain — how long it lasts, how often it occurs, what triggers it, and how it responds to rest or treatment — remains stable for at least two months.

• Unstable angina. This is either new chest pain or a change in your usual pattern of chest pain, whether it’s worsening, lasting longer, or not being relieved by rest or medication.

  Unstable angina is dangerous and a warning sign of a heart attack. If your angina is unstable, seek urgent medical care.

Other types of angina include variant or Prinzmetal’s angina — a rare type caused by a spasm in the coronary arteries — and microvascular angina, which can be a symptom of disease in the small coronary artery blood vessels.

Treatment options

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Coronary artery stent

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Coronary artery stent

Coronary artery stent

When placing a coronary artery stent, your doctor will find a blockage in your heart’s arteries (A) using cardiac catheterization techniques. A balloon on the tip of the catheter is inflated to widen the blocked artery, and a metal mesh stent is placed (B). After the stent is placed, the artery is held open by the stent, which allows blood to flow through the previously blocked artery (C).

The best treatment for your angina depends on the type of angina you have and other factors. If your angina is stable, you might be able to control it with lifestyle changes and medicines. Unstable angina requires immediate treatment in a hospital, which could involve medicines and surgical procedures.

Medications

Several medications can improve angina symptoms, including:

• Aspirin. Aspirin and other anti-platelet medications reduce the ability of your blood to clot, making it easier for blood to flow through narrowed heart arteries.
• Nitrates. Often used to treat angina, nitrates relax and widen your blood vessels, allowing more blood to flow to your heart muscle. Nitrates in pills or sprays act quickly to relieve pain during an event. There are also long-acting nitrate pills and skin patches.
• Beta blockers. These block the effects of the hormone epinephrine, also known as adrenaline. They help your heart beat more slowly and with less force, decreasing the effort your heart makes and easing the angina pain.
• Statins. Statins lower blood cholesterol by blocking a substance your body needs to make cholesterol. They might also help your body reabsorb cholesterol that has accumulated in the buildup of fats (plaques) in your artery walls, helping prevent further blockage in your blood vessels.
• Calcium channel blockers. Also called calcium antagonists, these drugs relax and widen blood vessels by affecting the muscle cells in the arterial walls. This increases blood flow in your heart, reducing or preventing angina.
• Ranolazine (Ranexa). This anti-angina medication might be prescribed with other angina medications, such as beta blockers. It can also be used as a substitute if your symptoms don’t improve with the other medications.

Procedures

Angioplasty and stent placement

Angioplasty, also known as percutaneous coronary intervention, increases blood flow through a blocked artery and decreases angina.

During an angioplasty (AN-jee-o-plas-tee), your doctor threads a tiny, deflated balloon attached to special tubing up through an artery, generally in your groin, to your narrowed coronary artery. Your doctor inflates the balloon to widen the artery. He or she might then insert a small metal tube (stent) to keep the artery open.

This procedure can take 30 minutes to several hours, and you’ll probably remain in the hospital at least overnight. You can generally return to work or your normal routine soon after the angioplasty and stent procedure.

Angioplasty and stenting involve some risks, including a risk of the blockage re-forming. A stent coated with medication can help prevent this.

Enhanced external counterpulsation (EECP) therapy

EECP therapy might be recommended for some people whose angina doesn’t improve with other treatments. For this therapy, large cuffs are wrapped around your legs. Air pressure causes the cuffs to inflate and deflate in time to your heartbeat. This typically requires getting five one-hour treatments a week for seven weeks.

Lifestyle changes

Regardless of which angina treatment you choose, your doctor will recommend that you make heart-healthy lifestyle changes.

You can reduce or prevent angina by reducing your heart disease risks factors, including:

• Smoking. If you smoke, stop. If you need help quitting, talk to your doctor about smoking cessation therapies.
• Poor diet. Eat a healthy diet with limited amounts of saturated fat, trans fat, salt and sugar. Include a variety of fruits and vegetables, whole grains, lean meats, and low-fat dairy products in your diet.
• Lack of physical activity. Talk to your doctor about starting a safe exercise plan. If your angina is brought on by exertion, pace yourself and take rest breaks.
• Excess weight. If you’re overweight, find a way to achieve and maintain a healthy weight by balancing what and how much you eat with how much physical activity you get. Ask your doctor what a healthy weight is for you.
• Medical conditions. Get treatment for conditions that can increase your risk of angina, such as diabetes, high blood pressure and high blood cholesterol.
• Stress. Avoiding stress is easier said than done, but try to find ways to relax. Talk with your doctor about stress-reduction techniques.

How to choose

You and your doctor will discuss the pros and cons of each treatment to determine what might work best for you. For most people, first steps include medications and lifestyle changes. If those don’t work for you, angioplasty and stenting can be another option.

Talk to your doctor if you think your treatment isn’t controlling your angina well enough.