Angina

Treatment


Staying active, not smoking, and adopting healthy eating habits are important ways to manage stable angina. Your health care professional may also prescribe medicine to help. Some of the medications help reduce the risk factors that lead to angina and coronary artery disease, while others help manage the symptoms. 

Your health care professional will help you find the best combination of medications and treatments to manage your condition. 

What medications are used to manage angina symptoms?

Beta blockers help ease the work the heart has to do by slowing down your heart rate and lowering your blood pressure. If you have had a heart attack, these medications will help prevent another one and help you live longer. 

Nitroglycerin increases the blood flow to the heart by opening up, or dilating, the blood vessels in the body. This allows blood to flow to the heart muscle more easily when coronary arteries are narrowed. It also decreases the workload on the heart to supply blood to the body. 

Calcium channel blockers, like beta blockers, help ease the work the heart has to do by slowing down your heart rate and lowering your blood pressure. Not all medications of this type will slow down heart rate as well as others, but they are all useful for reducing high blood pressure. 

Ranolazine works directly at the heart to help it relax better. It helps to slow down the heart muscle so that it does not have to work as hard. Unlike other medications used in angina, it is able to do this without changing your blood pressure or your heart rate.

What other interventions can help?

Angioplasty and Bypass Surgery

Opening up narrowed coronary arteries to restore blood flow to the area of the heart muscles that is not getting enough can relieve the symptoms of angina. There are two main ways to restore blood flow to the heart:

  • Angioplasty, also called percutaneous coronary intervention (PCI), with a stent or a balloon procedure
  • Coronary artery bypass graft (CABG) surgery, or open heart surgery 

These treatments can significantly improve quality of life for patients with advanced coronary artery disease. The treatment recommended by your health care professional will depend on your symptoms and preferences, the number and locations of narrowed arteries, your age, overall health, and other risk factors. You should discuss these options with your cardiologist.

Cardiac Rehab

Cardiac rehabilitation is typically a 12-week, medically supervised program. It includes counseling on exercise, nutrition, stress management and smoking cessation. It also educates individuals about how to take better control of your health.  Cardiac rehab can decrease angina, reduce heart risk factors and improve quality of life.

Enhanced External Counterpulsation Therapy 

Enhanced external counterpulsation (EECP) therapy may be recommended in some patients if you have angina that limits you from your daily activities and that has not improved with standard treatments.  

During EECP, inflatable cuffs (similar to blood pressure cuffs) are placed on the calves, thighs and buttocks.  The cuffs inflate and deflate in rhythm with your heart, improving blood flow to the heart.  EECP may generate the formation of new small blood vessels in the heart to create a natural bypass around blocked or narrowed arteries. EECP may increase exercise duration and decrease angina. 

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Published: August 2017
Editorial Team Lead: Susan A. Matulevicius, MD, FACC
Medical Contributors and Reviewers: Ashish Aneja, MBBS, FACC; Nkechinyere Ijioma, MBBS, FACC; Antoine T. Jenkins, PHARMD; Nisha Jhalani, MD, FACC; Ion S. Jovin, MD, FACC; Ajay J. Kirtane, MD, FACC; Dorothy L. Murphy, NP, AACC

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