Treatments for Angina

There is no cure for the chest pain known as angina. However, treatment may relieve your pain and other symptoms. It also may make you less likely to have a heart attack.

Angina occurs when your heart muscle is not getting enough oxygen-rich blood. The most common cause is narrow or blocked coronary arteries—the main arteries that carry blood to your heart. Narrowing leads to chest pain. A complete blockage of the coronary arteries can cause a heart attack.

Treatment aims to improve the flow of blood through your coronary arteries. However, treatment is not the same for everyone. You will need to work with your doctor to find the best solution for you. Options include lifestyle changes, medication, heart procedures, and cardiac rehabilitation.

Lifestyle Changes

These changes are almost always part of angina treatment. They include:

• Diet changes. Recommendations usually involve eating less solid fats, salt, and foods with added sugar. Eating more fruits, vegetables, whole grains, and healthy proteins is also important. Healthy proteins include lean meats, poultry, fish, and nuts. Eating smaller portions to maintain a healthy weight may be necessary too.

• Exercise. Being physically active helps strengthen your heart. It also helps keep you at a healthy weight. Doctors often suggest about 30 minutes of exercise at least five times a week. Work with your doctor to find an exercise program that suits you.

• Not smoking. Smoking is bad for your arteries because it can make them narrower. If you smoke, quitting is a must. Your doctor may prescribe a smoking cessation program to help you.

• Stress reduction. Emotional stress makes your heart work harder. The first step in stress reduction is figuring out what causes your stress. Then try to avoid those situations as much as you can. In reality, this is not always possible. So, it’s important to find some healthy ways to manage stress. This may include relaxation techniques like deep breathing and meditation.

Medications

The most common medicine for angina is nitroglycerin—a type of drug called a nitrate. Nitrates help relax and open coronary arteries. Nitroglycerin comes as a dissolvable tablet or as spray you put in your mouth. It works quickly to relieve chest pain. If your doctor prescribes nitroglycerin, you will take it at the first sign of angina. You should also rest and stop any activity. If angina continues for more than five minutes, call 911.

Other medicines for angina include:

• Aspirin. A daily aspirin reduces the risk of a blood clot forming in a coronary artery and blocking blood flow.

• Blood thinners. Several other types of medications, including antiplatelet medications, can make your blood less likely to clot.

• Beta blockers and calcium channel blockers. These drugs slow down your heart and lower your blood pressure. This eases angina because it reduces the amount of oxygen your heart uses.

• Long-acting nitrates. These drugs reduce the risk and frequency of angina. However, they do not act immediately, so you might take this medicine every day as a pill or a skin patch.

• Statins. These drugs lower your cholesterol. This is important because cholesterol contributes to buildup of a waxy substance—or plaque—in coronary arteries. Plaque makes arteries narrower and can break off and form a clot.

Heart Procedures

Sometimes lifestyle changes and medicine are not enough to reduce angina. If this is the case, your doctor may recommend a heart procedure. There are two common procedures that can help restore blood flow through coronary arteries:

• Angioplasty. Your doctor inserts a long, thin tube—or catheter—into an artery in your groin or arm. The doctor then advances the catheter tip to the narrow or blocked coronary artery. When the tip of the catheter reaches the coronary artery, a balloon on the end of the catheter inflates. This opens the artery so blood can flow again. Often a wire-mesh device—or stent—is left in the artery to keep it open.

• Coronary artery bypass graft (CABG). This is open-heart surgery to bypass a narrow or blocked artery. You may need this procedure if the narrowing is severe or involves a long stretch of the artery. A blood vessel from another part of your body serves as a graft. Your surgeon will use the graft to replace the blocked or narrowed segment.

Cardiac Rehabilitation and Therapy

You may have cardiac rehabilitation along with other angina treatments. It's a common follow-up to angioplasty or CABG surgery and lasts about 12 weeks. A team of healthcare providers will supervise this therapy. The team may include doctors, nurses, exercise specialists, physical therapists, nurse educators, dietitians, and mental health therapists.

Cardiac rehabilitation teaches you how to live with angina in a healthy way. Your program may include:

• Counseling on heart-healthy eating

• Learning how to exercise correctly and safely

• Learning ways to manage stress

• Smoking cessation

• Therapy for anxiety or depression

People who continue to have angina after other treatments may need a therapy called EECP (enhanced external counterpulsation). It involves placing inflatable cuffs on your legs and inflating them. This forces oxygen-rich blood back into your heart between heartbeats. Sessions last 1 to 2 hours and usually take place daily for about seven weeks.