How is angina treated

How is angina treated

There are many known medicines which may prevent angina attacks and the development of such complication as myocardial infarction. Medical treatment of angina is based on two different groups of medicinal products:

1.  Medicines reducing the risk of cardiovascular disease:

    • Aspirin. Low-dose aspirin improves blood flow properties and decreases the risk of clotting. Unfortunately, aspirin has an adverse effect on gastrointestinal tract and may exacerbate ulcer disease in some patients. That is why, it is not the best option for everyone. However, treatment with aspirin is well tolerated by most patients.
    • Statins. These medicinal products help reduce the cholesterol level preventing further fat deposition in coronary arteries. If, during treatment, you notice that your blood cholesterol level is even below normal, this is the treatment effect of statins. You should not stop this treatment regimen without consulting your doctor.
    • ACE inhibitors. Treatment   with these antihypertensive drugs  allows  to slow down the progress of atherosclerosis.

2.  Medicinal products for symptomatic treatment:
These products help relieve any negative symptoms. In addition, some of them improve metabolism in the heart muscle.

    • Nitrates (nitroglycerin) dilate the arteries improving  the blood flow to the heart and other parts of the body. This makes it easier for your heart to pump blood without resistance of the narrowed vessels. Nitroglycerin is available in different dosage forms: sprays and tablets that go under your tongue. Some forms act very fast and are used for immediate relief during an attack, while others have a longer effect and prevent angina attacks. The drug enters your blood and relieves the symptoms of angina within several minutes. You should consult your doctor regarding the appropriate method of administration.
    • Beta-blockers. These medicines  protect  the heart from excess loads, reducing its sensitivity to stress hormones, such as epinephrine and norepinephrine. Beta-blockers control the heart rate reducing the risk of oxygen starvation. They are contraindicated in patients with asthma.
    • Calcium channel blockers. These medicinal products relax the coronary arteries and other blood vessels and reduce the force of the heartbeat. This type of medicines is often prescribed for patients intolerant to beta- blockers.
    • Sinus rhythm inhibitor. This medicinal product relieves angina attacks by reducing the heart rate and restoring the balance between oxygen supply and demand without affecting other parameters, such as blood pressure.
    • Metabolic drugs. These include drugs with various mechanisms of action, which preserve or alter cell energy metabolism increasing cell resistance to oxygen starvation, thus helping the heart to work more efficiently.

If the symptoms cannot be relieved by medical treatment or you angina becomes unstable, you cardiologist will recommend you to have coronary angiography (X-ray scan of coronary arteries). This is an invasive test where a dye visible in X-rays is injected into your coronary arteries to see if they are narrowed or blocked. You doctor will choose the most appropriate revascularization method considering the number, severity and location of stenosis. Revascularization aims at restoring healthy (adequate) circulation in the heart area with narrowed arteries to relieve the symptoms of angina and prevent myocardial infarction.

There are two main revascularization techniques in angina:

1. Angioplasty (percutaneous coronary intervention  (PCI) or percutaneous transluminal coronary angioplasty (PTCA));
2. Coronary artery bypass graft (CABG).

1.  Angioplasty (PCI or PTCA) is an invasive (interventional) procedure to expand blood vessels. It is widely used in patients with minor blockages of one or two coronary arteries. During angioplasty, a vascular surgeon inserts a catheter (a thin tube) into the radial artery of the arm or the femoral artery of the leg and threads it through your vessels until it reaches the heart.

A special dye enters blood through a catheter visualizing the coronary arteries, and the entire process can be seen on the monitor screen. The doctor may wake you up during the procedure, and you may talk to him/her while he/she is working. As soon as the catheter reaches a blocked coronary artery, the vascular surgeon removes the blockage or flattens it inside the artery using different techniques. These techniques include:

    • Balloon angioplasty, where a tiny balloon is attached to the catheter tip. When the catheter reaches the blockage site, the balloon is inflated, the plaque flattens against the artery walls, and the coronary artery opens. This procedure is followed by stenting.
    • Stenting is a more recent technique used to keep the coronary arteries open. A small expandable tube made of metal mesh is placed around the catheter in the newly-opened area of the artery to keep it from narrowing again.

These two techniques are used together. After these procedures, you will be prescribed medicines to make you blood thinner and prevent clot formation at the site where the stent was placed. These medicinal products also increase the risk of bleeding; therefore, if you notice bruises on your skin after minor injuries, you should contact your doctor

Angioplasty (PCI or PTCA)

2.  Coronary artery bypass graft surgery (CABG)
is a procedure  in which a part of blood vessel (usually from the patient’s leg) is “grafted” to the heart to create a “bypass”  around the narrowing of a coronary artery. Just like angioplasty, this procedure improves blood flow to the heart significantly reducing the risk of myocardial infarction.  The CABG technique  is normally used when all three main coronary arteries are blocked (the so- called triple vessel disease), when there is a significant  blockage of the left main coronary artery, or when the blockage is diffuse and not amenable to angioplasty. Bypass surgery is a more aggressive technique compared to angioplasty: it is an open-heart surgery performed by a cardiac surgeon under general anesthesia (i.e., you will be unconscious).

Today, bypass surgery is a widely used technique; however, there are still some risks both directly associated with the surgical procedure and related to the patient’s general health. You cardiologist can explain possible risks and benefits in each particular case.