heart and blood vessel disorders
Angina
Treatment of Angina
Lifestyle changes Drug therapy Sometimes treatment to open clogged blood vessels (revascularization therapy) Treatment begins with attempts to slow or reverse the progression of coronary artery disease by dealing with risk factors. Risk factors, such as high blood pressure and high cholesterol levels, are treated promptly. Smoking Cessation is crucial. A low-fat, varied diet that is low in simple sugar carbohydrates and exercise (for most people) are recommended. Weight loss, if needed, is also recommended. Treatment of angina depends partly on the stability and severity of the symptoms. When symptoms are stable and mild to moderate, the most effective treatment may be modification of risk factors and the use of certain drugs. If modification of risk factors and drug therapy do not cause symptoms to subside markedly, a procedure to restore blood flow to affected areas of the heart (a revascularization procedure) may be needed. When symptoms worsen rapidly, immediate hospitalization is usually required and the person is evaluated for an Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) . Doctors use several types of drugs for people with angina. Different drugs are used to help Resolve an attack of angina (nitrates) Prevent angina from occurring (beta-blockers, calcium channel blockers, sometimes other drugs, such asranolazineorivabradine) Prevent and reverse coronary artery blockage (angiotensin-converting enzyme [ACE] inhibitors,angiotensin IIreceptor blockers, statins, and antiplatelet drugs) Nitrates are a type of drug that dilates (widens) blood vessels and thus increase blood flow through that vessel. Nitroglycerinis a very short-acting nitrate drug. Takingnitroglycerinusually relieves an episode of angina in 1 1/2 to 3 minutes, and the effects last 30 minutes.Nitroglycerinis usually taken as a tablet placed under the tongue (sublingual administration) or as a spray inhaled through the mouth. Alternatively, the tablet may be placed next to the gum. People with chronic stable angina should keepnitroglycerintablets or spray with them at all times. Takingnitroglycerinjust before reaching a level of exertion known to induce angina may be useful. Long-acting nitrates(such as isosorbide) are taken by mouth 1 to 4 times a day. Nitrate skin patches and, less often, a paste, in which the drug is absorbed through the skin over many hours, are also effective. Long-acting nitrates taken regularly can soon lose their ability to provide relief. Most experts recommend that people not take the drug for an 8- to 12-hour period each day, usually at night unless that is when angina occurs. This approach helps maintain the long-term effectiveness of the drug. Unlike beta-blockers, nitrates do not reduce the risk of heart attacks and sudden death, but they greatly reduce symptoms in people with coronary artery disease. Beta-blockers interfere with the effects of the hormonesepinephrine(adrenaline) andnorepinephrine(noradrenaline) on the heart and other organs. These hormones stimulate the heart to beat faster and more forcefully and cause most arterioles to constrict (causing blood pressure to increase). Thus, beta-blockers reduce the resting heart rate and blood pressure. During exercise, they limit the increase in heart rate and in blood pressure and so reduce the demand for oxygen and decrease the likelihood of angina. Beta-blockers also reduce the risk of heart attacks and sudden death, improving the long-term outcome for people with coronary artery disease. Calcium channel blockers prevent blood vessels from narrowing (constricting) and can counter coronary artery spasm. In addition to treatment of stable angina, these drugs are also effective in treating variant angina. All calcium channel blockers reduce blood pressure. Some of these drugs, such asverapamilanddiltiazem, may also reduce the heart rate. Reducing blood pressure and heart rate reduces the demand for oxygen and decreases the likelihood of angina. This effect can be useful to many people, especially those who cannot take beta-blockers or who do not get enough relief from nitrates. Angiotensin-converting enzyme (ACE) inhibitors andangiotensin IIreceptor blockers (ARBs) are often given to people who have evidence of coronary artery disease, including angina. These drugs do not treat angina itself, but they can reduce blood pressure (and so reduce the work the heart has to do to pump blood) and also they reduce the risk of heart attack and of death due to coronary artery disease. Treatment are drugs that lower blood levels of LDL cholesterol, the type of cholesterol that can cause coronary artery disease. These drugs reduce the chance of heart attack, stroke, and death. Antiplatelet drugs, such asaspirin,ticlopidine,clopidogrel,prasugrelorticagrelor, modify platelets so that they do not clump and stick on blood vessel walls. Platelets, which circulate in the blood, promote clot formation (thrombosis) when a blood vessel is injured. However, when platelets collect on atheromas in an artery’s walls, the resulting clot can narrow or block the artery and result in a heart attack. Aspirinmodifies platelets irreversibly and reduces the risk of death from coronary artery disease. Doctors recommend that most people who have coronary artery disease takeaspirindaily to reduce the risk of a heart attack.Prasugrel,ticlopidine,clopidogrel, andticagreloralso further modify platelets. One of these drugs may be used in addition toaspirinfor a period of time after a heart attack or PCI to reduce the chances of a future heart attack. An antiplatelet drug is usually given to people with angina unless there is a reason not to. For example, they are not given to people who have a bleeding disorder. More information on the specific drugs for coronary artery disease can be found elsewhere in THE MANUAL (see table). People who continue to have angina despite use of preventive drugs sometimes benefit from procedures that open up or replace (bypass) the coronary arteries. These procedures are termed revascularization and include Percutaneous coronary intervention (PCI) procedures (also called angioplasty) Coronary artery bypass grafting (CABG) These invasive techniques are effective, but they are only mechanical measures for correcting the immediate problem. They do not stop the progression of the underlying disease. People still need to modify risk factors. Percutaneous Coronary Intervention None Coronary Artery Bypass Grafting None 