Angina And Its Treatment

Angina is a pain that comes from the heart usually as a result of narrowing of the coronary arteries and as a result the heart muscle does not get as much blood and oxygen supply as needed. The pain of angina is described as an uncomfortable pressure, discomfort and squeezing in the center of the chest. Sometimes the pain may be felt in the arm, neck, jaw or shoulder. A number of medications and treatment options are available for managing angina.

Non-Pharmacological Treatment:

• If the patient smokes it is important to make every possible effort to stop him smoking.
• The blood pressure should be checked regularly and if high should be manged accordingly.
• If the patient is over weight , loosing weight is advised.
• Avoid inactivity and the aim should be a moderate physical activity on most of the days of the week for at least 30 minutes daily.
• If blood cholesterol is high it should be treated
• The patient should eat a healthy diet and avoid fatty foods.
• Avoid drinking alcohol.
• Avoid taking large heavy meals that may trigger an attack of angina.
• Patients are advised to slow down or take rest if physical activity triggers an attack of angina.
• Some patients may get an angina due to a emotional stress so try to avoid the situations that causes stress.

Pharmacological Treatment:

1. Nitrates: are the most common drugs used for the angina treatment. Among the nitrates Nitroglycerin is the most commonly used medicine. Nitrates act by relaxing and dilating the blood vessels. This allows more blood to flow to the heart and also decreases the work load of the heart. Nitroglycerin or glyceryl trinitrate medicine comes in the form of a tablet or a spray and the dose is given under the tongue when the pain of angina develops. The medicine is absorbed quickly into the blood stream and acts within minutes to relieve the pain. The patients with a history of angina or those who are at risk are advised to carry the medicine with them all the time and use it as soon as needed. The most common side effect with this drug is a headache which usually improves with continued use.

2. Beta Blockers: slow the heart rate and decreases the work load of the heart and so there is decreased oxygen requirement by the myocardium. They also improve the blood flow through the myocardial blood vessels by reducing the frequency of ventricular contractions. There is a good evidence that beta 1 selective drugs are better tolerated with lesser side effects. patients who are given beta blockers it is important to review the associated conditions and balance the benefits against the risk factors and the side effect of the medicine.

3. Calcium channel blockers: commonly used drugs in this group are nifedipine, amlodipine and felodipine which act by relaxation of the vascular smooth muscles. while other drugs in this group veramapil and diltiazem act primarily on the cardiac smooth muscle and the conducting tissue.

4. Aspirin: or other anti coagulants act by reducing the ability of blood to clot and so improves the blood flow through the narrowed arteries of the heart.

5. Statins: are the drugs that are used to lower the blood cholesterol and thus help prevents blockage of the blood vessels.

6. ACE inhibitors: help relax the blood vessels thus controls the blood pressure and the work load on the heart.

Surgical treatment:
Sometimes if the patient is at a very high risk of a heart attack or the symptoms of angina cannot be controled by lifestyle modification and medications,surgical intervention may be needed.

1. Coronary artery Bypass grafting: is done by removing the effected portion of the coronary artery and replacing it with a suitable graft. In selected groups of patients this procedure is highly effective and helps in relieving the symptoms as well as reduces the risk of death.

2. Percutaneous transluminal coronary angioplasty: involves passing a catheter to the point of the blockage in the coronary artery and then physically stretching the vessel by inflating a small balloon at the tip of the catheter.