It is essential to know that angina is a treatable condition and that treatment modalities depend on both the type and the severity of the problem. They range from lifestyle modifications to emergency bypass surgeries. The main goal of treatment is to control the underlying pathology, relieve the symptoms, and prevent future cardiovascular events by controlling the risk factors, fixing the narrowing of the arteries by medications or anatomically by changing the pathology.
Lifestyle modifications may be sufficient if your condition is mild and your symptoms are minimal. However, they are always required, even in the most severe forms of angina because they modulate the main risk factors and hence, work by preventing a recurrence. They include:
♦ Weight control
The equation is actually simple: excess fat means excessive deposition of fat in your coronaries, which will aggravate their narrowing and, therefore, your condition.
♦ Smoking cessation
There has never been a more significant correlation between a disease and a risk factor than there is between heart conditions and smoking. Smoking reduces oxygen delivery, favors clot formation and raises blood pressure. Studies have found that smoking cessation alone decreased the risk of death from coronary artery disease by 61% within 5 years.
♦ Modifying your daily activity
Activities that precipitate angina should be detected thoroughly and performed slowly, on intervals, or stopped completely if needed.
♦ Physical activity
Sedentary lifestyle is a significant risk factor for angina, and physical exercise has a cardioprotective effect. Thus, increasing your daily physical activity is always good, but it is important to consult your doctor about the type of exercise you need to do because some types of training might be too strenuous to your heart in your current condition.
♦ Controlling your hypertension, diabetes, and hypercholesterolemia
Whereas diabetes increases fat deposition in your coronaries, hypertension “injures” the walls of your coronaries making them more susceptible to fat deposition and clot formation. At the same time, hypercholesterolemia increases the level of cholesterol fats in your bloodstream. Controlling these risk factors significantly improves the quality of life.
♦ Decreasing alcohol intake
Excessive alcohol aggravates angina, precipitate anginal pain attacks, and interacts with many medications typically used by these patients, such as statins, which lower your cholesterol level, and warfarin, a blood thinner that helps preventing clot formation in your blood vessels.
♦ Eating healthy food
Food rich in saturated fats and refined sugars should be avoided since they increase the level of LDL cholesterol or what we call “the bad cholesterol,” a molecule that favors cholesterol deposition in the coronaries.
As mentioned before, treatment is decided based on severity. In the case of stable angina, lifestyle changes and medications are usually sufficient to control the condition. These medications include:
• Medications used during the attack (nitrates)
These dilate the coronary arteries supplying the heart muscle and therefore, increase the blood supply to the heart, relieving the attack within minutes. You should never self-medicate with nitroglycerin or other nitrates without consulting your treating physician, especially if you are using other medications for erectile dysfunction as Sildenafil (Viagra) or Tadalafil (Cialis), or if you are liable to hypotension.
• Medications that lower blood pressure
They include ACE inhibitors and calcium channel blockers. They lower blood pressure by vasodilation (increasing the diameter of blood vessels) and the work the heart has to do to overcome such pressure, decreasing its oxygen demand and the incidence of angina. Calcium channel blockers also dilate the coronary arteries thus increasing the heart’s blood supply.
These medications decrease the heart rate and reduce the oxygen demand by the heart. They also prolong the time it takes for coronary arteries to fill, improving the blood supply to the heart.
• Medications that lower blood cholesterol
The most commonly used class is statins, such as atorvastatin and simvastatin. They decrease the formation of cholesterol in the body, decrease its absorption, and help reabsorb cholesterol that’s been already deposited in the coronaries and other blood vessels, reversing the pathology.
• Aspirin and other antiplatelets
These medications may be also prescribed by your doctor. They act by preventing your platelets from “sticking together” quickly and thus, decreasing the risk of blood clots.
Ranolazine is a relatively novel drug used either as a substitute or complementary to beta-blockers and ACE inhibitors. It reduces the heart’s need for oxygen making the diminished blood supply more tolerable, thus preventing heart attacks.
Surgical and invasive options
Invasive options are usually needed in case of stable angina which is not relieved by rest nor controlled by medications. They offer a more permanent but invasive solution to the primary pathology of angina through bypassing the narrowing. They include:
◘ Percutaneous intervention or (PCI)
PCI replaced open-heart procedures in many instances, decreasing the morbidity and mortality associated with it and improving patient’s outcome. It involves inserting a catheter, which is a thin tube-like structure, through your forearm or leg vessels. Then, the catheter goes up till reaching your coronaries at the site of narrowing. After that, the doctor will inflate a balloon to dilate the vessel. He may or may not leave a “stent.” A stent is a wire mesh-like structure that keeps the arteries open and wide to prevent the recurrence of narrowing and is usually “absorbed” into the wall of your artery. It is called “percutaneous” because it is done through a small incision over your arteries in your leg or forearm, without the need to have large incisions nor major surgeries.
◘ Coronary artery bypass surgery/graft or (CABG)
It is another option for the management of unstable angina when a PCI fails, in cases of narrowing of multiple vessels, and when there’s a significant narrowing of a primary vessel. It involves bypassing the narrowed vessel or vessels using grafts taken from elsewhere in the body, thus creating a new “route” rather than trying to widen an existing one. Most grafts are taken from vessels of your calves (saphenous veins) or your chest (internal mammary artery) and rarely, your forearm (radial artery). It is an open heart procedure that carries some risks and thus, reserved for particular cases.