Medical treatment:

A wide variety of medical treatments is used to treat angina and can be used alone or in combination.

• Nitrates. Drugs such as nitroglycerine or Glyceryl trinitrate are highly effective in relieving the pain of angina. Nitrates dilate the coronary arteries, improving the blood supply to the heart muscle. They are available in tablet form or as a spray for under the tongue. Pain is usually relieved in 2-3 minutes. Nitroglycerine is also available in skin patches (transdermal patches). If you are taking glyceryl trinitrate, you should not take Viagra (sildenafil).
• Beta-blockers and calcium channel blockers.
• Aspirin. Taking low-dose aspirin daily helps prevent blood clotting and reduces the risk of heart attack.
• Statins. Help lower cholesterol if high.

Surgery:

Surgical treatment for angina may be necessary when angina is severe, progressive and not relieved by medical treatment. A coronary angiogram will show the extent and location of the blockages and will help determine which form of treatment is most suitable. Two types of surgical treatment are available - balloon angioplasty and coronary bypass graft surgery.
Coronary angioplasty (balloon angioplasty).

This procedure widens the narrowed coronary arteries. A small tube with a balloon tip (a balloon catheter) is pushed into the narrowed artery. The balloon is inflated. This expands the artery. A stent (a kind of internal splint) is usually inserted to help keep the artery open. The balloon is then deflated and removed with the tube. With stents, the risk of the artery blocking again is only 10% - 15%. Hospital stay for this procedure is usually only a few days. The results of angioplasty are excellent, but the procedure may have to be repeated.

Bypass surgery.

In coronary bypass graft surgery, blood vessels are taken from other parts of the body and attached to the coronary arteries beyond the blockage. The blood is then able to flow around, or bypass, the blockage. Bypass surgery is a major operation with a long recovery period and is carried out only in specialist centres.

How can I prevent angina or stop it getting worse?

By controlling risk factors for coronary artery disease, you may be able to prevent angina and will certainly slow the progression of coronary heart disease.

• Take your medication as prescribed by your doctor.
• Stop smoking.
• Begin a regular exercise programme under your doctor’s supervision.
• Keep to a healthy weight. Eat a diet low in saturated fats and cholesterol.
• If you have diabetes, aim for very good control of blood sugar levels.
• Have your blood pressure checked regularly.
• Get enough sleep.
• Try to avoid emotional upset and stressful situations. Practice stress management or relaxation techniques

When should I call the doctor?

Contact your doctor if your angina gets worse, occurs more often, lasts longer or occurs at rest.

Call your doctor or go to A&E immediately if:

• You have chest discomfort with feeling faint/weakness/vomiting.
• You are sweating a lot during an attack of angina.
• You have chest discomfort (pressure, fullness, squeezing, or pain) that lasts more than 10 minutes or goes away and comes back.
• You still have pain after taking 3 nitroglycerin tablets 5 minutes apart.