Treatment of Angina

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The drug glyceryl trinitrate (nitroglycerine) is highly effective in controlling the pain of angina. You can take it as a tablet that dissolves under your tongue, and the pain is usually relieved in two to three minutes. The drug is also available in skin patches (transdermal patches) and as a spray (again for under the tongue), and all forms are available from a pharmacy without prescription.

Nitrates have a powerful action in widening (dilating) arteries, including the coronary arteries, thus improving the blood supply to the heart muscle. Note that you should not take Viagra (sildenafil) if you take glyceryl trinitrate.

Taking low-dose aspirin daily helps prevent blood clotting and reduces the risk of heart attack. Mild or moderate angina may need further treatment by drugs such as beta blockers (eg Antenolol) or calcium-channel blockers (eg Nifedipine).

Potassium-channel activator drugs also help to widen the coronary arteries. These drugs can slow the force of contraction of the heart and dilate the coronary arteries, thus reducing the demand for oxygen and increasing supply to the heart.

For unstable angina the treatment is a daily 300 mg dose of aspirin, and injectable anticoagulants such as Heparin are administered in hospital. Nitrates and beta blockers may also be necessary.

An effective treatment for angina is to widen the narrowed coronary arteries by a procedure called coronary angioplasty. This is done using a small-gauge tube called a balloon catheter. This has a sausage-shaped balloon segment near one end and is pushed into the narrowed part of the artery. The balloon is then inflated to widen the narrowed artery. The results are excellent, but the procedure may have to be repeated.

In other cases, a bypass operation may be considered more suitable. Segments of vein are used to provide a new channel by which the blood can be shunted past the blocked part of the artery. Some surgeons prefer to connect a local artery from the chest wall to the narrowed coronary beyond the point of the block.