Medical treatment of angina
The main aims of treatment are:
- To control your symptoms of angina
- To maintain as high a level of activity as possible
- To improve your quality of life
- To prevent any worsening of the narrowed coronary arteries
Treatment approaches, which are explained more fully in the treatments section, can include:
If you have frequent angina attacks it is likely that you will need to take a combination of drugs to help:
- Relieve chest pain
- Prevent chest pain from worsening
- Protect you from serious events such as heart attacks
There are several groups of drugs which are useful in preventing angina. Your doctor will try and find the most effective combination for you. These may include:
- ACE inhibitors (Angiotensin Converting Enzyme inhibitors)
- Antiplatelets: usually this will be aspirin. In the event of true aspirin intolerance or allergy, clopidogrel or dipyridamole may be considered as an alternative.
- ARBs (Angiotensin II receptor blockers): these are mainly used in angina when ACE inhibitors are not suitable.
- Beta blockers
- Calcium channel blockers: can be effective in reducing the number of angina attacks as well as helping you to be more active. Sometimes calcium channel blockers, for example diltiazem, are used in combination with beta blockers, or for people who are not able to take beta blockers, to control angina.
- Nitrates (e.g. GTN): open up the arteries by relaxing the muscle in the artery wall causing the blood vessels to dilate.
- Potassium channel activators: tend to be used in combination with other drugs. They may be helpful when angina is not well controlled by other drugs.
- Statins: even if your cholesterol is not high your doctor may prescribe statin tablets to lower your cholesterol.
- Glyceryl trinitrate (GTN) is a type of heart drug, called a nitrate. Nitrates open up the arteries by relaxing the muscle in the artery wall causing the blood vessels to dilate. This reduces the work the heart muscle has to do.
- Nearly everyone will need GTN (glyceryl trinitrate) to relieve angina pain as it happens. It is absorbed in the mouth, under the tongue (sublingual) making it effective in 1-2 mins with the effect lasting 20-30 mins. It can be used in tablet or spray form, whichever you prefer.
- GTN is used to relieve angina pain when it happens. It is absorbed in the mouth, under the tongue (sublingual) making it effective in 1-2 mins with the effect lasting 20-30 mins. It can be used in tablet or spray form, whichever you prefer.
- Learning to use your GTN correctly and at the right time is a big step towards taking control of angina.
- Some people think that if they have to use their tablets or spray a lot it means that they are worse; others think that by not using their spray it means they are better. Neither of these ways of thinking is going to help you.
- GTN is very useful and effective in helping control angina. Accepting the use of your GTN spray or tablets will give you much more freedom and take away the fear of pain coming on.
- It is also helpful to explain to those around you about using your GTN. This will alleviate their fear and also give you reassurance that you will get help if you need it.
- Side effects of GTN include: headache, flushing, dizzines and nausea.
- If you use your GTN and it wasn't necessary, the worst thing likely to happen to you is a headache.
After being diagnosed with angina it is important that you learn how to deal with an 'attack'. The following table shows what to do when you feel your angina coming on.
- Please note: If you are having chest pain for the first time then you must seek urgent medical advice.
|WHAT TO DO WHEN YOU HAVE ANGINA / CHEST PAIN|
|STEP 1 Pain / breathlessness: Stop what you are doing and sit down. Take 1 dose GTN (Spray / tablet) wait 5 minutes|
|STEP 2 If pain / breathlessness remains: Take another dose GTN wait 5 minutes|
|STEP 3 If pain / breathlessness remains: Take another dose GTN wait 5 minutes|
|STEP 4 If pain / breathlessness remains: Call 999|
Stable angina is normally relieved by stopping what you are doing and taking your GTN. You will not normally move beyond step 1 in the above table.
If your angina attacks are happening more frequently / with less and less activity and are not relieved by GTN then try not to panic. Follow steps 2, 3 and 4 and do not hesitate in calling 999 if you think you need to.
- GTN can be used prior to doing an activity that you might be afraid will bring angina on.
- There is no limit to the number of occasions you can take GTN.
- It is not addictive and your body will not become used to it with frequent use.
- It is a good idea to take GTN sitting down especially when experiencing angina as it can occasionally cause dizziness.
- If you suffer a severe headache when taking GTN, a tablet can be spat out and the headache should resolve.
- GTN tablets have a short shelf life and so need to be replaced every 8 weeks when open. The spray however has a two to three year shelf life.
- Learn to recognise fear and anxiety and how to deal with it.
- Use your GTN to allow you to enjoy your life.
- Use your GTN to control angina, don't let angina control you.