Angina treatment: Stents, drugs, lifestyle changes — What’s best?

By Mayo Clinic Staff

Reduced blood flow to the heart can cause a type of chest pain called angina. Angina is a symptom that means the heart isn’t getting enough oxygen. It’s important to treat the cause of angina to prevent heart attacks and other complications.

The type of treatment your healthcare professional recommends depends on the type of angina you have.

The most common types of angina are stable angina and unstable angina.

Stable angina. This chest pain usually happens during activity. It goes away with rest or angina medicine. The pattern of pain — how long it lasts, how often it occurs, what triggers it, and how it responds to rest or treatment — stays the same for at least two months.

Unstable angina. This type is unpredictable and occurs at rest. Or the pain gets worse and happens with less activity. If you have a history of stable angina, the pain is different from usual. The pain is usually very bad and lasts longer than the pain of stable angina. The pain doesn’t go away with rest or the usual angina medicines.

Unstable angina is dangerous and a warning sign of a heart attack. If you have new or changed chest pain, get medical care right away.

Other types of angina include variant angina, also called Prinzmetal angina. This rare type is caused by a spasm in the coronary arteries. Another type, called microvascular angina, can be a symptom of disease in the small coronary artery blood vessels.

If your angina is stable, you might be able to control it with lifestyle changes and medicines. Unstable angina requires treatment right away in a hospital. This treatment may involve medicines, a heart procedure or heart surgery.

Several medicines can improve angina symptoms, including:

• Aspirin. Aspirin and other antiplatelet medicines prevent blood clotting. This makes it easier for blood to flow through narrowed heart arteries.
• Nitroglycerin. This medicine widens the heart arteries. It can help control or relieve chest pain. Nitroglycerin is available as a pill, spray or patch.
• Beta blockers. These medicines help the heart beat more slowly and with less force. This eases angina pain.
• Statins. Statins are often used to treat high cholesterol. They also might help prevent fatty deposits called plaque from clogging heart arteries.
• Calcium channel blockers. These medicines relax and widen blood vessels, increasing blood flow to the heart.
• Ranolazine. This medicine might be given with or instead of beta blockers for angina. It’s typically used if angina symptoms don’t improve with other medicines.

Angioplasty, also called percutaneous coronary intervention, increases blood flow through a blocked artery. It reduces angina.

During an angioplasty, a doctor inserts a thin, flexible tube called a catheter into a blood vessel, usually in the groin or wrist. The tube is guided to the blocked heart artery. A tiny balloon is on the end of the tube. The doctor inflates the balloon to widen the artery. A small metal mesh tube called a stent is usually placed to keep the artery open.

This treatment can take 30 minutes to several hours. You usually stay in the hospital at least overnight. Your healthcare team tells you when you can return to your daily activities.

Sometimes the blockage returns after an angioplasty. Using a stent coated with medicine can help prevent this.

If unstable angina or stable angina affects some of the main heart arteries and does not get better with stenting and other treatments, heart bypass surgery may be needed. Heart bypass surgery is open-heart surgery. It’s also called coronary artery bypass grafting or CABG — pronounced “cabbage.”

EECP therapy might be recommended for some people whose angina doesn’t improve with other treatments. For this therapy, large cuffs are wrapped around the legs. Air pressure causes the cuffs to inflate and deflate in time with the heartbeat. The typical treatment is five one-hour treatments a week for seven weeks.

Lifestyle changes are an important part of angina treatment. Try these heart-healthy tips:

• Do not smoke. Smoking is a major risk factor for heart disease. If you smoke and can’t quit, talk with your healthcare team about programs or treatments that can help.
• Eat a healthy diet. Eat plenty of fruits, vegetables and whole grains. Limit sugar, salt and saturated fats.
• Bleibe aktiv. Regular exercise and activity help control diabetes, high cholesterol and high blood pressure — all risk factors for heart disease. Talk with your healthcare team about starting a safe exercise plan. If your angina occurs with activity, go slow and take rest breaks.
• Keep a healthy weight. Being overweight increases the risk of heart disease. Ask your healthcare team what weight is best for you.
• Treat medical conditions. Get treatment for health conditions that can increase your risk of angina. These conditions include diabetes, high blood pressure and high blood cholesterol.
• Reduce emotional stress. Some tips are to get more exercise, practice mindfulness and connect with others in support groups.
• Get good sleep. Poor sleep may increase the risk of heart disease and other long-term health conditions. Adults should try to get 7 to 9 hours of sleep daily.

You and your healthcare team should discuss the pros and cons of each treatment to decide which is best for you. For most people, first steps include medicines and lifestyle changes. If those don’t work for you, angioplasty and stenting may be another option.

Talk with your healthcare professional if you think your treatment isn’t controlling your angina well enough.