Angina (Chest Pain) Treatment

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Your healthcare provider will decide on a treatment approach based on the type of angina you have, your symptoms, test results, and the risk of complications. Unstable angina is a medical emergency that requires immediate treatment in a hospital.

If your angina is stable and your symptoms are not getting worse, you may be able to manage your angina with heart-healthy lifestyle changes and medicines. If lifestyle changes and medicines cannot manage your angina, you may need a medical procedure to improve blood flow and relieve your symptoms.

Angina occurs when your heart muscle receives less oxygen-rich blood than it needs. To correct that mismatch, treatments for angina usually involve the following two approaches:

• Increasing blood flow to the heart muscle so that it can get enough oxygen to work
• Lowering the heart’s workload so that it needs less oxygen to work

If you are diagnosed with angina, your healthcare provider may prescribe fast-acting medicines you can take to manage angina events and relieve pain. Often, other medicines are also prescribed to help manage angina long-term. The choice of medicines may depend on what type of angina you have.

• Beta-blockers help your heart beat slower and with less force. These medicines may help relieve angina. Side effects may include headache, dizziness, and an upset stomach. If you have vasospastic angina, beta-blockers may make your angina worse.
• Nitrates, such as nitroglycerin, widen and relax blood vessels. This lowers the heart’s workload and also increases blood flow to the heart muscle. If you cannot take beta-blockers, long-acting nitrates are the preferred alternative. Nitrate pills or sprays act quickly and can relieve pain during an angina event. Taking nitrates right before an activity that usually triggers your angina may help delay or avoid an angina event. Long-acting nitrates are available as pills or skin patches. If you are hospitalized for chest pain, you may receive intravenous (IV) nitrates to relieve your angina pain as quickly as possible. Side effects of nitrates can include headache and dizziness.
• Calcium channel blockers relax the muscle cells of your heart and blood vessels. If you cannot take beta-blockers or nitrates, calcium channel blockers may be another option to relieve your symptoms. For vasospastic angina, your provider will probably prescribe calcium channel blockers and avoid giving you beta-blockers. Side effects of calcium channel blockers can include headache, drowsiness, upset stomach, and ankle swelling.

Your provider may also prescribe medicines that lower your chance of having a heart attack, a stroke, or other cardiovascular events.

• Antiplatelet medicines keep blood clots from forming. If you have stable or unstable angina, you may need aspirin to lower your chances of having complications of heart disease. Your provider may also prescribe a combination of aspirin with clopidogrel or other platelet inhibitors.
• Anticoagulant medicines, or blood thinners such as heparin, slow down clotting and lower your chance of blood clots and future complications.
• Statins stop plaque from forming and can slow down coronary heart disease. Statins can also relieve blood vessel spasms or inflammation , lowering the risk of complications after emergency treatment.

If you still have symptoms or experience serious side effects, your healthcare provider may prescribe other medicines.

• Ranolazine can prevent your angina symptoms from occurring as often. When given with other angina medicines, ranolazine can also increase the amount of physical activity you can do without triggering angina. Side effects may include dizziness, headache, constipation, and nausea. Healthcare providers sometimes prescribe this medicine for microvascular angina or for refractory angina that does not respond to other treatments. Ranolazine may be a substitute for nitrates for men who have stable angina and take medicines for erectile dysfunction.
• Morphine is an opioid that can relieve pain and help relax the muscles in your blood vessels. Your provider may suggest it if you are in a lot of pain and other medicines have not helped to manage your angina.

If lifestyle changes and medicines cannot manage your angina, you may need a medical procedure to treat the underlying medical condition.

• Coronary artery bypass grafting (CABG) may help treat coronary heart disease and relieve angina. CABG can improve blood flow to your heart, relieve chest pain, and help prevent a heart attack.
• Percutaneous coronary intervention (PCI), also known as coronary angioplasty, can open narrowed or blocked blood vessels that supply blood to the heart. This procedure requires cardiac catheterization. Your healthcare provider may also put a small mesh tube, or stent, in your artery to help keep the artery open. Combining PCI with certain medicines that widen coronary arteries may help relieve vasospastic angina.