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

Blocked heart arteries can cause a type of chest pain called angina. Angina pain is a symptom that means the heart isn't getting enough oxygen. It's important to treat blockages that cause angina to avoid a heart attack and other complications.

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

Types of angina

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

• Chronic stable angina. This chest pain occurs when your heart is working hard enough to need more oxygen, such as during moderate or vigorous exercise or mental stress. The pain can go away when you rest. The pattern of pain — how long it lasts, how often it occurs, what triggers it, and how it responds to rest or treatment — remains stable for at least two months.

• Unstable angina. This is either new or changed chest pain. The pain is believed to be coming from the heart muscle. If you have a history of stable angina, the pain is different than usual. For example, the pain may feel worse, or it may last longer than usual. The pain might occur during lighter levels of activity, or it doesn't get better with rest or medicine.

  Unstable angina is dangerous and a warning sign of a heart attack. If you have new or changed chest pain, seek 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.

Treatment options

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Coronary artery stent

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Coronary artery stent

Coronary artery stent

When placing a coronary artery stent, a doctor looks for a blockage in the heart's arteries (A) using cardiac catheterization techniques. A balloon on the tip of the catheter is inflated to widen the blocked artery. A metal mesh stent is used to hold the artery open (B). The stent allows blood to flow through the previously blocked artery (C).

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 may involve medicines or a procedure.

Medicines

Several medicines can improve angina symptoms, including:

• Aspirin. Aspirin and other anti-platelet 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 prescribed 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 and stent placement

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

During an angioplasty, a doctor inserts a thin, flexible tube called a catheter into a blood vessel, usually in the groin or wrist. 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 may be placed to keep the artery open.

This process can take 30 minutes to several hours. You usually stay in the hospital at least overnight. Your health care 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 improve 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."

Enhanced external counterpulsation (EECP) therapy

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

Lifestyle changes

Making lifestyle changes to keep the heart healthy is an important part of angina treatment. Try these tips:

• Quit smoking. If you smoke, stop. If you need help quitting, talk to your health care team about therapies that can help.
• Eat a healthy diet. Eat a healthy diet with limited amounts of saturated fat, trans fat, salt and sugar. Include a variety of fruits and vegetables, whole grains, lean meats, and low-fat dairy products in your diet.
• Stay active. Regular exercise and activity help control diabetes, high cholesterol and high blood pressure &mdash all risk factors for heart disease. Talk to your health care team about starting a safe exercise plan. If your angina occurs with activity, pace yourself and take rest breaks.
• Manage weight. Ask your doctor what a healthy weight is for you and how to achieve it.
• Treat medical conditions. Get treatment for health conditions that can increase your risk of angina, such as diabetes, high blood pressure and high blood cholesterol.
• Reduce stress. Find ways to help reduce emotional stress. Getting more exercise, practicing mindfulness and connecting with others in support groups are some ways to reduce and manage stress.

How to choose

You and your care 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 can be another option.

Talk to your doctor if you think your treatment isn't controlling your angina well enough.