What are the treatment options for chronic stable angina?

Angioplasty and stenting

During an angioplasty (AN-jee-o-plas-tee), your doctor inserts a tiny balloon in your narrowed artery through a catheter that's placed in an artery, generally in your groin. Your doctor inflates the balloon to widen the artery, and then he or she may insert a small metal tube (stent) to keep the artery open. Some stents are bare metal, some are covered with a synthetic fabric, and others are coated with medications to help keep your artery open (drug-eluting stents).

Angioplasty and stenting involve some risks. These include a risk of blockages re-forming after a stent is implanted, a risk of a blood clot forming in the stent, as well as small risks of having a heart attack, stroke, or life-threatening bleeding during or after the procedure.

You should consider that even if you have a stent placed, you'll likely need to take aspirin for the rest of your life. You may also need to take additional medications to prevent blood clots.

You'll probably remain hospitalized for at least a day while your heart is monitored and your vital signs are checked frequently. You can generally return to work or your normal routine soon after angioplasty.

Many doctors consider angioplasty with stent placement to be a good angina treatment option for blocked arteries and chronic stable angina. Some reasons that it may be considered a good treatment option are that it's less invasive than open-heart surgery and generally has good results.

Medications

If you have stable angina, you may be able to treat it with medications and lifestyle changes alone, and you may not need angioplasty with stenting. Several medications can improve angina symptoms, including:

• Aspirin. Aspirin reduces the ability of your blood to clot, making it easier for blood to flow through narrowed heart arteries. Preventing blood clotting may reduce your risk of a heart attack.

• Nitrates. Nitrates are often used to treat angina. Nitrates relax and widen your blood vessels, allowing more blood to flow to your heart muscle.

  You might take a nitrate when you have angina-related chest discomfort, before doing something that usually triggers angina (such as physical exertion), or on a long-term preventive basis. The most common form of nitrate used to treat angina is sublingual nitroglycerin tablets, which you put under your tongue.

• Beta blockers. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. As a result, your heart beats more slowly and with less force, reducing blood pressure and reducing the workload on your heart. Beta blockers also help blood vessels relax and open up to improve blood flow, which reduces or prevents angina.
• Statins. Statins are drugs used to lower blood cholesterol. They work by blocking a substance your body needs to make cholesterol. They may also help your body reabsorb cholesterol that has accumulated in the buildup of fats (plaques) in your artery walls, helping prevent further blockage in your blood vessels.
• Calcium channel blockers. Calcium channel blockers, also called calcium antagonists, relax and widen blood vessels by affecting the muscle cells in the arterial walls. This increases blood flow in your heart, reducing or preventing angina. Calcium channel blockers also slow your pulse and reduce the workload on your heart.
• Ranolazine (Ranexa). Ranolazine, an anti-angina medication, may be prescribed with other angina medications, such as beta blockers. It can also be used as a substitute if you can't take beta blockers.
• Angiotensin-converting enzyme (ACE) inhibitors. These drugs help relax blood vessels. ACE inhibitors prevent an enzyme in your body from producing angiotensin II, a substance in your body that affects your cardiovascular system in numerous ways, including narrowing your blood vessels. This narrowing can cause high blood pressure and force your heart to work harder. These medications might help people with other conditions such as high blood pressure and diabetes.

If you try drug treatment and lifestyle changes and you still have symptoms that are limiting you, an angioplasty with stenting or coronary bypass surgery may be an option, depending on your condition and the cause of your angina.

Enhanced external counterpulsation therapy (EECP) therapy

EECP therapy may be recommended for some people with angina. During this therapy, a doctor places cuffs on your legs and applies air pressure to your legs in rhythm with your heartbeats. This therapy may help improve blood flow to your heart and may improve angina.

Lifestyle changes: Part of all treatments

Regardless of which angina treatment you choose, your doctor will recommend that you make healthy lifestyle changes.

Because heart disease is often the underlying cause of most forms of angina, you can reduce or prevent angina by working on reducing your heart disease risk factors and making healthy lifestyle changes. These risk factors may include:

• Smoking. If you smoke, stop.
• Poor diet. Eat a healthy diet with limited amounts of saturated fat, trans fat and salt. Include a variety of fruits and vegetables, whole grains, lean meats, and low-fat dairy products in your diet.
• High cholesterol. Know your cholesterol numbers and ask your doctor if you've optimized them to the recommended levels.
• Lack of physical activity. Talk to your doctor about starting a safe exercise plan. Because angina is often brought on by exertion, it's helpful to pace yourself and take rest breaks.
• Excess weight. If you're overweight, talk to your doctor about weight-loss options.
• Underlying conditions. Get treatment for diseases or conditions that can increase your risk of angina, such as diabetes, high blood pressure and high blood cholesterol.
• Stress. Avoiding stress is easier said than done, but try to find ways to relax. Talk with your doctor about stress-reduction techniques.