Drug Therapy

There are numerous drugs that control or prevent angina. The choice depends on the circumstances and whether or not there are other contributing disorders, such as high blood pressure. Two classes of drugs nitrates and calcium channel blockers open, or dilate, the arteries, allowing more blood to flow through them. This action lowers blood pressure, reduces the heart’s workload, and increases blood flow to the heart muscle .A third class of drugs, beta blockers, alleviates angina by reducing the action of norepinephrine, a neurotransmitter that carries signals from the sympathetic nervous system. Blocking these signals also reduces the heart’s workload by allowing it to beat slower and less forcefully than usual. Calcium channel blockers and beta blockers are taken daily to prevent angina; nitroglycerin-the most commonly prescribed nitrate is used both to stop and prevent angina. During an attack, a nitroglycerin pill placed under the tongue or in the cheek pocket is absorbed rapidly into the bloodstream, usually providing relief within five minutes. The effect wears off quickly, however; for more sustained or preventive action, nitroglycerin is available as a skin patch or ointment. In these forms, the drug is slowly absorbed through the skin, thus providing protection from attacks. A note of caution, Nitroglycerin can cause flushing, dizziness, and headache. Doctors advise sitting down when taking the medication, This reduces dizziness and prevents fainting from a sudden drop in blood pressure.

Drug Therapy

Angioplasty

This is an invasive procedure designed to alleviate angina by physically opening up narrowed blood vessels. It is similar to cardiac catheterization, except that a catheter with a balloon tip is inserted into the coronary arteries while being followed on a fluoroscope monitor, a special type of moving X-ray. When the catheter reaches a narrowed segment, the balloon is inflated to flatten the plaque. In a new variation, a rotating blade similar to a tiny rotorooter shaves the plaque into tiny particles, rather than simply flattening it out. In another, still experimental variation, a laser beam is used to vaporize the plaque.

Coronary Bypass Surgery

This operation is reserved for severe coronary disease that cannot be adequately controlled with drugs and is not amenable to angioplasty. Segments of healthy blood vessels, from either an artery in the chest wall or a vein in the leg, are used to bypass severely narrowed parts of the coronary arteries. Up to seven or even eight bypass grafts may be done in a single operation, greatly increasing blood flow to the heart muscle and reducing the incidence of angina and the risk of a heart attack. The operation usually takes 3 or 4 hours, although some complicated cases require 8 to 10 hours. The patient then spends two or three days in an intensive care unit, and another five to seven days in the hospital. Even though the operation is relatively safe, it is not risk free, and the potential dangers must be weighed against the benefits that are expected.

Alternative Therapies

Angina is always a serious warning sign, and any alternative therapy should be considered an adjunct to, not a substitute for, conventional medical treatments. A number of prominent researchers and cardiologists have been trying out combinations of conventional and alternative therapies, especially in preventive cardiology. Alternative approaches include.