The underlying coronary artery disease
that causes angina should be attacked by controlling existing "risk
factors." These include high blood pressure, cigarette smoking, high
blood cholesterol levels, and excess weight. If the doctor has
prescribed a drug to lower blood pressure, it should be taken as
directed. Controlling the risk factors reduces the likelihood
that coronary artery disease will lead to a heart attack.
Most people with angina learn to adjust
their lives to minimize episodes of angina, by taking sensible
precautions and using medications if necessary.
Usually the first line of defense
involves changing one's living habits to avoid bringing on attacks of
angina. Controlling physical activity, adopting good eating habits,
moderating alcohol consumption, and not smoking are some of the
precautions that can help patients live more comfortably and with less
For example, if angina comes on with
strenuous exercise, exercise a little less strenuously, but do
exercise. If angina occurs after heavy meals, avoid large meals and
rich foods that leave one feeling stuffed. Controlling weight,
reducing the amount of fat in the diet, and avoiding emotional upsets
may also help.
Angina is often controlled by drugs.
The most commonly prescribed drug for angina is nitroglycerin, which
relieves pain by widening blood vessels. This allows more blood to
flow to the heart muscle and also decreases the work load of the
heart. Nitroglycerin is taken when discomfort occurs or is expected.
Doctors also frequently prescribe other
drugs, to be taken regularly, that reduce the heart's workload. Beta
blockers slow the heart rate and lessen the force of the heart muscle
contraction. Calcium channel blockers are also effective in reducing
the frequency and severity of angina attacks.
What if medication fails
to control angina?
Doctors may recommend
angioplasty if drugs fail to ease angina or if the risk of heart
attack is high. Coronary artery bypass surgery is an operation in
which a blood vessel is grafted onto the blocked artery to bypass the
blocked or diseased section so that blood can get to the heart muscle.
An artery from inside the chest (an "internal mammary" graft) or long
vein from the leg (a "saphenous vein" graft) may be used.
Balloon angioplasty involves inserting
a catheter with a tiny balloon at the end into a forearm or groin
artery. The balloon is inflated briefly to open the vessel in places
where the artery is narrowed. Other catheter techniques are also being
developed for opening narrowed coronary arteries, including laser and
mechanical devices applied by means of catheters.
Can a person with angina
Yes. It is important to work with the
doctor to develop an exercise plan. Exercise may increase the level of
pain-free activity, relieve stress, improve the heart's blood supply,
and help control weight.
A person with angina should start an
exercise program only with the doctor's advice. Many doctors tell
angina patients to gradually build up their fitness level--for
example, start with a 5-minute walk and increase over weeks or months
to 30 minutes or 1 hour. The idea is to gradually increase stamina by
working at a steady pace, but avoiding sudden bursts of effort.