Angina of Effort Treatment and Prevention
Angina treatment includes:
- Pain management, reduction or elimination of angina symptoms;
- Improvement of the course of disease prognosis and prevention of complications which comes to myocardial infarction and sudden cardiac death prophylaxis.
The following approaches are used in order to treat angina of effort successfully:
- Nondrug treatment;
- Pharmacotherapy;
- Surgical treatment.
Nondrug treatment involves reduction of the coronary heart disease risk factors and includes:
- Dieting to reduce the level of cholesterol and low density lipoproteins as well as to lose weight.
Effort angina diet has the following requirements:
- Animal fats should be replaced with vegetable and marine fats. Cholesterol consumption should not exceed 300mg/day;
- Increased consumption of fresh fruits and vegetables, and cereals;
- Reduction of caloric intake for overweight persons;
- Limited consumption of salt and alcohol in patients with high blood pressure.
- Avoiding stressful situations;
- STOP smoking;
- Adequate and feasible physical activity if there are no contraindications;
- Normalization of blood pressure, regular high blood pressure therapy in case of hypertension;
- Correction of the disturbed carbohydrate and lipid metabolism.
Pharmacotherapy or drug treatment of effort angina is aimed at the elimination of the imbalance between the myocardial oxygen demand and oxygen supply. It has two main approaches:
- Increase of oxygen supply;
- Decrease of myocardial oxygen demand.
Oxygen supply can be increased with the help of drugs dilating coronary arteries. Oxygen demand can be lowered by the decrease in heart rate as well as by the reduction of the load on the left ventricle myocardium.
Three main groups of medicines are used in order to reduce or eliminate the symptoms of angina of effort:
- Nitrates – increase coronary blood flow and reduce oxygen demand of myocardium. Nitroglycerin is the most popular and effective drug belonging to this group. It stops angina attack in 5-10 minutes;
- Beta blockers – reduce heart effort and myocardial oxygen consumption which helps balance oxygen demand and its supply to the myocardial tissues;
- Calcium channel blockers – reduce myocardial burden, have a vasodilator effect, lower high blood pressure, normalize heart rhythm, reduce platelet aggregation and, thus, reduce the risk of thrombosis.
Antiplatelet drugs and anticoagulants can also be prescribed. Anticoagulants are indicated in patients after myocardial infarction when there is an increased risk of thromboembolism. These drugs should be used under the control of a medical specialist and with the monitoring of blood-clotting factors.
The crucial part of the effort angina therapy consists in the treatment of the concomitant hypertension with antihypertensive drugs. The optimal blood pressure is considered less than 140/90 mmHg.
Surgical treatment is indicated if drug therapy has shown to be ineffective as well as in case of some critical conditions.
These methods include:
- Coronary artery bypass surgery – this surgery is aimed at the restoration of the blood flow in the cardiac muscle. During the procedure an alternative route for the blood supply to the heart is created;
- Coronary angioplasty – a contrast agent is injected in the arteries, and then a catheter with a balloon on one end is inserted. If X-ray shows some vessel narrowing, then this balloon catheter is passed into the narrowed location, the balloon is inflated, and the atherosclerosis plaque blocking the vessel lumen is pressed against the walls of the artery. As a result, the lumen is widened, and its patency is restored;
- Stenting–angioplasty can be often combined with this procedure which places a stent (a small metal tube consisting of many meshes and inflated with a special balloon) into the artery in order to restore coronary blood flow. When the stent is passed to the affected vessel, it is pressed into its walls and, thus, enlarges its lumen.
The decision about the treatment of effort angina, as well as its treatment, should be made by a doctor in every case. If an angina attack lasts too long, the pain comes in waves and is unusually intense. If the pain is not stopped by taking the usual dose of nitroglycerin, painkillers or anti-inflammatory drugs, it is necessary to call for an ambulance because these symptoms may indicate the development of myocardial infarction, which requires immediate qualified medical help.
