• Treatment of Angina


    Angina is your body’s way of telling you that you have coronary artery disease (CAD). A waxy substance made up of cholesterol and other substances (plaque), builds up in the arteries to the point where blood flow is restricted and the heart is not getting enough oxygen to do its work. Treating angina means treating this underlying problem. In other words, increasing the blood flow to the heart will ease symptoms.

    Unfortunately, there’s no magic pill for angina. It cannot be “cured.” But you can find some relief by working with your doctor to find the right combination of lifestyle changes, medications and medical procedures.

    Immediate Relief from Symptoms

    If you need immediate relief from your angina:

    • Stop, relax, and rest. Lie down if you can. Calm yourself by focusing on your breathing. Breathe in through the nose and breathe out slowly from the mouth.
    • Take nitroglycerin.
    • If the pain or discomfort doesn’t stop a few minutes after taking nitroglycerin or if your symptoms become more severe, call 911 or let someone know that you need immediate medical assistance.

    After you have recovered from your symptoms, record them on the SecondsCount Tracking Your Angina Worksheet and read on to learn about pursuing a treatment plan that can help to reduce the frequency and severity of your angina.

    Don’t Hold Back

    If you have angina, one of the most important things you can do for yourself is communicate openly with your doctor—when your angina is first diagnosed and throughout your treatment. You and your doctor should closely monitor your progress and make adjustments, as needed, over time.

    Click to watch Donnette's story

    Donnette experienced some relief from her angina after learning the value of openly discussing her symptoms and concerns. (Video provided courtesy of Speak from the Heart www.SpeakFromTheHeart.com, a trademark of Gilead Sciences, Inc.)
    Click here to watch Donnette's story…

    It is very important to be specific with your doctor about your symptoms. Recording and tracking your symptoms on the SecondsCount Tracking Your Angina Worksheet is one key piece, but angina affects you in many ways beyond the immediate experience of your symptoms. Think about how angina affects you emotionally and physically each day, and tell your doctor. If that’s too difficult, talk with a close friend or family member first for support and encouragement. Take a look at Is Angina Ruining Your Life? Sharing your answers to these questions is another great way to start the conversation.

    Lifestyle Adjustments

    With the help of your doctor you can do a lot to treat your angina and feel better. Choices you make each day can slow the build up of plaque in your arteries and reduce your risk of heart attack. Here’s a list to get you started—

    • Adopt a Heart-Healthy Diet—Maintaining a healthy weight and eating a healthy diet that is low in fat and salt will reduce your risk of heart attack and stroke. See SecondsCount’s Heart-Healthy Nutrition & Diet center for tips and tools that will change your life.
    • Stop smoking—Smoking is one of the most significant risk factors for coronary artery disease, stroke and heart attack.
    • Maintain an ideal body weight—Excess weight contributes strongly to the critical risk factors for heart disease, such as diabetes and high blood pressure.You can do a lot to reduce your risk of coronary artery disease with a healthy diet that includes portion control. A regular exercise program will also help you maintain your ideal body weight.
    • Exercise at least 30 minutes, 5 times a week—Making regular physical activity part of your lifestyle is one of the most effective ways to improve your heart health. See SecondsCount’s center on physical activity and exercise to help to help you get started.
    • Manage your stress—Whether you know it or not, your mind and body are very closely connected. Anxiety and other powerful emotions are driven by thoughts but felt by the body. What happens when you become stressed or scared? Chances are your heart beats faster and it’s harder to breath. It makes your heart work harder, which means you might have angina. Stress management skills such as learning how taking a positive approach to life, setting realistic expectations and discovering healthy ways to relax and manage your stress can help you reduce your symptoms.
    • Ask your doctor about cardiac rehabilitation—It is not easy to change so many areas of your life all at once. Cardiac rehab is a great way to learn new habits and build a support system by meeting other people who are making similar changes. It may also reduce your risk of depression—a problem that is common among people with heart problems.


    In addition to nitroglycerin for immediate symptom relief, your doctor may prescribe one or more of the medications listed below to reduce your symptoms and risk of heart attack and cardiovascular problems.

    Medication Type Purpose
    Aspirin To prevent and dissolve clots in the arteries
    Other antiplatelet medications (plavix, brilinta, effient) To thin the blood and help prevent and dissolve clots, especially in arteries and stents
    Beta blockers To lower blood pressure and heart rate, thus reducing oxygen demands on the heart
    Calcium channel blockers To lower blood pressure and/or heart rate, thus reducing oxygen demands on the heart.
    Ranolazine Favorably affects the metabolism of the heart muscle and increases the time that one can exercise before angina occurs
    Short-term nitrates To relieve or prevent angina on an as-needed basis
    Long-term nitrates Taken daily to decrease episodes of angina
    Statins To lower cholesterol level and reduce the risk of heart attack and stroke

    To learn more about Medications for Angina, click here.

    It may seem obvious, but for medication to be effective it has to be taken as prescribed. It’s one thing to know that and another thing to practice it. It’s very easy to forget, and for many of us, medication has expensive. See SecondsCount’s center on Medications & Heart Health for tips and resources for overcoming these challenges.

    Angioplasty and Stenting

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    Angioplasty and stenting gave Ruth relief from her angina and more years on the dance floor. (Video courtesy of Washington Adventist Hospital, Takoma Park, Maryland.)

    If you find that after making significant changes to your lifestyle and taking medication, you don’t see enough improvement in your symptoms, talk to your doctor about angioplasty and stenting. Angioplasty is a minimally invasive procedure to open arteries that are blocked or narrowed by plaque to increase the flow of oxygen-rich blood to the heart.

    Angioplasty is performed by inserting a small tube called a sheath into an artery and then maneuvering long plastic tubes called catheters up to the arteries of the heart to take pictures that are used in identifying blockages that may be interfering with blood flow to the heart. Once the blockages are identified the catheter can also be used to insert a stent, which is a mesh tube that is permanently inserted into the artery to keep it open.

    Click here to learn more about angioplasty and stenting.

    Coronary Artery Bypass Graft Surgery (CABG)

    Your doctor may recommend coronary bypass surgery if a lengthy portion of an artery becomes narrowed, if an artery is severely blocked, or if the blockage is in a critical location. A surgeon makes a cut near the blocked artery, and then attaches a new blood vessel (from another part of the body) above and below the blockage. By providing a channel for the blood to bypass the blockage, the new vessel, called a graft, allows blood to continue to flow to the leg and foot. Once the vessel is attached, the surgeon closes the cut with sutures or staples. Click here to learn more about coronary bypass surgery, which is also known as coronary artery bypass graft surgery (CABG).

    Enhanced External Counterpulsation (EECP)

    Generally, EECP is used to treat angina in patients who continue to have chest pain or discomfort even after treatment with medication and angioplasty and stenting. It is also used to treat patients with blood flow problems in blood vessels too small to treat with other procedures.

    EECP is a non-invasive procedure that increases blood flow to the heart by using inflatable cuffs on the legs to push blood back to the heart in between beats. Treatment takes one or two hours per daily session for about 7 weeks. Learn more about EECP here.

    How Does Your Doctor Decide Which Treatment Is Best for You?

    Doctors develop guidelines based on research to help them determine the best treatment for each patient. The research on angina shows that medication can make a significant difference so the guidelines recommend trying lifestyle changes and medication before angioplasty and stenting. For more information on how research influences your doctor’s treatment recommendations, see Treating Angina with COURAGE and FAME-2: Meds, Stents, or Both?

    Give Your Doctor As Much Information as Possible

    Remember, you are the expert on your own angina. You live with it every day and know how it feels. Your doctors have a wealth of medical knowledge but they cannot know exactly what you feel or experience unless you tell them.