Treatment

Several types of medications are often used in combination to reduce the symptoms of stable angina:

• Aspirin (in low dose): Reduces small blood cells called platelets from sticking together which helps prevent the formation of thrombosis.
• Glyceryl trinitrate (GTN tablets or spray) which relaxes the heart artery and diminishes acute symptoms
• Longer-acting nitroglycerin preparations and transdermal delivery systems are useful in preventing and reducing the frequency and intensity of episodes in patients with chronic angina. The use of nitroglycerin preparations can be limited by headaches and light-headedness due to excess lowering of blood pressure.
• Beta-blockers relieve angina by inhibiting the effect of adrenaline on the heart. Inhibiting adrenaline decreases the heart rate, lowers the blood pressure, and reduces the pumping force of the heart muscle, all of which reduce the heart muscle's demand for oxygen. They are also important in protecting the heart after heart attacks. Side effects include worsening of asthma, excess lowering of the heart rate and blood pressure, depression, fatigue, impotence, increased cholesterol levels, and shortness of breath due to diminished heart muscle function (congestive heart failure).
• Calcium channel blockers relieve angina by lowering blood pressure, and reducing the pumping force of the heart muscle, thereby reducing muscle oxygen demand. Calcium channel blockers also relieve coronary artery spasm. Side effects include swelling of the legs, excess lowering of the heart rate and blood pressure, and depressing heart muscle function, thereby causing an increased shortness of breath.

Several procedures can be used to reduce the symptoms of stable angina. Doctors may recommend surgery or angioplasty if drugs fail to ease angina or if the risk of heart attack is high. Coronary artery bypass graft surgery (CABG) 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 (percutaneous transluminal coronary angioplasty or PTCA) 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.