Patient education: Treatment choices for angina (chest pain) (The Basics)

What is angina? — Angina is the medical term for chest pain or discomfort that is caused by a condition called "coronary heart disease or "coronary artery disease." In this disease, fatty deposits build up in the arteries that supply the heart with blood. When this happens, the arteries narrow, and the heart muscle does not get enough blood. This causes chest pain or discomfort, especially when you do physical activity.

What are the treatment choices for angina (chest pain)? — There are 2 main types of treatment for angina. They are:

Medical treatment — This includes different types of medicines, such as "nitrates" and "beta blockers." These medicines work by relaxing blood vessels going to the heart muscle or reducing the amount of work the heart muscle has to do (figure 1).

If you have heart disease, you will also need to take other medicines, including:

●Medicines called statins, which lower cholesterol

●Medicines to lower blood pressure

●Aspirin or other medicines that help prevent blood clots in the arteries

You should also make these lifestyle changes:

●Quit smoking, if you smoke.

●Eat lots of fruits and vegetables and low-fat dairy products, but not a lot of meat or fatty foods.

●Walk or do some form of physical activity on most days of the week.

●Lose weight, if you are overweight.

Procedures — These restore blood flow to the part of the heart that is not getting enough blood. They include:

●Stenting – During this procedure, the doctor puts a thin tube (called a "catheter") into a blood vessel in the leg or arm and moves it to the clogged artery in the heart. Then, the doctor inflates a tiny balloon inside the clogged artery to open it. In most people, the doctor keeps the artery open using a tiny metal tube called a stent (figure 2).

●Bypass surgery (also known as "coronary artery bypass grafting") – During bypass surgery, the doctor uses a healthy blood vessel from another part of your body where it is not needed. The doctor attaches this new blood vessel below the area that is clogged. This re-routes blood around the clogged artery, and allows it to get to the part of the heart that was not getting blood (figure 3).

For relieving angina, either stenting or bypass surgery might be better than medicines alone. Some patients get both procedures. But people who have a procedure still need to take medicines. In fact, skipping medicines after these procedures can be very dangerous.

How do I know which treatment is best for me? — Your doctor will help you decide which treatment is best for you. Many different factors affect the decision. These factors include your age, your symptoms, and the results of certain heart tests.

If your doctor recommends stenting or bypass surgery, ask these questions:

●How might this procedure help me?

●Will it help me live longer?

●Will it reduce my chance of having a heart attack?

●Will I feel better if I have this procedure than I would with medicines alone?

●What are the risks of the procedure?

●What happens if I don't have this procedure?

More on this topic

Patient education: Cardiac catheterization (The Basics)
Patient education: Chest pain (The Basics)
Patient education: Coronary artery disease (The Basics)
Patient education: Heart attack (The Basics)
Patient education: Medicines for angina (chest pain) (The Basics)
Patient education: Medicines after a heart attack (The Basics)

Patient education: Medications for angina (Beyond the Basics)
Patient education: Angina treatment — medical versus interventional therapy (Beyond the Basics)