Angina treatement

How is angina treated?

Angina pectoris can be treated with drugs that affect 1) the supply of blood to the heart muscle or 2) the heart's demand for oxygen. Some drugs, called coronary vasodilators, cause blood vessels to relax. When this happens the opening inside the vessels (the lumen) gets bigger. Then blood flow improves, allowing more oxygen and nutrients to reach the heart muscle. Nitroglycerin is the drug most often used. It relaxes the veins (reducing the amount of blood returning to the heart and thus lessening the work of pumping) and the coronary arteries (increasing the blood supply to the heart).

Alternatively, the heart's demand for oxygen also can be modified. For example, a drug can be prescribed to reduce blood pressure and thus reduce the heart's workload and need for oxygen. Drugs that slow the heart rate achieve a similar effect.

Invasive techniques that improve the blood supply to the heart also may be used. One technique is percutaneous transluminal coronary angioplasty (PTCA), also known as angioplasty or balloon angioplasty. Another procedure is coronary artery bypass graft surgery.

Before performing either of these procedures, a doctor must find the blocked part of the coronary arteries. This is done using coronary arteriography, which is done during a procedure called cardiac catheterization. In this procedure a doctor guides a thin plastic tube (a Catheter) through an artery in the arm or leg and into the coronary arteries. Then the doctor injects a liquid dye visible in X-rays through the catheter. High-speed X-ray movies record the course of the liquid as it flows through the arteries. Doctors can identify obstructions in the arteries by tracing the liquid's flow.

Some newer diagnostic procedures are available to evaluate how well the heart works. These tests may be done before or after a heart attack. Some of these tests are still relatively experimental and are limited to larger medical centers.

PTCA is a procedure designed to dilate (widen or expand) narrowed coronary arteries. In it a doctor inserts a catheter into an artery in an arm or leg and guides it to an obstructed coronary artery. Then a second catheter with a balloon tip is passed inside the first, and the balloon tip is inflated at the arterial blockage. This compresses the plaque, enlarging the inner diameter of the blood vessel so blood can flow more easily. Then the balloon is deflated and the catheters are withdrawn.