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Management of Angina pectoris

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The management of angina requires a thorough approach to the patient and his/her family including attention to the emotional aspectsof the illness. Comprehensive risk stratification should be conducted with specific attention to the elements of lifestyle that could have contributed to the condition.2

The aim of therapy is to alleviate symptoms and to improve prognosis by preventing myocardial infarction and death. Treatments for angina incorporate several different aspects which include lifestyle modifications, medications and surgical procedures when indicated.1

Lifestyle Modifications

Lifestyle changes are recommended to help reduce risk factors and to slow the progression of underlying CAD.

These changes include the following:

  • Body weight control
  • Limit alcohol intake
  • Moderate exercise
  • Stress management
  • Avoidance of unaccustomed exertion


Pharmacological Management

Anti-anginal drug therapy tailored to the needs of the individual patient should be monitored individually. Major classes of drugs used to treat angina include the following:1

Nitrates—Nitrates work by reducing the oxygen requirements of the myocardium. Glyceryl trinitrate (GTN) taken under the tongue (sublingual) relieves pain within 2–3 min. This GTN can also be given subcutaneously in the form of paste or plaster, which gives longer duration of action. Oral nitrates such as isosorbide dinitrate are also available which have a prolonged action.

Beta Blockers—These agents reduce the oxygen demand of the heart act by blocking the sympathetic nervous system effect on the heart, slowing heart rate and decreasing the blood pressure. Some of the commonly used beta blockers are propranolol, atenolol and metoprolol.

Calcium-Channel Blockers—These drugs cause vasodilatation, thereby decreasing the workload of the heart and also lower the heart rate by reducing the excitability and conductivity of the heart. The commonly used ones are nifedipine, verapamil and diltiazem.

AntiplateletsAspirin should be administered routinely to all angina patients, if not contraindicated. This recommendation is based on evidence showing that aspirin helps prevent the recurrence of events such as heart attack and hospitalization for recurrent angina. Aspirin also helps prevent these events from occurring in people at high risk.

Surgical Intervention

Although a medical management approach is preferable in angina and CAD patients, many patients remain symptomatic even with multiple anti-anginal agents.

Failure of medical management in these patients has led to the introduction of more invasive procedures such as coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI) and percutaneous transluminal myocardial revascularization (PTMR).3             

Written by: Healthplus24 team
Date last modified : July 25, 2012