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FAQ (Health)

 Dr. George Jacob
Heart Infocenter



Conventional Treatments for Angina

Maintaining an overall healthy life style is very important. This includes proper diet, exercise, weight management, and no smoking.

There are three classes of angina drugs- nitrates, beta-adrenergic blockers, and calcium channel blockers. Often a combination of the three medications is used to treat angina.

Nitrates cause arteries to expand and allow for greater blood flow. Nitroglycerin (Nitrostat) is the most widely nitrate. Relief is normally obtained within a few minutes after taking the medication. Some users may develop headaches, flushing and dizziness as a result of taking this medication. People who have frequent attacks may require longer lasting preparations. Drugs such as isosorbide dinitrate (Isonate, Isordil, Sorbitrate) and the new isosorbide mononitrate (Ismol) are examples of longer lasting preparations. These help prevent attacks from occurring. One problem with these preparations is that your body may develop tolerance as you use it for a while. They also are more likely to cause side effects such as headache and dizziness. It is also important to use fresh medications. Nitrates lose their effectiveness very quickly. Store them in a dark, tightly closed bottle.

Beta-adrenergic blockers lower blood pressure and reduces the cardiac oxygen consumption. They work by inhibiting the transmission of nerve signals to the heart. This slows the heart and hence the heart consumes less oxygen. Usually beta blockers are given to reduce the heart rate and is effective in combination with nitrates or alone. Examples of prescription drugs that fall under beta blockers are: metoprolol (Lopressor) and propranolol (Inderal). Beta blockers are considered quite safe. But some patients may experience insomnia, nightmares, and fatigue. It may cause a slight rise in cholesterol levels, possibly leading to more angina pain. A new generation of beta blockers (e.g.., acebutolol (sectral)) can help stop anginal pain without causing rise in cholesterol levels.

Calcium channel blockers work by relaxing muscles that surround the blood vessels. This causes the vessels to widen, allowing more blood and oxygen to reach the heart. Prescription medications such as diltiazem (Cardizem), nifedipine (Adalat, Procardia) and verapamil (Calan, Isoptin, Verelan) are all Calcium channel blockers. Some patients may feel dizzy and light headed after taking calcium channel blockers. Some have reported ankle swelling.

Patients with severe unstable angina are often treated with the anticoagulant heparin in conjunction with aspirin, nitrates, and beta blockers.

If drug therapy does not work, or is not enough, coronary artery angioplasty or bypass surgery may be required.

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