What treatments are available for angina?

Hi, I'm Dr Sukh Nidja and I'm an interventional cardiologist working in central London. One question that we often get asked is, how is angina treated? Angina is a central chest discomfort that can occur whenever a patient undertakes activity and it's typically caused by narrowing of the heart arteries. This is usually of the main arteries that sit on top of the heart but can also be due to the micro vessels that are much harder to see using our usual tests. Patients with anxiety, particularly if it is stable, will require a number of different medicines in order to stabilize them and we consider a lot of different classes of medicines in turn until we have controlled the patient's symptoms. The first medication we typically tend to add is a beta blocker. Beta blockers are medicines that control heart rate and mean that the heart does not race when you are underdoing activity. This means that the heart is much more steady and stable and the symptoms are often improved just with this one medication. In some patients we use medications which we call vasodilators and there are calcium channel inhibitors that work very effectively to do this. They reduce the amount of pressure in the main aorta and all the other small blood vessels and therefore they reduce the amount of work that our heart has to do whenever you're exerting yourself and they can be a very effective treatment of angina. In other patients we have to use medications such as nitrate medicines. You may have seen patients having to take a spray under the tongue or take very small tablets and these medicines can be given in a long-acting form that provide the same effect as a short-acting spray but sustained over the day. The way these medicines work is to make sure the artery as big and open as possible. These medications may be used in combination and there are a number of more advanced medicines that we use in patients who continue to have chest discomfort despite these tablets. In those patients that continue to have symptoms and we've done our best to control them with our usual medications, then we do typically perform a procedure called a coronary angiogram in order to understand the heart arteries better. Once we performed angiogram we may see a narrowing in the heart artery and we may measure the blood flow through it using a technology called pressure wire which has increasingly grown in dominance around the world. In those patients with a reduction in blood flow then actually they may well be better off having something called a coronary stent to open up that artery and we know that these stents are very good at improving patient symptoms. However in some cases patients can have symptoms that are are due to a number of other factors including not heart related issues or even the microcirculation and so whilst coronary stents can certainly improve blood flow we may not relieve all of the symptoms. Even in patients who've had either coronary stents or even coronary bypass surgery they can continue to have some symptoms of chest tightness afterwards because there are lots of smaller bug vessels that may not well be treated by these technologies and that's why typically continuing medicines are very important. Other medicines that we like to give our patients include aspirin or another blood thinning medication and we typically do this because we worry about the potential for heart attack. In those patients who've had coronary stents taking blood thinning medicines is really important because the stents can block suddenly if they are stopped. Other medicines like statins are very useful for controlling cholesterol and have been shown to delay plaque progression that means the buildup of plaque in the heart arteries, stabilize the plaque of where it is. So taking statin is very important as well, although it's not strictly for the chest tightness as per se. So there are a number of different medicines. So we can summarize our treatment of angina as part of a process. We assess the patient and we try and understand what the cause is. We'd start a number of medicines which include beta blockers and vasodilators and other nitrate medicines. And in those patients with ongoing symptoms, we typically also perform a coronary angiogram to try and understand why they're having these symptoms. And in those cases where there is a significant problem, then they may well need angioplasty with stenting. And this is modern treatment of stable angina.