Treatment:

The options for treating angina include lifestyle changes, medications, and procedures such as coronary angioplasty or stent placement and coronary artery bypass surgery.

You and your doctor should agree on a plan for treating your angina on a daily basis. This should include:

• What medicines you should be taking to prevent angina
• What activities are okay for you to do, and which ones are not
• What medicines you should take when you have angina
• What are the signs that your angina is getting worse
• When you should call the doctor or 911

MEDICATIONS

You may be asked to take one or more medicines to treat blood pressure, diabetes, or high cholesterol levels. Follow your doctor's directions closely to help prevent your angina from getting worse.

Nitroglycerin pills or spray may be used to stop chest pain.

Taking aspirin and clopidogrel (Plavix) or prasugrel (Effient) helps prevent blood clots from forming in your arteries, and reduces your risk of having a heart attack. Ask your doctor whether you should be taking these medications.

Your doctor may give you one or more medicines to help prevent you from having angina.

• ACE inhibitors to lower blood pressure and protect your heart
• Beta-blockers to lower heart rate, blood pressure, and oxygen use by the heart
• Calcium channel blockers to relax arteries, lower blood pressure, and reduce strain on the heart
• Nitrates to help prevent angina
• Ranolazine (Ranexa) to treat chronic angina

NEVER STOP TAKING ANY OF THESE DRUGS ON YOUR OWN. Always talk to your doctor first. Stopping these drugs suddenly can make your angina worse or cause a heart attack. This is especially true of anti-clotting drugs (aspirin, clopidogrel, and prasugrel).

Your doctor may recommend a cardiac rehabilitation program to help improve your heart's fitness.

SURGICAL TREATMENT

Some people will be treated with medicines and will not need surgery to treat a blockage or narrowing. Others will need a procedure to open narrowed or blocked blood vessels that supply blood to the heart.

• Angioplasty and stent placement (also called percutaneous coronary intervention)
• Blockages that cannot be treated with angioplasty may need a heart bypass

Expectations (prognosis):

Stable angina usually improves with medication.

Complications:

• Heart attack
• Sudden death caused by abnormal heart rhythms (arrhythmias)
• Unstable angina

Calling your health care provider:

Seek medical attention if you have new, unexplained chest pain or pressure. If you have had angina before, call your doctor.

Call 911 if your angina pain:

• Is not better 5 minutes after you take nitroglycerin
• Does not go away after three doses of nitroglycerin
• Is getting worse
• Returns after the nitroglycerin helped at first

Call your doctor if:

• You are having angina symptoms more often
• You are having angina when you are sitting (rest angina)
• You are feeling tired more often
• You are feeling faint or light-headed
• Your heart is beating very slowly (less than 60 beats a minute) or very fast (more than 120 beats a minute), or it is not steady
• You are having trouble taking your heart medicines
• You have any other unusual symptoms

Seek medical help right away if a person with angina loses consciousness.