Therapy of angina involves aggressive treatment for CAD. The most beneficial therapy is aspirin. One systematic review has found that aspirin reduces the risk of death, heart attack and stroke in people with unstable angina. One commonly prescribed drug for angina likely to be beneficial is nitroglycerin, which is taken when discomfort occurs or is expected. Other medications considered important for treatment include thienopyridine therapy (Clopidogrel, Ticlopidine) – both aimed at inhibiting platelet function. Heparin, low molecular weight heparin or Coumadin (blood thinners) are aimed at anti-thrombin therapy. Beta-blockers slow the heart rate and lessen the force of the heart muscle contraction, reducing heart oxygen demand. These drugs also protect the heart from the effect of catecholamines (e.g., epinephrine) that may be toxic to the injured heart muscle. Cholesterol-lowering medications decrease the level of circulating cholesterol; ultimately reducing the size and formation of plaques. The exact combination of therapy is dependent upon the individual patient’s history, physical examination and EKG changes. If the patient continues to have angina or is a high risk patient, the physician may recommend cardiac catheterization, where a small tube is placed into a forearm or groin artery and dye is injected to look at the blood vessels of the heart (coronary arteries). Based on this test, the physician my recommend surgery, balloon angioplasty or stent placement.
Doctors may recommend surgery or angioplasty if drugs fail to treat the CAD and its symptoms (like angina) or if the risk of heart attack is high. Coronary artery bypass surgery is an operation in which a blood vessel is grafted onto a coronary artery to bypass the blocked or diseased section so that blood can get to the heart muscle. An artery from inside the chest (an "internal mammary" graft) or long vein from the leg (a "saphenous vein" graft) may be used.
Balloon angioplasty (PTCA) involves the insertion of a catheter with a tiny balloon at the end into a forearm or groin artery. The balloon is inflated briefly to open the vessel in places where the artery is narrowed.
Physicians may also use a mechanical device to open the arteries, called a stent. A stent is placed in a vessel via a catheter and is expanded to keep the artery open. The stents may be used as initial therapy or used after a balloon angioplasty depending upon the findings at cardiac catheterization.
Other catheter techniques are also being developed for opening narrowed coronary arteries, including laser and radiofrequency devices applied by means of catheters.
Angina implies an underlying coronary artery disease. Patients with angina are at an increased risk of heart attack compared with those who have no symptoms of cardiovascular disease. In contrast, when the pattern of angina changes—if episodes become more frequent, last longer, or occur without exercise—the risk of heart attack is much higher.
