Treatment options for angina 




Lifestyle changes

Eating a healthy, low-fat diet; reducing salt and alcohol consumption; losing weight if overweight; regular exercise; quitting smoking

  • May prevent symptoms worsening
  • Reduces your risk of heart disease, heart attack, stroke, cancer
  • None

Medication

Nitrates

Medications such as glyceryl trinitrate and isosorbide mononitrate that help widen the blood vessels, increasing blood flow to the heart

  • Can immediately relieve symptoms
  • Can be used to prevent angina attacks
  • Only needs to be taken when needed
  • Will not prevent symptoms returning
  • Can cause headaches, dizziness
  • Glyceryl trinitrate tablets will need to be replaced about every eight weeks
Beta-blockers

Medication that relaxes the muscles of the heart, which slows the heartbeat, meaning it requires less oxygen

  • Helps prevent or reduce frequency of symptoms
  • Not usually suitable for people with chronic lung conditions, such as asthma or COPD
  • Can cause side effects if taken with certain other medications
  • May need to be taken every day for life
  • Can cause tiredness, diarrhoea, and cold hands and feet
Calcium channel blockers

Medication that relaxes the muscle wall of the arteries, increasing blood flow to the heart

  • An effective option for those unable to take or tolerate beta-blockers
  • Side effects normally pass within a few days
  • May need to be taken every day for life
  • Can cause a serious drop in blood pressure if you drink graprefruit juice while taking them
  • Can cause flushed face, headaches, swollen ankles, dizziness, tiredness, skin rashes
Long-acting nitrates

Works in a similar way to glyceryl trinitrate in that it improves the flow of blood to the heart 

  • Can provide long-term prevention of symptoms in some cases
  • May need to be taken every day for life
  • Can cause a serous drop in blood pressure if taken with sildenafil (Viagra)
  • Side effects include headache and flushed face; these should improve with time
Ivabradine

Has similar effect to beta-blockers, in that it slows down heartbeat 

  • Useful alternative for people who are unable to take beta-blockers for medical reasons
  • May need to be taken every day for life
  • Common side effect is temporary flashes of light in field of vision; can make driving at night unsafe
Nicorandil

Works in a similar way to calcium channel blockers by relaxing the muscles of the arteries, improving blood flow

  • Useful alternative for people who are unable to take calcium channel blockers for medical reasons
  • May need to be taken every day for life
  • Side effects include dizziness, headaches, feeling sick
Ranolazine

Relaxes muscles of the heart, improving the flow of blood

  • Unlike other angina medication, does not affect heartbeat speed, so can be used safely in people with heart failure or abnormal heart rhythm
  • May need to be taken every day for life
  • Side effects include constipation, dizziness, feeling very weak
Statins

Medication to lower your cholesterol level

  • Will help prevent heart disease, heart attacks and stroke
  • May need to be taken every day for life
  • Can cause muscle ache, constipation, diarrhoea, headaches, abdominal pain
Low-dose aspirin

Medication to reduce your risk of blood clots

  • Reduces your risk of a heart attack
  • Not usually suitable for people with a history of stomach ulcers or allergy to aspirin
  • Can worsen asthma symptoms
  • May need to be taken every day for life
  • Can cause upset stomach, nausea and vomiting
Clopidogrel

Medication to reduce your risk of blood clots

  • An effective option for those unable to take or tolerate aspirin
  • Usually needs to be taken for at least 12 months
  • Can cause diarrhoea, indigestion, stomach and bowel pain, nosebleeds, bruising and blood in the urine and stools
ACE inhibitors

Medication to lower blood pressure and improve heart muscle function

  • Lowers blood pressure, reducing your risk of heart attack and stroke
  • Not suitable if you have a history of kidney or heart disease
  • Annual blood and urine tests may be needed
  • Can cause side effects if taken with certain other medications
  • Less effective in black people
  • May need to be taken every day for life
  • Can cause dizziness, tiredness, headaches and a persistent dry cough

Surgery

Coronary artery bypass graft (CABG)

Invasive surgery, where a section of vein or artery is taken from another part of the body and used to bypass blood flow past the blocked artery

  • More effective than PCI in people aged over 65, people with diabetes, and people with extensive disease or poor heart muscle function 
  • Longer recovery time (about 12 weeks) and more post-operative pain compared to percutaneous coronary intervention
Percutaneous coronary intervention (PCI)

Non-invasive treatment, where a balloon and usually a stent are used to widen the coronary artery

  • Can relieve symptoms that fail to respond to medication
  • Shorter recovery time (one or two weeks) than CABG
  • Not suitable for everyone (for example, it can be difficult in people with an unusual blood vessel structure)
  • In around 1 in 25 cases, the coronary artery narrows significantly, meaning further treatment is needed