Other treatments that may be advised

Other drugs to prevent angina pains
A beta-blocker (described above) may be sufficient to prevent angina pains. There are also other drugs that can be taken in addition, if required, to reduce the number and severity of angina pains. There are many drugs that can be used, but they fall into three main groups.

• Calcium channel blockers 'relax' the coronary arteries to increase blood flow. Some of these drugs also reduce the heart rate at rest, and the rate of rise in the heart rate when you exert yourself. So, less oxygen is needed by the heart.
• Nitrate drugs work in a similar way to GTN.
• Potassium channel blockers work in a similar way to nitrates.

There are several types and brands in each group. They are all good at preventing angina pains. If the pains are not well controlled by taking one drug, then another drug can be added from another group. As the different groups of drugs work in different ways, combinations of these drugs complement each other. It is quite common to take a 'combination therapy' of two or three drugs to prevent angina pains. The possible side-effects vary between the different drugs. Therefore, if a particular drug does not suit, you may find that a different one is fine. The aim is to find a drug, or combination of drugs, that prevent your pains, but with minimal side-effects.

Note: even when taking regular medication to prevent angina pains, you can still take GTN for 'breakthrough' angina pains that may still occur from time to time.

Surgery and angioplasty
These treatments are an option if drugs fail to control the pains, or if the condition becomes severe with one or more coronary arteries becoming very narrow.医学 全在.线提供www.med126.com

• Angioplasty. In this procedure a tiny wire with a balloon at the end is put into a large artery in the groin or arm. It is then passed up to the heart and into the narrowed section of a coronary artery using special x-ray guidance. The balloon is then blown up inside the narrowed part of the artery to open it wide again. This procedure is only suitable in some cases as only arteries with short narrowed sections can be treated this way. (See separate leaflet called 'Coronary Angioplasty' for details.)
• Surgery. This involves an operation to bypass the narrowed sections of arteries with healthy blood vessel segments (grafts) which are taken from other parts of the body. The operation is called coronary artery bypass graft surgery (CABG). More blood can then get past into the heart muscle. Not all people with angina are suitable for this operation as it depends on where the narrowed arteries are.

Some common worries about angina

• 'Straining the heart' by exertion is a common worry. On the contrary, more physical activity is usually advised. You will normally be encouraged to exercise regularly. Physical activity helps to get the heart 'fitter' and improves the blood supply to the heart muscle.
• Sex. Some people with angina worry that the physical effort of having sex will damage the heart. This is wrong, and you do not need to stop having sex. If sex does bring on an angina pain, it may be helpful to take some GTN beforehand.
• Driving and flying. If you are a car driver, there is usually no restriction for driving your own car unless pains occur at rest, or while driving. However, you must inform your insurance company if you have angina. People with PSV or HGV licenses who have angina must stop driving and contact the DVLA. As regards flying, in general, if you can climb 12 stairs and walk 100 metres on the level without pain or getting very breathless, you are fit to fly as a passenger. People with frequent angina pains or unstable angina should avoid flying.

Some other points about angina

Stable angina and unstable angina
In most cases, angina pains come on with a certain amount of exertion, and you can predict the level of exertion that triggers a pain. This situation is called 'stable angina'. More than a million people in the UK have stable angina. It is common to have stable angina for many years. With treatment, most pains can be prevented. In time, over months or years, the pains may come on with a lesser amount of exertion.

If the pattern of your pain changes fairly suddenly, and the pains come on minimal exertion, or while you are resting, this is called 'unstable angina'. This is an emergency and needs immediate medical care.

Heart attack
If you have angina, you have a higher than average risk of having a heart attack (myocardial infarction). Briefly, a heart attack usually occurs when there is a sudden total blockage of a coronary artery. This is caused by a blood clot that forms over a patch of atheroma, and blocks the blood supply to a segment of heart muscle. However, your risk of having a heart attack is much reduced if you take aspirin and a statin - as discussed above.

Prolonged pain
If you have a pain that lasts longer than 15 minutes, or is different or more severe than usual, then call an ambulance immediately. It may be unstable angina or a heart attack and immediate medical care is needed.

Immunisation
People with angina should be immunised against the pnuemococcus, and have an annual 'flu-jab'.

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