Treatment

Treatment can help stop angina attacks and reduce the risk of further problems like heart attacks.

Most people with angina need to take several medicines. Surgery may be recommended if medicines don't help.

It's also important to make healthy lifestyle changes. Read about living with angina for information about this.

Medicines

Medicines to treat attacks

If you have stable angina (the most common type), you'll be given medicine to take when you have an angina attack.

This is called glyceryl trinitrate, or GTN. It comes as a mouth spray or tablets that dissolve under your tongue.

If you have an angina attack:

1. Stop what you're doing and rest.
2. Use your GTN medicine.
3. Take another dose after 5 minutes if the first one doesn't help.
4. Call 999 for an ambulance if you still have symptoms 5 minutes after taking the second dose.

You can also use GTN to avoid an attack before doing something like exercise. You may have a headache, flushing or dizziness soon after using it.

GTN tablets usually expire about 8 weeks after the packet is opened, at which point you'll need to replace them. GTN spray lasts much longer, so may be more convenient.

Medicines to prevent attacks

To help avoid more attacks, you'll also need to take at least 1 other medicine every day for the rest of your life. Some people need to take 2 or more medicines.

The main medicines used to prevent angina attacks are:

• beta-blockers – to make the heart beat slower and with less force
• calcium channel blockers – to relax the arteries, increasing blood supply to the heart muscle

If you can't have either of these medicines, you may be given another medicine such as ivabradine, nicorandil or ranolazine.

Medicines to prevent hearts attacks and strokes

Angina is a warning sign that you're at a higher risk of serious problems like heart attacks or strokes.

You may also need to take extra medicines to reduce this risk.

These include:

• low-dose aspirin to prevent blood clots
• statins to reduce your cholesterol (blood fats) level
• ACE inhibitors to reduce your blood pressure

Surgery

Surgery may be recommended if medicines aren't helping control your angina.

The 2 main types of surgery for angina are:

• coronary artery bypass graft (CABG) – a section of blood vessel is taken from another part of the body and used to reroute blood around a blocked or narrow section of artery
• percutaneous coronary intervention (PCI) – a narrowed section of artery is widened using a tiny tube called a stent

Both of these operations are similarly effective. The best one for you depends on your circumstances. If surgery is recommended, talk to your doctor or surgeon about your options.

You'll probably need to continue taking some medicines after surgery.

Unstable angina

If you have unstable angina (where symptoms develop unpredictably), you'll need medicines to prevent blood clots and reduce your risk of having a heart attack or stroke.

You may be given:

• low-dose aspirin
• clopidogrel
• an injection of a blood-thinning medicine soon after you're diagnosed

Surgery (either CABG or PCI) may be recommended if you have a high risk of having another angina attack, or you're at a high risk of having a heart attack or stroke.

Page last reviewed: Tue Mar 2021 Next review due: Fri Feb 2020