Forms of angina pectoris and their treatment:

Angina pectoris (chest tightness) is a symptom that usually occurs as part of a circulatory disorder of the heart vessels, known as coronary heart disease (CHD). A stable angina pectoris is present if it has occurred repeatedly and always to about the same extent. Although this is a symptom that indicates heart disease, it is not an acute emergency.

Medications are available to treat the unpleasant feeling of pressure in the area of the chest. These are preparations containing the active ingredient nitroglycerine, also known as glycerol trinitrate. In colloquial language they are often also called nitrates or nitrospray for short.

Nitroglycerin releases nitrogen (NO) in the body. This leads via a reaction chain to vasodilatation. The blood vessels, especially the coronary arteries (coronary arteries), are the trigger for the symptoms in an acute attack of angina pectoris.

Not enough blood passes through the vessels, resulting in reduced blood flow to the heart muscle. If nitroglycerine is now used, the blood vessels dilate and more blood reaches the heart. If angina pectoris is stable, the symptoms usually subside quickly after taking nitroglycerine.

Nitroglycerin is available in different forms, for example as a pump spray which has to be put under the tongue or as bite capsules. Angina pectoris often occurs during physical exertion. In addition to drug therapy, it is important to stop the physical strain immediately.

If the symptoms do not stop promptly after taking nitro preparations or if they feel different than usual, a doctor should be consulted immediately. Unstable angina pectoris is equivalent to acute coronary syndrome. In contrast to stable angina pectoris, in acute coronary syndrome it is to be assumed that an acute heart attack is present until proven otherwise.

Unstable angina pectoris is therefore initially an acute emergency, which requires an immediate medical presentation. The first doctor to treat the patient will immediately write an ECG and take blood samples to decide whether it is a heart attack or not. If ECG changes typical of a heart attack are detected, the patient should be transported immediately to a hospital where a heart catheter examination can be performed.

As soon as it is certain that it is a heart attack, certain drugs are given. These include acetylsalicylic acid (ASA) and heparin. Both substances serve to thin the blood.

A third blood thinner (usually clopidogrel or prasugrel) may also be given. Nitro preparations such as nitroglycerine can also be used in principle. However, they have no causal effect in unstable angina pectoris.

Depending on the accompanying symptoms, other drugs are used in unstable angina pectoris: morphine can be used for severe pain and to calm the symptoms. In the presence of a high heart rate, the use of drugs from the beta-blocker group may be considered. If the medical staff on site cannot immediately determine whether or not it is a heart attack, for example because no ECG machine is available or blood cannot be taken, drug therapy for unstable angina pectoris is usually started as soon as acute heart attack is suspected.

In the case of unstable angina pectoris, it is essential that the patient is quickly transported to a clinical facility for further diagnostics. Unlike angina pectoris, prinzmetal angina is not a vascular change due to calcification but a vasospasm. The musculature of the coronary arteries therefore cramps and thus leads to a short-term reduction in blood flow.

In acute cases, as with the classic form of angina pectoris, nitrate preparations are used for drug therapy. Furthermore, within the framework of prophylactic (preventive) therapy, drugs from the group of calcium antagonists are used for treatment. These include drugs such as verapamil, diltiazem and amlodipine.