Guidelines | Therapy of angina pectoris


The guidelines of the German Society of Cardiology contain recommendations for the treatment of angina pectoris. They are not binding for the attending physician, but are orienting and guiding. In summary, the guidelines suggest the following treatment concepts.

First, the patient should pay attention to a healthy lifestyle. Cholesterol levels and blood fats should be reduced by eating healthy, low-fat food and taking cholesterol-lowering medication. No smoking and possible overweight should be reduced.

Drug treatment includes ASS 100mg to prevent blood clots. In addition, drugs can be prescribed for the prophylaxis of seizures, nitrate is prescribed for an acute attack of angina pectoris. The patient can apply this medication under the tongue, whereby it is absorbed very quickly. If the drug therapy is not sufficient or if coronary heart disease with ischemia of the heart muscle is present, it is recommended to widen constrictions in the coronary vessels in the cardiac catheterization laboratory and possibly to take further measures such as stent implantation. If angina pectoris and coronary artery disease are severe, consideration should also be given to bypass surgery.


In the acute attack of angina pectoris, so-called nitro sprays are used, which act quickly and dilate the coronary vessels, thus alleviating the symptoms. Nitrate tablets, which can be dissolved under the tongue, act just as quickly. To prevent seizures, long-term medication must also be taken.

This consists of calcium antagonists such as amlodipine, which dilate the blood vessels and thus improve the blood circulation of the heart. Long-acting nitrate preparations have the same vasodilating effect. Beta-blockers are used in angina pectoris to reduce the oxygen consumption of the heart.

If high blood pressure exists, it should be treated with medication because of its damaging effect on the blood vessels. In addition to these drugs, patients with angina pectoris should take acetysalicylic acid (ASA). This prevents the formation of blood clots, which can cause a heart attack or stroke.

In addition, heparin is used to inhibit blood clotting and must be injected into the subcutaneous fatty tissue. In order to stop the progression of vascular disease, cholesterol-lowering statins are used, since lowering cholesterol levels counteracts plaque formation in the vessels. Are you more interested in this topic?

nitrospray is a drug that is typically used for the treatment of stable angina pectoris. In addition to this indication it is also used for the acute treatment of high blood pressure. The active substance contained is called nitroglycerin or glycerol trinitrate.

By releasing nitrogen molecules, it dilates the blood vessels and thus improves blood circulation or lowers blood pressure. Nitrospray is available only on prescription. One to two strokes can be sprayed into the mouth, preferably under the tongue. The active ingredient is then absorbed through the oral mucosa. The effect sets in very quickly.