The therapy of angina pectoris is divided into different areas. These include symptomatic therapy during an acute attack of angina pectoris, long-term drug therapy and the reopening of narrowed vessel sections (revascularization). Possible measures are listed below and then explained in more detail.
In the case of an acute attack of angina pectoris, the patient is given one or two sprays of nitroglycerine under the tongue, which can alleviate the symptoms within a few minutes. Caution is advised when taking sexual enhancers such as Viagra at the same time: the combination of both drugs can lead to a life-threatening drop in blood pressure. Long-term therapy is intended to prevent the further occurrence of angina pectoris attacks and to delay the progression of the disease.
The most important measure is a healthy lifestyle: Stopping smoking, weight reduction and regular light endurance training, for example in heart sport groups. In addition, existing high blood pressure, diabetes mellitus and elevated blood lipid levels should be treated. These basic measures are supported by drugs which, depending on the active ingredient they contain, improve the oxygen supply to the heart or reduce the heart’s oxygen requirement.
In the case of high-grade constrictions of more than 50% of the diameter in a coronary vessel, cardiologists perform interventional balloon dilatation (PTCA) using minimally invasive techniques. Usually a vascular support, a so-called stent, is then implanted to keep the lumen of the coronary artery open. The mortality rate of the procedure is 0.5% in patients with stable angina pectoris.
The success rate of this procedure is very high at up to 95%, but the implanted stent closes in up to 40% of patients in the first six months, triggering renewed angina pectoris. To prevent stent occlusion, patients must take anticoagulants for up to one year. In case of severe narrowing of several coronary vessels or the main vessel, a bypass operation is performed in cardiac surgery.
This involves bypassing the narrowed vessel sections by implanting a vein or artery in the patient. The vena saphena magna or the arteria mammaria interna is usually used. The mortality rate of this procedure is 1-3% with stable angina pectoris.
The surgery reduces the mortality rate within the first five years by 30% compared to drug treatment in patients with multiple affected vessels. The success rate is high with 80% of patients free of complaints after the operation, venous bypasses close in 30% of cases after five years, arterial bypasses close much less frequently. – Nitrospray
- Drug therapy
- Bypass surgery
Nitrospray is the typical emergency medication for people suffering from angina pectoris.
The nitroglycerine contained in the nitrospray releases nitric oxide (chemical formula: NO) in the body. This acts on the smooth muscle cells of the vessels and leads to relaxation there. This causes the vessels to dilate.
Through the inhalation of nitrospray it reaches the lungs from where it is transported with the blood flow directly into the heart, where it causes a dilatation (widening of the vessels) at the coronary vessels. This vascular dilatation leads within a very short time to a significantly improved blood supply to the heart muscles and thus relieves the angina pectoris attack. Acute therapy consists of the administration of one to two strokes of nitroglycerine spray and anticoagulants (heparin and ASA).
If necessary, additional oxygen and strong painkillers (morphines) can be administered. Long-term drug therapy includes the treatment of the underlying coronary heart disease. It should consist of ASA, a beta blocker, a statin and an ACE inhibitor or aldosterone antagonist.
These drugs improve the prognosis of CHD and reduce the mortality rate. ACE (aspirin) is an anticoagulant that inhibits the blood platelets and thus reduces the attachment of these cells to endothelial damage. Beta-blockers are actually drugs used to treat high blood pressure and prevent attacks of angina pectoris.
Statins have a regulating effect on the fat metabolism and lower the LDL cholesterol level, which means that less cholesterol is built into the vessel walls. ACE inhibitors lower blood pressure and thus reduce the oxygen demand of the heart. In addition, they inhibit the so-called remodelling of the heart, a process in which the heart muscle tissue is pathologically altered as a result of CHD.
Aldosterone antagonists belong to the group of diuretics (water-driving agents) and also counteract these remodeling processes. The stent is a small wire mesh which can be inserted into a narrowed coronary vessel. A catheter is used to place the stent in the vessel.
There it should keep the vessel open and thus prevent angina pectoris attacks. The decision to use a stent depends on the symptoms of the person affected. The greater the degree of suffering, the more likely one is to resort to a stent.
A vascular constriction is considered critical if more than 50% of the vessel is blocked. Therefore, a stent is used from a stenosis degree of about 50%. You can find everything about this topic here: StentBypass is a method of bypassing blocked or severely constricted vessels.
A vessel from the body (often a piece of a leg vein) is removed and sutured to the heart in such a way that the blood flow is diverted around the congested area. Since bypass surgery is a more extensive procedure than the insertion of a stent, bypasses are usually only inserted if the stent fails or the insertion of a stent is not possible. Bypass surgery is also not performed in every patient with angina pectoris.
The decision to use bypass depends on the severity of the symptoms. Homeopathy plays an important role in the treatment of many diseases in addition to the medications of traditional medicine. In the case of angina pectoris, homeopathic gold drops are used in particular.
Arnica and Pulsatilla are also used. Medicinal plants that help with angina pectoris are the helmet herb and sage leaves. The homeopathic treatment also includes changing the diet from animal fats to a fibre-rich and balanced diet. Green vegetables and nuts are particularly valuable in this respect. As homeopathic remedies can interact with classical medicines, it is essential to inform the doctor about the intake of such remedies.