Treatments

Angina is your body’s way of telling you that you have coronary artery disease (CAD). Unfortunately, there’s no magic pill for angina, and it cannot be “cured,” but you can find some relief by working with your doctor to find the right treatment for you. Doctors develop guidelines based on research to help them determine the best treatment plan for each patient. The research on angina shows that medication can make a significant difference, so the guidelines recommend a combination of lifestyle changes and medication before trying medical procedures.

Lifestyle adjustments

Following heart-healthy lifestyle habits that focus on diet, weight management, physical activity, and stress management can reduce your symptoms of angina, thereby also helping to slow the buildup of plaque in your arteries and to reduce your risk of having a heart attack.

Adopt a heart-healthy diet—Maintaining a healthy weight and eating a healthy diet that is low in fat and salt will reduce your risk of heart attack and stroke.
Stop smoking—Smoking is one of the most significant risk factors for coronary artery disease (CAD)—the main cause of angina—stroke, and heart attack. If you smoke, it's a good idea to talk with your doctor about strategies to help quit smoking.
Maintain an ideal body weight—Excess weight contributes strongly to the critical risk factors for heart disease such as diabetes and high blood pressure. You can do a lot to reduce your risk of heart disease with a healthy diet and a regular program will also help you maintain your ideal body weight.
Exercise regularly—Making regular physical activity part of your lifestyle is one of the most effective ways to improve your heart health. You should aim for at least 30 minutes of activity five days a week. For more information, check out the Centers for Disease Control and Prevention’s (CDC’s) recommended physical activity levels.
Manage your stress—Whether you realize it or not, your mind and body are closely connected. Anxiety and other powerful emotions are driven by thoughts but felt by the body. When you’re stressed or scared, chances are your heart beats faster and it’s harder for you to breathe. It makes your heart work harder, which means you might have angina. Taking a positive approach to life, setting realistic expectations, and discovering healthy ways to relax and manage your stress can help you reduce your symptoms.
Ask your doctor about cardiac rehabilitation—It’s not easy to change so many areas of your life all at once. Cardiac rehabilitation is a great way to learn new habits and build a support system by meeting other people who are making similar changes. It may also reduce your risk of depression—a problem that is common among people with heart problems.

Medications

Although nitroglycerin is prescribed for immediate symptom relief, your doctor may also prescribe one or more of the medications listed below reduce your symptoms of angina as well as reduce your risk of having a heart attack and other cardiovascular problems. For these medications to be effective, they must be taken as prescribed.

Medication Type	Purpose
Antiplatelet medications (clopidogrel, prasugrel, ticagrelor)	To thin the blood and help prevent and dissolve clots, especially in arteries and stents
Aspirin	To prevent and dissolve blood clots in the arteries
Beta-blockers	To lower blood pressure and heart rate, thus reducing oxygen demands on the heart
Calcium channel blockers	To lower blood pressure and/or heart rate, thus reducing oxygen demands on the heart, and to dilate the arteries of the heart
Long-term nitrates	To decrease episodes of angina daily
Ranolazine	To favorably affect the metabolism of the heart muscle and increase the amount of time that one can exercise before angina occurs
Short-term nitrates	To relieve or prevent angina on an as-needed basis
Statins	To lower cholesterol level and reduce the risk of heart attack and stroke

Angioplasty and stenting

If you find that after making significant changes to your lifestyle and taking medication, you don’t see enough improvement in your symptoms, talk to your doctor about angioplasty and stenting. Angioplasty is a minimally invasive procedure to open arteries blocked or narrowed by plaque to increase the flow of oxygen-rich blood to the heart.

Angioplasty is performed by inserting a small tube (sheath) into an artery and then maneuvering long plastic tubes (catheters) up to the arteries of the heart to take pictures that are used in identifying blockages interfering with blood flow to the heart. Once the blockages are identified, the catheter can also be used to insert a mesh tube (stent) permanently into the artery to keep it open.

Coronary artery bypass graft (CABG)

If your angina has led to a lengthy, narrowed portion of an artery, a severe blockage of an artery, or a blockage in a critical location, your doctor may recommend a coronary bypass surgery, also known as a coronary artery bypass graft (CABG).

In this procedure, a surgeon cuts the blocked artery and then attaches a new blood vessel (from another part of the body) above and below the blockage. By providing a channel for the blood to bypass the blockage, the new vessel (graft) allows blood to flow to the leg and foot.