Reviewed by Dr Neal Uren, consultant cardiologist and Dr Patrick Davey, cardiologist and Dr Stephen Collins, GP
What can the doctor do?
Your GP can:
help identify and reduce risk factors, eg by treating high cholesterol and high blood pressure that are not responding to lifestyle changes
prescribe medicines for relief of angina
refer you for further examinations by a cardiologist (heart specialist).
How is angina treated?
You may need to take several medicines to control symptoms and improve your angina.
Aspirin in low dose reduces the tendency of small blood cells called platelets to stick together, which helps prevent the formation of a blood clots.
Glyceryl trinitrate (GTN) relaxes the arteries of the heart and relieves angina attacks. GTN comes in sublingual tablet or spray form.
Long-acting nitrates reduce the frequency of angina attacks. These can be in the form of tablets or patches and are very effective. Their main side-effect is headache, but this often disappears once the nitrate has been taken for some weeks.
Beta-blockers block the effect of the hormone adrenaline so that the pulse is slowed and the blood pressure lowered. This reduces the heart's need for oxygen and improves the supply of blood to the heart muscle. They are also important in protecting the heart after heart attacks.
Calcium-channel blockers reduce the muscle tension in the coronary arteries, expanding them and creating more room. They also slightly relax the heart muscle, reducing the heart's need for oxygen and reducing blood pressure.
The potassium-channel activator nicorandil reduces muscle tension in the blood vessel walls, expanding them and improving the flow of blood and the supply of oxygen.
Surgery
If you have severe angina that is not responding to medication, a cardiologist may decide you need surgery to restore heart function to an adequate level and reduce the likelihood of a heart attack.
This can be done by one of the following operations.
Angioplasty: the narrowed coronary artery is dilated (opened up) with a balloon.
Bypass operation: a superficial blood vessel is taken from another part of your body, usually the leg, and joined to the coronary artery to bypass the obstruction to blood flow.
What can be done to prevent angina?
Many of the risk factors for angina can be tackled by lifestyle changes.
Eat a varied and healthy diet with plenty of leafy vegetables. Avoid sugary foods and saturated fats found in meat and full-fat dairy products.
Stop smoking. Your doctor or pharmacist will be able to provide advice about stop-smoking programmes and medicines that can help you quit.
Lose weight if you are overweight.
Exercise more: aim for a half-hour walk each day.
If you have diabetes or high blood pressure, maintain treatment for these conditions.
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