Nitroglycerin widens the coronary arteries to allow more oxygen-rich blood to flow to the heart. A heart attack is caused by a lack of oxygen to the heart causing damage to the heart muscle. What do you do if angina lasts longer than a few minutes? Call or your local emergency response number immediately. Types of angina The two most common types of angina are stable and unstable. Stable angina Usually lasts 5 minutes; rarely more than 15 minutes. Triggered by physical activity, emotional stress, heavy meals, extreme cold or hot weather.
Relieved within 5 minutes by rest, nitroglycerin or both. Pain in the chest that may spread to the jaw, neck, arms, back or other areas. May feel like the burning sensation of heartburn or indigestion. What you can do if you experience an episode of stable angina: Track what triggers it. Record how long it lasts. Note what helped ease the pain.
Unstable angina Often happens while you are resting. It occurs suddenly. You feel chest pain you did not have before. Discomfort lasts longer than stable angina more than 20 minutes.
Not relieved by rest or nitroglycerin. Episodes may get worse over time. What you can do if you experience an episode of unstable angina: Unstable angina should be treated as a medical emergency. Your doctor will do tests to find out if you are experiencing unstable angina. You may need medical treatment to prevent a heart attack.
Variant angina also called Prinzmetal angina Caused by a spasm in the coronary arteries. Spasms can be the result of exposure to cold weather, stress, smoking, cocaine use or medications that may tighten or narrow the arteries. Most people with variant angina have a severe blockage in at least one major coronary artery and the spasm usually happens close to the blockage.
Usually happens while resting, and during the night or early morning. Can be treated by medication. MVD affects the smallest blood vessels of the heart. Pain is more severe and can last longer than stable angina, sometimes 30 minutes or more. Pain is unpredictable. It can happen during exercise or while resting. Nitroglycerin may not relieve the pain.
The prognosis is surprisingly good for people with stable angina and normal pumping ability. Reduced pumping ability dramatically worsens the prognosis. The death rate each year for people with angina and no other risk factors is about 1. The rate is higher for people with risk factors such as high blood pressure, abnormal ECG results, or a previous heart attack, particularly in those who have diabetes.
Treatment begins with attempts to slow or reverse the progression of coronary artery disease by dealing with risk factors. Risk factors, such as high blood pressure and high cholesterol levels, are treated promptly.
Quitting smoking Smoking Cessation While often very challenging, quitting smoking is one of the most important things smokers can do for their health. Quitting smoking brings immediate health benefits that increase over time A low-fat, varied diet that is low in simple sugar carbohydrates and exercise for most people are recommended. Weight loss, if needed, is also recommended. Treatment of angina depends partly on the stability and severity of the symptoms.
When symptoms are stable and mild to moderate, the most effective treatment may be modification of risk factors and the use of certain drugs. If modification of risk factors and drug therapy do not cause symptoms to subside markedly, a procedure to restore blood flow to affected areas of the heart a revascularization procedure may be needed. When symptoms worsen rapidly, immediate hospitalization is usually required and the person is evaluated for an acute coronary syndrome Acute Coronary Syndromes Heart Attack; Myocardial Infarction; Unstable Angina Acute coronary syndromes result from a sudden blockage in a coronary artery.
Prevent angina from occurring beta-blockers, calcium channel blockers, sometimes newer drugs, such as ranolazine or ivabradine. Prevent and reverse coronary artery blockage angiotensin-converting enzyme [ACE] inhibitors, angiotensin II receptor blockers, statins, and antiplatelet drugs. Nitrates are a type of drug that dilates widens blood vessels and thus increase blood flow through that vessel. Nitroglycerin is a very short-acting nitrate drug.
Nitroglycerin is usually taken as a tablet placed under the tongue sublingual administration or as a spray inhaled through the mouth. Alternatively, the tablet may be placed next to the gum. People with chronic stable angina should keep nitroglycerin tablets or spray with them at all times. Taking nitroglycerin just before reaching a level of exertion known to induce angina may be useful.
Long-acting nitrates such as isosorbide are taken by mouth 1 to 4 times a day. Nitrate skin patches and paste, in which the drug is absorbed through the skin over many hours, are also effective.
Long-acting nitrates taken regularly can soon lose their ability to provide relief. Most experts recommend that people not take the drug for an 8- to hour period each day, usually at night unless that is when angina occurs.
This approach helps maintain the long-term effectiveness of the drug. Unlike beta-blockers, nitrates do not reduce the risk of heart attacks and sudden death, but they greatly reduce symptoms in people with coronary artery disease.
Beta-blockers interfere with the effects of the hormones epinephrine adrenaline and norepinephrine noradrenaline on the heart and other organs.
These hormones stimulate the heart to beat faster and more forcefully and cause most arterioles to constrict causing blood pressure to increase. Thus, beta-blockers reduce the resting heart rate and blood pressure. During exercise, they limit the increase in heart rate and in blood pressure and so reduce the demand for oxygen and decrease the likelihood of angina.
Beta-blockers also reduce the risk of heart attacks and sudden death, improving the long-term outcome for people with coronary artery disease. Calcium channel blockers prevent blood vessels from narrowing constricting and can counter coronary artery spasm. In addition to treatment of stable angina, these drugs are also effective in treating variant angina. All calcium channel blockers reduce blood pressure.
Some of these drugs, such as verapamil and diltiazem , may also reduce the heart rate. Reducing blood pressure and heart rate reduces the demand for oxygen and decreases the likelihood of angina. This effect can be useful to many people, especially those who cannot take beta-blockers or who do not get enough relief from nitrates. Angiotensin converting enzyme ACE inhibitors and angiotensin II receptor blockers ARBs are often given to people who have evidence of coronary artery disease, including angina.
These drugs do not treat angina itself, but they can reduce blood pressure and so reduce the work the heart has to do to pump blood and also they reduce the risk of heart attack and of death due to coronary artery disease. Statins Treatment Dyslipidemia is a high level of lipids cholesterol, triglycerides, or both or a low high-density lipoprotein HDL cholesterol level.
Lifestyle, genetics, disorders such as low thyroid hormone These drugs reduce the chance of heart attack, stroke, and death. Antiplatelet drugs, such as aspirin , ticlopidine , clopidogrel , prasugrel or ticagrelor , modify platelets so that they do not clump and stick on blood vessel walls.
Platelets, which circulate in the blood, promote clot formation thrombosis when a blood vessel is injured. Aspirin modifies platelets irreversibly and reduces the risk of death from coronary artery disease. Doctors recommend that most people who have coronary artery disease take aspirin daily to reduce the risk of a heart attack.
Prasugrel , ticlopidine , clopidogrel , and ticagrelor also further modify platelets in addition to aspirin. One of these drugs may be used in addition to aspirin for a period of time after a heart attack or PCI to reduce the chances of a future heart attack. An antiplatelet drug is usually given to people with angina unless there is a reason not to. For example, they are not given to people who have a bleeding disorder. Tests may include:. If necessary, your doctor will recommend imaging tests that can better evaluate the structure and function of the heart and blood vessels.
Variant angina is often treated with medications called calcium channel blockers. These medications can decrease variant angina attacks and are often used in combination with nitrates during attacks.
If another condition is contributing to your angina, such as CAD, then it will need to be treated as well.. The goal of treating variant angina is to stop the symptoms. Your doctor will work with you to come up with a plan that also includes:.
For example, heartburn , injury, or inflammation of the lungs may also cause chest pain. However, there may be no way for you to distinguish one type of chest pain from another. Therefore, any chest pain you experience should be evaluated by emergency medical services right away. It is important to note that you should not drive to the hospital.
Emergency medical services begin life-saving treatment on the way to the hospital, which could save your life if you are having a heart attack. However, if you have a history of variant angina, there are some things you can do to take care of yourself such as:. Acute coronary syndromes. Updated September 29, Accessed October 17, Coronary artery disease CAD.
Updated June 7, Variant angina and coronary artery spasm: the clinical spectrum, pathophysiology, and management. J Nippon Med Sch. Prinzmetal angina, variant angina, and angina inversa. American Heart Association website. Updated August 21, The spasms tend to come in cycles — appearing for a time, then going away. After six to 12 months of treatment, doctors may gradually reduce the medication.
Prinzmetal's angina is a chronic condition that will need to be followed by your healthcare provider even though the prognosis is generally good. Track your angina symptoms with our Angina Log. Written by American Heart Association editorial staff and reviewed by science and medicine advisers. See our editorial policies and staff.
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