The Optimal Treatment for Angina Pectoris

Angina pectoris, a common symptom of coronary artery disease, often presents as chest pain or discomfort due to reduced blood flow to the heart muscle. During an acute angina attack, sublingual administration of nitroglycerin or isosorbide dinitrate can effectively relieve symptoms in most patients. These medications work by dilating blood vessels, improving blood flow, and reducing the heart's workload.

Immediate Relief During an Angina Attack

If the initial dose of nitroglycerin or isosorbide dinitrate does not alleviate symptoms, a second dose may be taken after a short interval. However, if chest pain persists despite two doses or lasts more than 20 minutes, it may indicate a more serious condition such as myocardial infarction (heart attack). In such cases, immediate medical attention is crucial, and emergency services should be contacted without delay.

Long-Term Management and Secondary Prevention

For patients diagnosed with coronary artery disease and chronic angina, long-term pharmacological therapy is essential to reduce the risk of future cardiac events. This approach, known as secondary prevention, typically involves a combination of medications tailored to the individual's health profile and cardiovascular risk factors.

Key Medications for Angina Management

Antiplatelet Agents: Drugs such as aspirin, clopidogrel, or ticagrelor help prevent blood clots by inhibiting platelet aggregation. These medications are foundational in reducing the risk of heart attack and stroke.

Lipid-Lowering Agents: Statins like atorvastatin, simvastatin, or rosuvastatin are prescribed to lower cholesterol levels, stabilize arterial plaques, and slow the progression of atherosclerosis. Maintaining healthy lipid levels is vital in managing coronary artery disease.

Beta-Blockers: Medications such as metoprolol tartrate or bisoprolol are used to reduce heart rate and myocardial oxygen demand. The goal is to maintain a resting heart rate around 60 beats per minute, which helps prevent angina episodes and improves overall cardiac efficiency.

ACE Inhibitors or ARBs: When blood pressure allows, angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) are recommended. These drugs help suppress neurohormonal activation, prevent ventricular remodeling, and offer additional benefits in patients with hypertension or heart failure.

Conclusion

Effective management of angina requires both immediate relief during acute episodes and a comprehensive long-term strategy. Patients should work closely with their healthcare providers to optimize medication regimens, monitor cardiovascular health, and adopt lifestyle changes that support heart function and reduce the risk of complications.