John P. Cunha, DO, FACOEP
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
Daniel Lee Kulick, MD, FACC, FSCAI
Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Angina facts
- Introduction to angina
- What is angina and what are the symptoms of angina?
- What causes angina?
- What are other causes of chest pain?
- Why is it important to establish the diagnosis of angina?
- How is angina diagnosed?
- What are the treatment options for angina patients?
- Angina medications
- Angioplasty and coronary artery bypass surgery
- What's new in the evaluation of angina?
- What's new in the treatment of angina and heart attacks?
- Find a local Cardiologist in your town
What are the treatment options for angina patients?
Treatment options include:
Treatment options include:
- medications (nitroglycerin, beta blockers, or calcium channel blockers),
- percutaneous coronary intervention (stenting or transluminal coronary angioplasty (PTCA), or
- coronary artery bypass graft surgery (CABG).
Resting, nitroglycerin tablets (placed under the tongue), and nitroglycerin sprays all relieve angina by reducing the heart muscle's demand for oxygen. Nitroglycerin also relieves spasm of the coronary arteries and can redistribute coronary artery blood flow to areas that need it most. Short-acting nitroglycerin can be repeated at five minute intervals. When three doses of nitroglycerin fail to relieve the angina, further medical attention is recommended. Short-acting nitroglycerin can also be used prior to exertion to prevent angina.
Longer-acting nitroglycerin preparations, such as Isordil tablets, Nitro-Dur transdermal systems (patch form), and Nitrol ointment are useful in preventing and reducing the frequency and intensity of episodes in patients with chronic angina. The use of nitroglycerin preparations may cause headaches and lightheadedness due to an excess lowering of blood pressure. Also these agents may be of danger when used with certain medications for erectile dysfunction.
Beta blockers relieve angina by inhibiting the effect of adrenaline on the heart. Inhibiting adrenaline decreases the heart rate, lowers the blood pressure, and reduces the pumping force of the heart muscle, all of which reduce the heart muscle's demand for oxygen. Beta blockers include:
- acebutolol (Sectral)
- atenolol (Tenormin)
- bisoprolol (Zebeta)
- metoprolol (Lopressor, Lopressor LA, Toprol XL)
- nadolol (Corgard)
- propranolol (Inderal)
- timolol (Blocadren)
- carvedilol (Coreg)
Side effects include of beta blockers include:
- worsening of asthma,
- excess lowering of the heart rate and blood pressure,
- increased cholesterol levels, and
- shortness of breath due to diminished heart muscle function (congestive heart failure).
Calcium Channel Blockers
Calcium channel blockers relieve angina by lowering blood pressure, and reducing the pumping force of the heart muscle, thereby reducing muscle oxygen demand. Calcium channel blockers also relieve coronary artery spasm. Calcium channel blockers include:
- amlodipine (Norvasc)
- bepridil (Vascor)
- diltiazem (Cardizem)
- felodipine (Plendil)
- isradipine> (Dynacirc)
- nicardipine, (Cardene)
- nifedipine (Adalat, Procardia)
- nimodipine (Nimotop)
- nisoldipine (Sular)
- verapamil (Calan)
Side effects of calcium channel blockers include:
- swelling of the legs,
- excess lowering of the heart rate and blood pressure, and
- depression of heart muscle function.
Other antianginal drugs
Ranolazine (Ranexa) is indicated for the treatment of chronic angina. Ranexa may be used with beta blockers, nitrates, calcium channel blockers, antiplatelet therapy, lipid-lowering therapy, ACE inhibitors, and angiotensin receptor blockers (ARBs).
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