Aging & Health A to Z
Coronary Artery Disease, Angina
Care & Treatment
Find diet, exercise, and other strategies to help prevent and manage coronary artery disease in the Prevention section.
In addition to lifestyle measures, your healthcare provider may decide that medications or surgery are necessary to treat your condition.
Ask your healthcare provider about the possible side effects of the medications he or she prescribes, and be sure to let him or her know if you experience side effects. But don’t stop taking your meds without talking to your healthcare provider first—this could worsen your condition, and certain medications are dangerous if stopped suddenly.
Blood thinners (antiplatelet drugs) help prevent blood clots.
- Aspirin is a key drug for treating coronary artery disease. The dosage varies from one “baby” aspirin (81 mg) to one regular-strength (325 mg) tablet per day, depending on your condition. Potential side effects include stomach upset, ulcers, and bleeding problems. Though coated aspirin helps prevent stomach problems, also keep uncoated, full-strength aspirin tablets on hand in the event of a heart attack.
- Other common blood thinners include clopidogrel (Plavix) and prasugrel (Effient).
Nitroglycerin relaxes and widens blood vessels to your heart so that more blood can flow to the heart muscle. This helps relieve chest pain and makes breathing easier. Nitroglycerin tablets are usually placed under your tongue so that the drug quickly passes into your bloodstream. Since fainting is a possible side effect, it’s best to sit down before taking nitroglycerin. Nitroglycerin also comes in a cream, in a patch, or an aerosol spray.
Blood Pressure Medications
Treating high blood pressure can ease angina pain and decrease your risk of heart attack and other conditions, such as stroke and kidney disease. Generally, blood pressure is treated if it is higher than 140/90 mmHg, or 130/80 mmHg in people with diabetes or chronic kidney disease. A particular class of blood pressure medications known as "beta blockers" are especially helpful in people with coronary artery disease.
Several medications can raise the level of “good” HDL cholesterol and lower the level of “bad” LDL cholesterol in your blood. This helps prevent plaque buildup in your coronary arteries, and are especially important right after a heart attack.
- Statins block a substance that your body uses to make cholesterol. Common statins include atorvastatin (Lipitor), lovastatin (Mevacor), rosuvastatin (Crestor), and simvastatin (Zocor). Ask your doctor about prescribing a generic form, which is less expensive and equally as effective.
- Niacin (vitamin B-3 or nicotinic acid) helps raise your “good” HDL cholesterol and lower “bad” LDL cholesterol. Niacin can cause itching, redness, or a tingling feeling under your skin. To minimize these effects, do not drink alcohol or hot beverages shortly after you take niacin. Once your body is used to niacin, these effects usually go away.
- Fibric acid or "fibrates" are used when triglycerides are high in addition to high "bad" LDL cholesterol.
Severely narrowed coronary arteries may require surgery to prevent a heart attack.
Angioplasty and Stent Placement
In this procedure, your doctor will thread a tiny collapsed “balloon” through a very thin tube into your damaged coronary artery. When the balloon inflates, it opens the blockage. A small stent (a wire mesh cloth) is often left inside the artery to help keep it open. Some stents contain a slow-releasing medication that also helps keep the artery open.
Coronary Bypass Surgery
In this surgery, a new artery is connected (grafted) to the blocked artery, from a point just before the blockage to just after it. This allows the blood to bypass the blockage. The graft is often a vein taken from another part of your body. Since this procedure requires open-heart surgery, your doctor usually recommends it only when multiple coronary arteries are blocked.
Complications of Coronary Artery Disease
Chronic Stable Angina
If you have coronary artery disease, you may experience chest pain, or angina, that occurs in situations when the heart muscle requires increased oxygen.
The causes of stable angina usually include:
- Strenuous physical activity
- Large meals
- Cold weather
- Severe emotional stress .
If you have stable angina, you’ll begin to recognize the things that bring on chest pain, and you can modify your activities accordingly. For example, usually as soon as you slow down or stop exercising, your chest pain will improve and eventually go away.
Angina pain usually does not last more than a few minutes, and it is relieved by taking nitroglycerin or another medication.
If you have chronic stable angina, you should notify your doctor if you:
- Have angina symptoms more frequently.
- Have angina when you are at rest.
- Feel tired more often.
- Feel dizzy or faint.
- Feel like your heart is skipping beats, or is beating very slowly or very fast.
Call 911 if your angina pain:
- Becomes stronger
- Does not go away after 15 minutes
- Does not go away after three doses of nitroglycerin
- Comes back after being relieved by nitroglycerin at first
These may be signs of a heart attack.
Heart Attack (also called myocardial infarction, or MI)
A heart attack occurs when a coronary artery becomes almost completely, or totally, blocked, usually due to a blood clot. The heart muscle becomes damaged due to a lack of blood flow and oxygen and can start to die if not treated quickly.
The pain of a heart attack is similar to that of angina, but it usually lasts longer and is more severe. It is sometimes described as “crushing” or “viselike.” It usually occurs in the center of the chest, but can also occur in the left chest or down the left arm.
Heart attack pain can vary among individuals, and women’s symptoms can be different than men’s. Pain may not come on suddenly. It might build over time, and begin as something that feels like indigestion or heartburn. Sometimes the pain comes and goes.
Heart attack symptoms include:
- Upper body discomfort in one or both arms, the back, neck, jaw, or stomach
- Shortness of breath
- Feeling sick to your stomach or vomiting
- Dizziness or fainting
- Breaking out in a sweat
- Unexplained anxiety, particularly for women.
If you think you are having a heart attack, call 911 immediately. The first minutes to hours after a heart attack are critical to your survival, so don’t delay. Getting treatment early can greatly decrease the damage to your heart muscle and improve your chances of recovery.
While you’re waiting for the ambulance, chew a non-coated, full-strength (325 mg) aspirin tablet, or 3 baby aspirin, which helps thin the blood and prevent clots. Be sure to tell the doctor in the emergency room you have already taken aspirin so that you don't receive another dose.
An emergency room doctor can inject you with “clot-busting” drugs such as TPA or TNK during or shortly after a heart attack to break up any blood clots.
Because of improved treatment and better public awareness of heart attack symptoms, most people survive heart attacks and are able to life full and normal lives, following treatment and rehabilitation.
Heart Attacks in Women
Women can experience the signs of a heart attack differently than men. While chest pain is still the most common symptom, it may be milder or may not be present at all.
Women are more likely to have pain in the jaw or back, or have some of the other symptoms, particularly shortness of breath and nausea and vomiting, or even anxiety.
Most heart attacks in women occur after menopause. Menopause increases the risk in older women because of a loss of estrogen, followed by an increase in “bad” LDL cholesterol levels.
Updated: March 2012
Posted: March 2012