Angina, unstable - Treatments
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Unstable angina is serious. You need to get emergency treatment at hospital. But if you get treatment quickly, you have a very good chance of not getting a heart attack.
The first treatments you are likely to have will:[1]
- Relieve the pain in your chest
- Stop the clot in your coronary artery getting any bigger.
You may also be offered other drugs to lower your risk of getting new blood clots.[1]
Your tests may show that you have a medium or high risk of getting worse and that the arteries to your heart are badly blocked. In that case, your doctor may advise you to have a procedure to widen them. You may have this as soon as possible or later on.[1] It depends on how well you are and what treatments you can get at your hospital. For more on how doctors determine your risk, see Unstable angina: working out your risk.
When you leave hospital, you will probably need to keep taking medicine every day for the rest of your life. This should lower your risk of getting another attack of unstable angina and of having a heart attack.
Key points about treating unstable angina
- Some treatments work best if you get them quickly. If you think you may be having an attack of unstable angina, call 999 straight away.
- In hospital, injections of drugs called nitrates will help the pain in your chest. You may also be given a drug called a beta-blocker, so your heart doesn't work so hard.
- Two other drugs, aspirin and clopidogrel, stop your blood clotting too much. They lower your risk of having a heart attack or stroke, and of dying. You might be given both these medicines or just one.
- You may also be given drugs to lower your risk of blood clots. One is called heparin. These drugs can lower your risk of having a heart attack and of dying.
- If tests show that a coronary artery is very narrow, you may have a procedure called angioplasty to widen it. If you have this, you may also have an injection of a drug called a glycoprotein IIb/IIIa inhibitor.
- After you leave hospital, you will probably need to keep taking some drugs every day.
- You and your doctor can also discuss other things you can do to stay as healthy as possible. These include stopping smoking, losing weight and taking more exercise. To learn more, see Unstable angina: what you can do to help yourself.
Treatments for unstable angina
There are several treatments for unstable angina. But which ones work best?
We have weighed up the evidence about treating unstable angina and divided the treatments into categories. You can find out more about each treatment by clicking on the links.
For help in deciding which treatment is best for you, see .
Treatments that are likely to work
- Clopidogrel: This is another drug that lowers your risk of blood clots. The brand name is Plavix. More...
- Glycoprotein IIb/IIIa inhibitors: These drugs help stop blood clots forming. There are three of them: abciximab (brand name ReoPro), eptifibatide (Integrilin) and tirofiban (Aggrastat). More...
- Direct thrombin inhibitors: These drugs also make your blood less likely to clot. But they do it in a different way from aspirin and clopidogrel. The names (and brand names) are bivalirudin (Angiox) and lepirudin (Refludan). More...
- Heparin: This is another type of drug that makes your blood less likely to clot. A type of heparin called unfractionated heparin (brand names Calciparine and Monoparin) works for only a short time. A newer type called low-molecular-weight heparin (LMWH for short) lasts longer. Some examples are dalteparin (Fragmin), enoxaparin (Clexane) and tinzaparin (Innohep). More...
Treatments that need further study
- Beta-blockers: These are drugs that make your heart beat more slowly, so it doesn't have to work so hard. Common beta-blockers (and their brand names) include atenolol (Tenormin), metoprolol (Lopresor) and propranolol (Inderal). More...
- Nitrates: These are drugs that widen your heart's blood vessels. Common nitrates (and their brand names) include isosorbide dinitrate (Cedocard Retard, Isoket Retard), isosorbide mononitrate (Elantan, Ismo, Imdur) and glyceryl trinitrate (GTN tablets, Nitrolingual pump spray, Nitromin, Nitronal, Nitrocine). More...
- Early coronary angioplasty: This is a procedure that widens the blocked artery in your heart. 'Early' means you have it soon after you're diagnosed with unstable angina. More...
Treatments that are unlikely to work
- Warfarin: This is a type of drug that makes your blood less likely to clot. The brand name is Marevan. More...
- Calcium channel blockers: These are drugs that make your heart beat more gently. Common ones (and their brand names) include diltiazem (Adizem, Dilzem, Tildiem), felodipine (Plendil), nifedipine (Adalat, Coracten SR) and verapamil (Cordilox, Securon, Univer). More...
References
- European Society of Cardiology. Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European Heart Journal. 2002; 23, 1809-1840.
Glossary
- heart attack
- Doctors call a heart attack an acute myocardial infarction (or acute MI). This is the name for the damage that occurs to the heart muscle if it isn't getting enough blood and oxygen because a branch of the is blocked. During a heart attack, you may have pain or heaviness over your chest, and pain, numbness or tingling in your jaw and left arm.
- coronary arteries
- Coronary arteries are the vessels that supply blood to the heart muscle. If yours are blocked, you may have a pain in your chest (known as ) or a heart attack (what doctors call an ) because parts of the heart are not getting enough blood and oxygen.
- stroke
- You have a stroke when your blood supply to a part of your brain is cut off. This damages your brain and can cause symptoms like weakness or numbness on one side of your body. You may also find it hard to speak if you've had a stroke.
© BMJ Publishing Group Limited ("BMJ Group") 2007. All rights reserved
This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.
