Unstable Angina
Alternate Names : Unstable Angina Pectoris
What are the treatments for the condition?
A person who has unstable angina is usually hospitalized. This allows the
healthcare provider to determine if the person is having a heart attack, which can cause the same symptoms as
unstable angina. The provider will attempt to optimize the person's medication
regimen. The types of medications include the following:
nitroglycerin, to expand the small arteries and veins
beta-blockers, to reduce the work of the heart
blood thinners, to reduce the chance of clotting in the already narrowed
arteries
Calcium channel blockers, such as
diltiazem, nifedipine, or
verapamil, have been used for over 20
years to open the coronary arteries and lower high blood pressure. However, the findings of
2 recent studies have shown that people who take a calcium channel blocker
have a much higher incidence of complications than people taking other
medications for coronary artery disease and high blood pressure. One study,
for example, found that the risk of heart
attack was 27% greater and the risk of congestive heart failure was 26% higher for those taking a calcium channel blocker. The American Heart
Association recommends discussing risks and benefits of the
medication with the healthcare provider.
Sometimes the even the best combination of medications fails to control angina. In this
case, surgery may be used to restore blood flow to the affected areas of the
heart. Common procedures include:
percutaneous transluminal coronary angioplasty, or PTCA. In this procedure,
a tube containing a balloon is inserted into the blocked artery and inflated. This reopens the artery and allows blood to flow.
heart bypass surgery, also
known as coronary artery bypass graft or CABG. In this procedure, veins taken
from the legs or arteries taken from the chest are used to bypass the narrowed
or blocked portion of the arteries in the heart.
a stent, or narrow tube, which is placed into the artery at the reopened
area to keep it from narrowing again
laser surgery, which uses light
waves to dissolve plaque
atherectomy, a surgical procedure in which plaque that causes narrowing of
a blood vessel is removed
What are the side effects of the treatments?
Beta-blockers can cause:
a slow heartbeat
low blood pressure
depression
erectile dysfunction
unpleasant dreams
Calcium channel blockers can cause:
flushing
nausea
headache
swelling of the ankles
low blood pressure
weakness
a higher risk of heart attack and
congestive heart failure
Nitrates can cause headaches and low blood pressure. Aspirin and warfarin
increase the risk of bleeding. Surgery can result in infection, bleeding, and
allergic reaction to anesthesia.
What happens after treatment for the condition?
A person whose unstable angina has been relieved will be monitored in the
hospital to be sure the treatment continues to work. If the person has had
surgery, the healthcare provider will also check to be sure that the blood flow
does not suddenly become blocked again. A cardiac rehabilitation program will be started and
will continue after the person leaves the hospital.
A person with unstable angina should make every effort to reduce coronary risk factors. This may include the following:
smoking cessation, control of other
diseases such as diabetes and high blood pressure, and following a healthy
diet to minimize heart disease. Medications
may need to be adjusted to achieve the best response.
How is the condition monitored?
A person who has been treated for unstable angina will periodically have an
ECG done during exercise. This
will show how the heart is working with the remaining blood supply. Cardiac catheterization may need to be
repeated in the future, especially if chest discomfort returns. Any new or
worsening symptoms should be reported to the healthcare provider.
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