Your doctor will decide on a treatment approach based on the type of angina you have, your symptoms, test results, and risk of complications. Unstable angina is a medical emergency that requires immediate treatment in a hospital. If your angina is stable and your symptoms are not getting worse, you may be able to control your angina with heart-healthy lifestyle changes and medicines. If lifestyle changes and medicines cannot control your angina, you may need a medical procedure to improve blood flow and relieve your angina.

• Medicines

If you are diagnosed with angina, your doctor will prescribe fast-acting medicines you can take to control angina events and relieve pain. Often, other medicines are also prescribed to help control angina long-term. The choice of medicines may depend on what type of angina you have.

• Anticoagulant medicines, or blood thinners, such as heparin, to prevent dangerous blood clots and future complications, such as a heart attack or another angina event.

• Antiplatelet medicines to prevent blood clots from forming. If you have stable or unstable angina, your doctor may recommend aspirin to treat angina and reduce the risk of complications of ischemic heart disease. Other platelet inhibitors, such as clopidogrel, may also be prescribed.

• Beta-blockers to help your heart beat slower and with less force. These drugs are often prescribed to help relieve angina. If you cannot take beta-blockers for some reason, long-acting nitrates are the preferred alternative.

• Calcium channel blockers to keep calcium from entering the muscle cells of your heart and blood vessels. This allows blood vessels to relax. Calcium channel blockers may be an alternative medicine if you are unable to take beta-blockers or nitrates. For variant angina, your doctor is likely to order calcium channel blockers and avoid giving you beta-blockers.

• Nitrates to widen and relax blood vessels, which allows more blood to flow to the heart while reducing the heart’s workload. Nitrate pills or sprays, including nitroglycerin, act quickly and can relieve pain during an event. Long-acting nitrates are available as pills or skin patches. If you are hospitalized with chest pain, your doctor may order intravenous (IV) nitrates to relieve your angina pain.

• Statins to prevent plaque from forming and to relieve blood vessel spasms or inflammation, reducing the risk of a heart attack or other complications after emergency treatment.

If you still have symptoms or experience side effects, your doctor may prescribe other medicines, including:

• Morphine to relieve pain and help relax the blood vessels. Your doctor may suggest it if other medicines have not helped.

• Ranolazine to help you have angina symptoms less often. When given with other anti-angina medicines, ranolazine can also increase the length of time you can be physically active without pain. This medicine may work for coronary microvascular disease, which causes microvascular angina. Ranolazine may be a substitute for nitrates for men with stable angina who take drugs for erectile dysfunction.

• Procedures

If lifestyle changes and medicines do not control angina, you may need a medical procedure to treat the underlying heart disease.

Coronary artery bypass grafting (CABG) to treat ischemic heart disease and relieve angina. CABG can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack. Your surgeon takes healthy arteries or veins from another part of your body and uses them to go around the blocked or narrowed blood vessels.

You can expect to stay in the hospital about a week after you have the procedure. You'll be in the intensive care unit for a day or two while nurses and doctors keep a close eye on your heart rate, blood pressure, and oxygen levels. Then, you'll move to a regular room to recover.

• Percutaneous coronary intervention (PCI), also known as coronary angioplasty, opens narrowed or blocked blood vessels that supply blood to the heart. This procedure requires cardiac catheterization. If PCI includes certain medicines to expand coronary arteries, the procedure may be helpful for some people who have variant angina.

• Angioplasty/stenting. The doctor threads a tiny tube, with a balloon inside, through a blood vessel and up to your heart. Then, they inflate the balloon inside the narrowed artery to widen it and restore blood flow. They may insert a small tube called a stent inside your artery to help keep it open. The stent is permanent and usually made of metal. It can also be made of a material that your body absorbs over time. Some stents also have medicine that helps keep your artery from getting blocked again.

The procedure typically takes less than 2 hours. You’ll probably stay overnight at the hospital.

Enhanced external counterpulsation

Enhanced external counterpulsation (EECP) may be an option to relieve your angina. Your doctor may recommend it if other treatments haven’t worked or aren’t right for you.

EECP uses several blood pressure cuffs on both legs to gently, but firmly, compress the blood vessels there to boost blood flow to your heart. Each wave is timed to your heartbeat. So more blood goes there when it’s relaxing.

When your heart pumps again, pressure is released right away. It lets blood be pumped more easily. It can help your blood vessels make a natural bypass around narrowed or blocked arteries that cause your chest pain. It may help some small blood vessels in your heart open. They may give more blood flow to your heart muscle to help ease your chest pain.

You might have EECP if you:

• Have chronic stable chest pain;

• Aren’t helped by nitrates, calcium channel blockers, and beta-blockers;

• Invasive procedures like bypass surgery, angioplasty, or stenting aren’t right for you.

EECP isn’t invasive. If you’re accepted for EECP treatment, you’ll have 35 hours of therapy. It’s given 1 to 2 hours a day, 5 days a week, for 7 weeks. Studies have shown its benefits include less need for anti-anginal medicine, fewer symptoms, and the ability to be more active without symptoms

• Lifestyle changes

You can still be active, but it's important to listen to your body. If you feel pain, stop what you’re doing and rest. Know what triggers your angina, like stress or intense exercise. Try to avoid things that tend to set it off. For example, if large meals cause problems, eat smaller ones and eat more often. If you still feel pain, talk to your doctor about having more tests or changing your medications. Because angina can be a sign of something dangerous, it’s important to get checked out.

These lifestyle tips may help protect your heart:

• If you smoke, stop. It can damage your blood vessels and increase your heart disease risk.

• Eat a heart-healthy diet to lower your blood pressure and cholesterol levels. When those are out of normal range, your chance of heart disease is higher. Eat mainly fruits and vegetables, whole grains, fish, lean meat, and fat-free or low-fat dairy. Limit salt, fat, and sugar.

• Use stress-relieving measures like meditation, deep breathing, or yoga to relax.

• Exercise most days of the week.

• See your doctor regularly.

If you have chest pain that is new or unusual for you, and you think you may be having a heart attack, call 911 right away. Quick treatment is very important. It can protect you from more damage.