Angina pectoris, also known as stable angina, is the medical designation for chest pain or discomfort caused by coronary heart disease. Angina pectoris hits when the cardiac muscle doesn’t receive as much blood as it requires. This mostly happens because one or several heart’s arteries are blocked or narrowed, a condition also called ischemia. In its own turn, ischemia is instigated by atherosclerosis (deposits of fat inside the arteries). Atherosclerotic angina constitutes about 90% of angina cases.
To further educate you on angina pectoris classification, let us add that less than 10% of angina cases are represented by vasospastic angina, also known as variant angina, rest angina, or Prinzmetal’s angina, which involves reversible coronary spasms occurring at the site of atherosclerotic plaques. Spasm can happen any time, even in sleep. Vasospastic angina may worsen into unstable angina. Cocaine abuse may trigger significant spasm in the coronary arteries and instigate a heart attack. Some rare angina cases are represented by microvascular angina, which may be a symptom of disorder in the small coronary blood arteries.
Angina pectoris usually produces fullness, uncomfortable pressure, pain or squeezing in central part of the chest. You might also experience the discomfort in your back, jaw, neck, arm or shoulder. Keep in mind that many types of chest discomfort — like lung infection, heartburn or inflammation — may not be related to angina.
Angina pectoris typically occurs when the heart muscle (myocardium) needs more blood than it is receiving, for example, during times of strong emotions or physical activity. Highly narrowed arteries might let in enough blood to enter the heart if the need for oxygen is small, for instance, if you’re sitting. But, when physical effort is involved — like climbing stairs or walking up a hill — the heart must work harder and it thus requires more oxygen.
Angina Pectoris Symptoms
Angina pectoris manifests via discomfort or pain that:
- Strikes when the heart must work harder, usually throughout physical activities
- Might feel like indigestion or gas
- Might feel like chest pain spreading to the back, arms, or other areas
- Doesn’t come as a surprise, and outbreaks of pain tend to feel alike
- Usually lasts for a short time (angina pectoris duration period is up to 5 minutes)
- Is relieved by rest or drugs
When a patient has underlying atherosclerosis, damage to the coronary arteries or spasm, angina symptoms usually are initiated by one of the following triggers:
- Physical efforts or exercise
- Emotional stress – deploy stress management
- Exposure to very cold or hot temperatures – learn how extreme weather affects the heart
- Heavy meals
- Declined oxygen content in the air, for example at high altitudes or when flying in an airplane
- Using a stimulant such as smoking cigarettes or consuming caffeine, which depresses the amount of oxygen in the bloodstream.
Normally, the angina-instigated chest discomfort can be relieved with nitroglycerin, rest, or both. If you have chest discomfort, be sure to visit your doctor for a complete evaluation and tests. If you have stable angina and start getting chest pain more often, see your doctor straightway as you may be seeing early signs of unstable angina.
Angina Pectoris Medications Online at Smart Canadian Pharmacy
Drugs used in angina treatment exploit two major strategies: decrease of oxygen demand and increase of oxygen supply to the myocardium. The most popular antianginal drugs include vasodilators, cardiac depressants, statins and anticoagulants.
- Long duration (transdermal nitroglycerin)
- Intermediate (oral nitroglycerin)
- Short duration (sublingual nitroglycerin)
- Calcium antagonists (also belong to a class of cardiac depressants)
- Beta blockers
- Calcium blockers
Other drugs (used in angina pectoris prevention):
Combination of nitrates, betablockers, and/or calcium antagonists is often required in cases with extreme limitation of exercise capacity.
At Smart Canadian Pharmacy, we offer a wide variety of drugs to manage angina and its underlying conditions.
Nitrates are the most popular drugs used to treat angina. Nitrates relax and widen blood vessels, thus allowing more blood to flow to myocardium. The most common type of nitrates used in angina treatment is sublingual nitroglycerin tablets (Nitrolingual, Nitro-Dur, Nitrostat). Nitroglycerin is only taken when the person actually experiences symptoms or anticipates having them. On the other hand, slow-acting nitroglycerin may be taken as a preventative treatment for angina pectoris, but not until beta blockers are attempted first. Other examples of nitrate drugs include: sosorbide dinitrate (Isordil, Dilatrate), isosorbide mononitrate (ISMO).
Calcium channel blockers (antagonists)
Calcium channel blockers, also called calcium antagonists, relax and widen blood vessels by working in the muscle cells along the arterial walls. This boosts blood flow into your heart, reducing or preventing angina. Calcium antagonists slow your pulse, in this way reducing the workload on your heart muscle.
Several calcium blockers are on the market, and they are not quite alike:
- The dihydropyradines. The drugs nicardipine (Cardene), felodipine (Plendil), nifedipine (Adalat, Procardia) and amlodipine (Norvasc) belong to the dihydropyridines. These medications cause strong dilation of blood vessels, while having relatively little effect on the heart rate and heart muscle. Dihydropyradines are particularly popular as hypertension treatment drugs.
- Verapamil (Calan, Isoptin, Covera, Verelan) affects the myocardium and is very effective in slowing the heart rate, while having little effect on blood vessels. Not useful in hypertension therapy, verapamil is quite good for treating angina and arrhythmias.
- Diltiazem (Dilacor, Cardizem, Tiazac) has modest effects on the blood vessels and the heart muscle, but tends to be better tolerated when compared with other calcium antagonists.
The longer-acting forms of verapamil and diltiazem are the most popular calcium blockers used for treating angina. Nifedipine should usually be avoided in angina patients, because the noticeable blood vessel dilation shaped by this medication can boost adrenaline, leading to a faster heart rate, increased cardiac oxygen needs, and thus, increase the odds of developing cardiac ischemia.
Beta blockers work by blocking the action of the hormone adrenaline. Consequently, heart beats with less force and more slowly reducing blood pressure and workload on the myocardium. This reduces the heart’s need for oxygen and thus lessens angina pectoris symptoms. Beta blockers are recommended for regular in-take, regardless of whether the patient is feeling angina symptoms, since they are proven to prevent myocardial infarction and sudden death.
Some beta blockers mostly affect the heart, while others affect both the heart and the blood vessels. Which one is optimal for you depends on your health condition and the problem at hand. Examples of oral beta blockers include: atenolol (Tenormin), acebutolol (Sectral), bisoprolol (Zebeta), betaxolol (Kerlone), metoprolol (Toprol-XL, Lopressor), nebivolol (Bystolic), nadolol (Corgard), propranolol (Inderal LA, InnoPran XL).
Aspirin decreases the ability of your blood to coagulate, so that blood flows easier through narrowed arteries. Preventing blood clotting decreases the risk of a heart attack. Daily aspirin therapy is often required to decrease the likelihood of sticky platelets in the blood forming a blood clot.
Statins, also known as HMG-CoA reductase inhibitors, are medicines used to decrease blood cholesterol levels. Statins work by hindering a substance your body requires to produce cholesterol. Statins might also assist your body in reabsorbing the cholesterol that has already accumulated in the plaques on your artery walls, thus preventing further impassibility in your blood vessels. Even when the blood cholesterol levels are normal or slightly increased, statins have been shown to stabilize the fatty plaques on the inner lining of the arteries. Low density lipoprotein (LDL) also known as “bad cholesterol” levels must be below 70 mg/dL for patients at high risk of coronary disease.
The most effective statin medications available on the market include atorvastatin, ovastatin, fluvastatin, pitavastatin, rosuvastatin, and pravastatin. Some mixed preparations of a statin with other agents, such as ezetimibe or simvastatin, are also obtainable at SmartCanadianPharmacy.com.
Sexual Activity in Chronic Angina Pectoris
Coital angina is angina that strikes during the minutes or hours after sexual activity and it represents less 5% of all angina attacks. Coital angina is typically rare in patients who do not have angina during vigorous physical exertion. On the opposite, it is more prevalent in inactive individuals with severe coronary disease who experience angina even with insignificant physical activity. Among such individuals, myocardial oxygen demand during coitus could exceed that during routine activities of daily lives. For those individuals, sex may become quite an examination.
As a rule, patients capable of climbing two or more flights of stairs without limiting symptoms or those able to complete stage II of a standard Bruce treadmill test are largely free of cardiovascular symptoms during their sexual activity. Such angina patients are a low-risk group and they constitute majority of angina patients (60-70%). Patients in this group might have suffered uncomplicated myocardial infarction 6-8 weeks ago, have controlled hypertension or mild form of valvular disease. Angina patients in this group can restart sexual activities or undergo treatment for erectile dysfunction – with PDE5 inhibitors – without further cardiac assessment.
High-risk angina patients typically have angina pectoris unstable, uncontrolled hypertension, might have suffered MI (myocardial infarction) or stroke syndrome within the recent two weeks, experience some form of cardiomyopathy, or moderate / severe valvuar disease. High-risk group makes 10-15% of angina patients. They should defer their sexual activity until their cardiac condition is stabilized after appropriate testing and treatment. High-risk patients should undergo angina pectoris examination and be properly treated before being considered for PDE5 inhibitors. Treatments that are deployed to reduce the risk of heart attack in these patients include combination pharmacotherapy, such as betablockers, angiotensin-converting enzyme (ACE) inhibitors, statins, and antiaggregants; as well as percutaneous coronary interventions (coronary angioplasty) and coronary artery bypass graft surgery.
The intermediate risk group consists of those patients whose risk profile lies between the high-risk and low-risk groups and makes 15-30% of all angina patients. Specialized cardiac testing such as treadmill exercise is often applied to reclassify the intermediate-risk patients into low risk or high-risk groups. Exercise tasting enables not only an objective evaluation of exercise tolerance, but also helps to identify predictive makers, such as blood pressure, heart rate, and workload at which symptoms of angina and fatigue develop.
ED Drugs For Patients With Angina Pectoris
Drugs for erectile dysfunction (ED) treatment may be contraindicated with nitrates frequently used to treat patients with angina pectoris, and certain antianginal therapies may even worsen ED. Clinical experts recommend that patients with coronary artery disease and ED who experience angina pectoris undergo full medical evaluations to assess the cardiovascular risks associated with continuing sexual activity before being prescribed therapy for ED.
Short- and long-acting nitrates constitute a strong contraindication with phosphodiesterase-5 inhibitors (Viagra, Levitra, Cialis) commonly used in ED treatment, and the benefits of the other antianginal therapies (beta blockers and calcium channel blockers) must be weighed against their effects on cardiovascular health and erectile function.
In conclusion, patients with coronary artery disease and ED who wish to initiate PDE5 inhibitor therapy need to discontinue nitrate therapy and require treatment options that manage their angina pectoris effectively, maintain their cardiovascular health, and allow to retain their sexual function.
Managing Angina Pectoris Without Nitrates
Angina patients who experience coital angina or other unstable angina (lasting 20 minutes or longer) and have NOT taken PDE5 inhibitor should use nitroglycerin. If 3 nitroglycerin tablets administered 5 minutes apart do not ease angina, patients must seek emergency help. It is strongly advised that PDE5 inhibitors and nitroglycerin be taken at least 24 hours apart.
Patients with acute coital angina who have taken PDE5 inhibitors before sexual activity should call for emergency assistance and be transported to a hospital. Nitrates must not be administered to these patients. Non-nitrate pharmacologic agents such as betablockers, morphine, calcium antagonists or aspirin can be used.
In non-acute cases, angina patients have medication such as aspirin, calcium antagonists, betablockers and statins in their disposal. All these drugs can be used to maintain stable condition and prevent acute angina cases.
Irrespective of angina pectoris treatment you pick, your doctor must recommend that you make lifestyle changes towards reducing your angina pectoris disease risk factors including (although, technically, angina pectoris is not a disease):
- Unhealthy diet. Limit the amount of trans fats, saturated fats, and salt. Include lean meats, whole grains, fruits and vegetables, as well as low-fat dairy products in your new angina pectoris die
- High cholesterol. Be aware of your cholesterol levels and ask your physician to optimize them to the healthy levels.
- Smoking. If you still smoke, quit.
- Insufficient physical activity. Starting a safe exercise plan under your doctor`s supervision. It is helpful to pace yourself because angina is often triggered by exertion.
- Being overweight. Discuss weight-loss options with your doctor.
- Underlying conditions. High blood pressure, diabetes and high cholesterol increase your risk of angina, so consider treating them first.
- Evading stress is easier said than done, but do find ways to relax.
If you try pharmacotherapy and lifestyle changes, but they don’t ease your angina, angioplasty and stenting might constitute an option for you. In some cases, coronary bypass surgery might be needed.
By following our angina pectoris guidelines, you are equipped with knowledge to maintain your cardiovascular health longer and handle acute cases of angina pectoris every single time with effectiveness and speed.