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:
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:
Beta-blockers can cause:
Calcium channel blockers can cause:
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.
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.
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.