How to treat angina pectoris? What are the commonly used drugs?

Author: Zhang Haicheng, Chief Physician, Peking University People's Hospital

Reviewer: Wang Fang, Chief Physician, Beijing Hospital

For a certain disease, the issue that people may be most concerned about is treatment.

Today we are going to talk about issues related to the treatment of angina pectoris. Friends who are interested, come and learn about it.

1. What are the serious consequences of not actively treating angina pectoris?

First, the quality of life is reduced. Because of chest pain when tired or excited, many people may have to change jobs because of angina. In life, some regular and favorite sports, such as long-distance running and playing basketball, may not be able to be done. Frequent angina attacks will not only limit daily activities, such as exercise and work, but also affect sleep and mood, and significantly reduce the quality of life.

Second, myocardial infarction. Angina pectoris indicates that there is already severe coronary artery sclerosis. If it is not properly treated and prevented, plaque rupture, thrombosis, vascular occlusion, acute myocardial infarction or sudden death may occur in the future.

Third, heart failure. If angina pectoris recurs, and after taking nitroglycerin to relieve it, you go back to work. The heart is hit every day, and over time, the heart will become "depressed." Just like a person, if you hit him every day, he may become listless over time. The same is true for heart cells. If angina pectoris occurs frequently, it will also cause myocardial cell apoptosis. The word apoptosis itself means "suicide." After the heart cells "commit suicide," the heart function will decline, and the clinical manifestations are heart failure, dyspnea, edema, fatigue, etc.

Fourth, psychological barriers. Long-term pain and limited activities can easily cause patients to have psychological problems such as anxiety and depression. Psychological barriers can affect the treatment and recovery of the disease, forming a vicious cycle. Therefore, special attention should be paid to the psychological problems of heart patients.

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Therefore, angina pectoris must be treated in a standardized manner to prevent it from developing into a more serious condition.

2. What are the treatments for angina pectoris?

From a doctor's perspective, there are three major options: drug therapy, stent intervention therapy, and surgical bypass therapy.

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In fact, in addition to these three treatments, there are also basic treatments, but basic treatments are often overlooked. Basic treatments are good eating habits, sleep, exercise, mentality, etc. These basic treatments are also the basis for all other treatments in the later stage.

Drug therapy is an important treatment method, but many people do not pay attention to it. Drug therapy can solve two problems. One is to relieve symptoms and control or reduce angina attacks; the other is to improve prognosis, that is, after taking the medicine, the survival time can be longer. Therefore, during drug treatment, you must follow the doctor's advice, take the medicine regularly, have regular checkups, and follow up if you feel unwell.

In addition, there are bypass surgery and stent surgery. What kind of people need bypass surgery, what kind of people need stent surgery, what kind of people need surgery, and when to have surgery, whether it is emergency surgery, elective surgery, or time-limited surgery, these issues must be judged by professional doctors.

Of course, even if you have a stent or bypass surgery, you still have to take medication after the operation. For patients with heart disease, drug treatment is lifelong. When tooth extraction or other surgery is needed, if you need to temporarily stop taking the medication, you must first be evaluated by a cardiologist and given temporary alternative treatment.

3. What are the commonly used drugs for treating angina pectoris?

In the past, there was only one drug treatment for angina pectoris, which is isosorbide dinitrate tablets, which is the same class of drugs as nitroglycerin. Nitroglycerin is used to relieve symptoms immediately after an attack, while isosorbide dinitrate tablets are used to prevent attacks.

For example, if a patient needs to do some physical work, he knows that once he does physical work, angina pectoris will occur. So he can take the medicine one hour before doing the physical work. It will usually take effect in half an hour and reach the maximum effect in two to three hours, which will prevent him from having an attack while working.

But this medicine usually lasts for a maximum of five to six hours. If you want to go back to work after five or six hours, you have to take it again, otherwise the angina pectoris will recur.

The commonly used one now is 5-isosorbide mononitrate, which is long-acting. It does not need to be metabolized by the liver, but directly enters the blood circulation, and can work for 24 hours. Now, for a working person, taking a pill in the morning and not having to worry about it for the whole day is quite convenient. Therefore, the progress of science has brought a lot of convenience to everyone.

The second largest category of drugs is beta-blockers, such as metoprolol and bisoprolol. This type of drug can lower blood pressure and slow down the heart rate, making the heart beat weaker and reducing the amount of nutrients consumed by the heart, so it can prevent angina attacks. This drug also has another function, which is that it can protect the heart, prevent premature beats, rapid arrhythmias and sudden death, and is a first-line drug. If there are no contraindications, it can basically be used.

However, after taking the medicine, you should pay attention to monitoring your blood pressure, which should not be too high or too low, and monitor your pulse, which should not be too high or too low. People with bronchial asthma should try not to take it, as it will aggravate or trigger asthma. People with severe heart failure or severe bradycardia should not use it.

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At present, in addition to these two most commonly used drugs, there are many other anti-angina drugs. For example, antiplatelet aggregation drugs such as aspirin or clopidogrel are used to prevent the formation of blood clots when plaques are unstable; statins lower cholesterol on the one hand and stabilize plaques on the other. These two types of drugs generally need to be taken for life. If the myocardial metabolism is not good, you can also take some drugs to improve myocardial metabolism, which can also prevent and treat angina pectoris; there are also some drugs that regulate heart cell channels, which can also help prevent and treat angina pectoris. But they should all be taken under the guidance of a doctor.