medicines used to treat angina reduce the heart muscle's demand for oxygen to compensate for the reduced blood supply. three commonly used classes of drugs are the nitrates beta blockers and calcium blockers. nitroglycerin (nitro-bid) is an example of a nitrate. examples of beta blockers include propranolol (inderal) and atenolol (tenormin). examples of calcium blockers include nicardipine (cardene) and nifedipine (procardia adalat). unstable angina is also treated with aspirin and the intravenous blood thinner heparin. aspirin prevents clumping of platelets while heparin prevents blood clotting on the surface of plaques in a critically narrowed artery. when patients continue to have angina despite taking maximum medications or when significant ischemia still occurs with exercise testing they usually need coronary arteriography. during coronary arteriography doctors decide whether the patient should be considered for percutaneous coronary intervention or percutaneous transluminal angioplasty (ptca) where a small balloon is used to inflate the blockage. angioplasty (ptca) is usually followed by placement of a stent or coronary artery bypass graft surgery (cabg) to increase coronary artery blood flow. angioplasty can produce excellent results in carefully selected patients. under x-ray guidance a wire is advanced from the groin to the coronary artery. a small catheter with a balloon at the end is threaded over the wire to reach the narrowed segment. the balloon is then inflated to push the artery open and a steel mesh stent is generally inserted. cabg surgery is performed to relieve angina in patients who have failed medical therapy and are not good candidates for angioplasty (ptca). cabg surgery is ideal for patients with many narrowings in multiple coronary artery branches such as is often seen in patients with diabetes. cabg surgery has been shown to improve long-term survival in patients with significant narrowing of the left main coronary artery and in patients with significant narrowing of multiple arteries especially in those with decreased heart muscle pump function.
how is coronary artery disease treated?