- Antianginal
- Calcium antagonists
- Beta blockers
- Antiplatelet agents against blood clots
- Statins
- Cytoprotectors
Angina attacks are familiar to many - sharp, sudden pain in the chest area, often radiating to the neck, arm, shoulder or even jaw. An exacerbation can last for quite a long time, bringing a lot of pain to the person. Therefore, people with this syndrome are prescribed specialized medications.
Antianginal
Antianginal drugs are prescribed for the prevention of coronary heart disease, as well as its complications, for example, myocardial infarction.
The basis of coronary heart disease is an imbalance between the myocardial need for oxygen and its direct supply. Based on this, antianginal drugs are aimed at eliminating imbalances.
For this category of medications there is a list of standard contraindications :
- aortic stenosis;
- arterial hypotension;
- bradycardia;
- severe arterial hypotension;
- severe dysfunction of the liver and kidneys;
- hypertrophic obstructive cardiomyopathy;
- angle-closure glaucoma with high intraocular pressure;
- isolated mitral stenosis;
- stroke;
- cardiogenic shock;
- collapse;
- constrictive pericarditis;
- cerebral hemorrhage;
- recent head injury;
- acute myocardial infarction;
- increased intracranial pressure;
- increased sensitivity to nitrates;
- cardiac tamponade;
- toxic pulmonary edema;
- severe anemia;
- cerebral ischemia;
- shock.
Nitroglycerine
Pharmacological forms:
- pills;
- spray;
- ampoules for injection;
- alcohol solution;
- films on the gums.
Active substance – Glyceryl trinitrate.
Side effects:
- allergic reactions;
- arterial hypotension;
- abdominal pain;
- excitability;
- headache;
- dizziness;
- disorientation;
- lethargy;
- methemoglobinemia;
- blurred vision;
- orthostatic collapse;
- feeling of heat;
- facial redness;
- vomit;
- reflex tachycardia;
- dry mouth;
- nausea;
- anxiety;
- cyanosis;
- feeling of weakness.
The maximum daily dose is 20 mcg per 1 kg of human weight.
The average cost is, depending on the form of the drug, from 20 to 300 rubles.
Isosorbide dinitrate
Pharmacological forms:
- concentrate for solution;
- solution for infusion;
- spray;
- pills.
The active substance is isosorbide dinitrate.
Side effects:
- bradycardia;
- hyperemia of the skin;
- headache;
- dizziness;
- collapse;
- orthostatic hypotension;
- reflex tachycardia;
- drowsiness;
- nausea;
- increased angina with a sharp decrease in blood pressure.
The maximum daily dose is 100 mg.
The average cost is 300 rubles.
Isosorbide mononitrate
Pharmacological form – tablets.
Active substance – Isosorbide mononitrate.
Side effects:
- allergic reactions;
- excitation;
- hypotension;
- headache;
- collapse;
- methemoglobinemia (with long-term treatment);
- sweating;
- vomit;
- syncope;
- weakness;
- dry mouth;
- nausea;
- transient redness of the facial skin;
- increased symptoms of angina pectoris.
The maximum daily dose is 120 mg.
The average cost is 100 rubles.
Isomonite
Pharmacological form - tablets.
The active substance is isosorbide mononitrate.
Side effects:
- arterial hypotension;
- bradycardia;
- headache;
- dizziness;
- dilatation of skin vessels with redness;
- skin allergic reactions;
- collapse;
- rhythm disturbance;
- inattention;
- vomit;
- reflex tachycardia;
- weakness;
- drowsiness;
- nausea.
The maximum daily dose is 120 mg.
The average cost is 100 rubles.
Pentacard
Pharmacological forms:
- capsules;
- pills.
The active substance is isosorbide mononitrate.
Side effects:
- facial skin hyperemia;
- headache;
- dizziness;
- cerebral ischemia;
- skin rash;
- collapse;
- blurred vision;
- feeling of heat;
- a slight burning sensation on the tongue;
- development of tolerance;
- vomit;
- stiffness;
- decreased blood pressure;
- decreased ability for quick mental and motor reactions;
- drowsiness;
- dry mouth;
- tachycardia;
- nausea;
- increased attacks of angina pectoris;
- exfoliative dermatitis.
The maximum daily dose is 80 mg.
The average cost is 150 rubles.
Monocinque
Pharmacological form - tablets.
The active substance is isosorbide mononitrate.
Side effects:
- headache;
- skin allergic reactions;
- facial redness;
- development of orthostatic hypotension;
- vomit;
- decreased blood pressure;
- nausea.
The maximum daily dose is 80 mg.
The average cost is 170 rubles.
Medicines for angina pectoris
Increased mortality occurs precisely because of heart disease. Any negative effect has a bad effect on the cardiovascular system, for example, frequent stress, abuse of alcohol and cigarettes.
How can you recognize an angina attack? The very first sign is pain: pressing and squeezing, and the person may also lack air. Pain occurs behind the sternum and can radiate to the neck, jaw, teeth, and between the shoulder blades. Lasts up to fifteen minutes. Occurs due to intense physical exercise or stressful situations.
Other symptoms may appear:
• high blood pressure;
• drowsiness, high fatigue;
• shortness of breath;
• increased sweating.
Types of angina
There are several types of this disease:
• Stable;
• Variant;
• Painless (mute).
Drugs for the treatment of angina pectoris
Angina is treated with drugs that help achieve the desired effect when taken together.
Nitrates
They relax the myocardium, reduce oxygen consumption and relieve pain.
The most popular of this group is Nitroglycerin. Release forms:
• Tablets under the tongue. The biggest advantage is that they act within a few minutes after administration;
• Spray. Intended for application to the oral mucosa;
• Capsules. They have a prolonged effect (the drug is released gradually).
This drug is used in case of angina attacks, as well as for preventive purposes. The dosage is calculated according to blood pressure readings, diseases (arrhythmia, kidney disease) and so on. It promotes addiction, so it should not be taken for a long time; you should take breaks, taking during this period drugs with similar effects.
Attention! Nitroglycerin should work immediately. If the attack persists, you can take another dosage of the drug. If the drug also does not work, you need to urgently call an ambulance team, there is a high probability of developing a myocardial infarction.
Adrenergic blockers
These angina medications reduce the heart's need for oxygen. The most popular drugs in this group:
• "Anaprilin". Dosage: in the first couple of days, take 20 milligrams three times a day. Then the dosage is gradually increased to 240 milligrams per day. If a headache, gastrointestinal tract dysfunction, or allergy to components occurs, you need to replace the drug with a similar one.
• "Betaxolol". It lasts longer than regular tablets (extended action). The release of the drug does not occur immediately, but over a certain period of time, which allows you to reduce the amount of the drug per day. For example, instead of two or three tablets, you can take one. Therefore, it is taken once a day.
• "Atenolol".
• "Concor".
• “Nebilet”.
Attention! Drugs are prescribed exclusively by a doctor based on the results of the examination, due to existing contraindications and side effects.
Calcium channel antagonists
These drugs cause the heart muscle to contract less. Most popular:
• Diltiazem.
• "Verapamil". It has a good effect on the myocardium, helps normalize heart rate and dilate blood vessels. Use caution in case of kidney and liver diseases. There is also a “retard” form.
• "Nifedipine".
• "Amlodipine".
Diuretics
They have a diuretic effect, remove excess water, and due to this, help remove swelling. They work better in combination with calcium channel antagonists or adrenergic receptor blockers. Usually prescribed:
• Lasix. Helps quickly lower blood pressure. Prescribed in acute cases due to its aggressive action. The daily dose is no more than one tablet.
Attention! Diuretics help to quickly lower blood pressure, so they are taken with caution along with antihypertensive drugs.
Antiplatelet agents that prevent the formation of blood clots
These medications consist of acetylsalicylic acid, better known as aspirin. The following drugs are usually prescribed:
• "Thrombo ACC";
• "Aspirin Cardio";
• "CardioMagnyl".
Their difference is that the drugs have less effect on the stomach than regular aspirin. A person with hypersensitivity to acetylsalicylic acid is prescribed Clopidogrel. It is stronger, but its price is higher.
Statins
These are quite strong medications that are used to quickly normalize cholesterol levels, because Its elevated level often leads to angina pectoris. Usually prescribed:
• "Simbastatin".
• Atorvastatin.
• "Rosuvastatin". Best taken before bed.
Most often, people who have visited a cardiologist, having looked at prices in pharmacies and calculated how much medications for angina pectoris will cost them, leave it for later and are in no hurry with treatment. Many people think that if something happens, they will cope with nitroglycerin. But it’s much easier to ask the doctor to replace an expensive drug with a similar one, but less expensive. There are also cases when people themselves reduce or increase the dosage of the drug without consultation. This decision should be made only by a specialist in accordance with the person’s condition and indications. Angina pectoris cannot be treated with folk remedies! It is very important to follow all doctor's recommendations for proper treatment.
The information presented in this article is intended for informational purposes only and cannot replace professional advice and qualified medical care.
Statins
Statins are a group of medications used to lower blood cholesterol levels. The effect is achieved by blocking the production of the HGM-CoA enzyme in the liver, which is necessary for the production of cholesterol. By lowering blood cholesterol levels, statins reduce the risk of angina pectoris and are prescribed directly as a prophylactic agent.
Crestor
Pharmacological form - tablets.
The active substance is rosuvastatin.
Contraindications:
- active liver disease;
- pregnancy;
- myopathy;
- lactation period;
- taking Cyclosporine;
- severe renal dysfunction;
- persistent increases in serum transaminases.
Side effects:
- asthenia;
- headache;
- dizziness;
- constipation;
- myalgia;
- diabetes;
- nausea.
The maximum daily dose is 40 mg.
The average cost is 1,200 rubles.
Zokor
Pharmacological form – film-coated tablets.
The active substance is simvastatin.
Contraindications:
- pregnancy and lactation;
- hypersensitivity to simvastatin or any component of the drug;
- liver disease in the active phase or an unclear and persistent increase in serum transaminase levels;
- concomitant use of powerful inhibitors - Gemfibrozil, Cyclosporine or Danazol.
Side effects:
- anemia;
- asthenia;
- insomnia;
- abdominal pain;
- headache;
- dizziness;
- flatulence;
- memory impairment;
- sleep disorders;
- paresthesia;
- peripheral neuropathy;
- confusion, etc.
The maximum daily dose is 80 mg.
The average cost is 500 rubles.
Calcium agonists
Calcium agonists
– are able to dilate the blood vessels of the heart, increasing the flow of blood to the heart muscle (myocardium), thereby reducing the number of angina attacks. They are divided into three main groups with characteristic features.
Drugs from the group of dihydropyridine calcium antagonists (nifedipine) can be prescribed together with beta blockers, or instead of beta blockers (if intolerance or contraindications to the latter). The first generations (nifedipine) increase the heart rate, so short-acting tablets (nifedipine 10 mg) are prohibited for angina pectoris. There are special prolonged forms (osmo-adalat, corinfar-retard, nifecard) containing from 20 to 60 mg of nifedipine. The third generation of drugs (amlodipine, felodipine) practically does not increase the pulse rate and is taken once a day.
Drugs from the verapamil and diltiazem group reduce the heart rate; combined use with beta blockers is contraindicated due to the risk of bradycardia and other complications. It has been proven that regular use of calcium antagonists can reduce the incidence of strokes.
Drug treatment
Medicines to prevent angina attacks
The goal of treatment is to stop attacks and prevent new ones, improve blood supply to the myocardium, increase oxygen delivery to it, and normalize the rheological properties of blood. In complex treatment the following drugs are used:
- Nitrates,
- b-receptor blockers,
- Calcium antagonists,
- Antiplatelet agents,
- Statins.
Nitrates as an antianginal category of drugs
When treating angina, cardiologists use the most proven and well-known medications. To begin with, it is worth considering nitrates (Nitroglycerin, Isosorbide dinitrate and mononitrate).
Nitrates do not cure, they only relieve an attack. They are consumed directly during an attack or as a preventive measure. To avoid the body getting used to it, take breaks from taking it.
Nitroglycerin (Nitradisk, Deponit) - available in the form of tablets, spray, drops, patch, ointment, capsules. The spray is sprayed into the mouth, the tablet is placed under the tongue.
The attack is eliminated (in 1–3 minutes), the result is maintained for 3–4 hours. Plates, ointment and patches are less effective. The dose is prescribed by a specialist.
Isosorbide dinitrate (Isoket, Cardiket) – is available in the form of tablets, capsules and aerosols.
The tablet must be placed under the tongue, then chewed (effective after 30 minutes after use), the aerosol is sprayed in the mouth in the amount of 1-3 presses (the result is noticeable after 3 minutes).
Isosorbide mononitrate (Mononit, Plodin) - available in capsules and tablets. Tablets are taken twice a day, capsules - once.
Non-drug treatment
Electroson
Non-drug methods of treating angina include physiotherapy, herbal medications, psychotherapy, and spa treatment. Physiotherapeutic treatment for angina pectoris improves blood circulation and metabolic processes in the heart, normalizes the balance between oxygen consumption and supply, and increases tissue saturation with oxygen.
Physiotherapy methods used for angina include: electrosleep, electrophoresis on the upper thoracic spine, subscapular areas with nicotinic acid, b-blockers, general carbon dioxide baths, hydrogen sulfide baths, laser, ultrasound therapy.
Taking sedative herbal preparations, such as an infusion of valerian root, a soothing herb, an infusion of motherwort herb, Corvalol, as well as psychotherapy can also have a positive effect in the treatment of angina, since normalizing the functioning of the nervous system can in some cases reduce the frequency of angina attacks and their severity.
Sanatorium-resort treatment is indicated only for stable angina pectoris FC I-III, without rhythm disturbances and circulatory failure. The most prominent are the seaside resorts of the southern coast of Crimea and the Baltic states. For patients with class IV angina, sanatorium treatment is contraindicated.
Prevention
Prevention of angina pectoris can be both primary (if there is no diagnosis of “angina pectoris” in the patient’s outpatient chart) and secondary (in patients suffering from this disease). Methods of primary prevention of angina include:
- control cholesterol levels,
- body weight control,
- healthy lifestyle without alcohol and cigarettes,
- sufficient physical activity,
- annual medical examination, medical examinations with a cardiologist (especially for persons 45 years and older).
Dosed walking
Secondary prevention is carried out in patients diagnosed with angina and is aimed at preventing the progression of the disease. Secondary prevention measures for angina pectoris include:
- Taking long-acting nitrate drugs, antiplatelet agents, long-term statins, metabolic drugs (mildronate, timetazidine) in courses twice a year;
- Physiotherapy. Systematic physical training in patients with angina pectoris significantly increases resistance to physical stress and ability to work. This could be measured walking, exercise on a bicycle ergometer, or morning exercises. The type and volume of training is established for each patient, depending on the severity of angina pectoris and concomitant pathology. Classes should be carried out under the supervision of a physical therapist, with monitoring of pulse rate, pressure, and periodic registration of ECG.
Treatment of the disease requires high medical professionalism; never try to prescribe treatment yourself.
Pressure and pulse in patients with angina: is there a relationship?
There is a strong relationship between arterial hypertension (AH) and ischemic heart disease.
The mechanisms of development of these pathologies are similar and have common risk factors, such as obesity, family history, poor diet, low physical activity, and smoking. Restructuring of pressure regulation in the presence of these factors first causes an increase in blood pressure, which leads to changes in the left ventricle and large vessels, as well as the capillary network. High blood pressure gives impetus to the development of atherosclerosis, including in the coronary arteries, which is the direct cause of angina attacks. Hypertensive crises lead to instability of the atherosclerotic plaque. In this state, the body balances on the verge of developing myocardial infarction. As the deposition of protein-fat masses into the vascular wall progresses, the arteries become rigid and cannot provide pressure regulation, which can cause the development of hypotension.
Features in women
Despite the fact that IHD is considered a “male disease,” women are equally susceptible to this pathology. The insidiousness of ischemia in them is that it does not always manifest itself with classic symptoms.
Most often women are concerned about:
- Pain and discomfort in the shoulder, back, abdomen;
- Dyspnea;
- Nausea and vomiting;
- Sweating;
- Dizziness and weakness
As a rule, there is no pain in the heart area, so the patient’s complaints are attributed to neurosis, menopause, and pathology related to the digestive and nervous systems. This misses the important moment of ischemia, at which myocardial infarction can occur.
Blood pressure in women with angina is often in the hypotension range. Low blood pressure, according to recent data, negatively affects the prognosis and course of coronary artery disease.
Heart medications for angina
Effective medications for heart pathologies must be taken to prevent serious consequences, including heart attack and stroke. Angina pectoris deserves special attention, which should be treated with several types of medications. Medicines interact with each other and increase the chances of successful treatment of severe pathology.
