What medicine should I take for angina symptoms?

Angina pectoris usually occurs after exercise or when you are excited. There will be a squeezing pain in the chest. Cloudy and rainy weather, excitement, eating too much, catching a cold, or excessive fatigue, etc. may all induce angina pectoris. Generally, most patients with angina pectoris are middle-aged men over 40.

(1) Rest: Rest immediately when an attack occurs. Symptoms will generally be relieved after the patient stops moving.

(2) For more severe attacks, fast-acting nitrate preparations can be used. In addition to dilating coronary arteries, reducing resistance and increasing blood flow, this type of drug also relieves angina pectoris by dilating peripheral blood vessels, reducing venous return to the heart, lowering ventricular capacity, intracardiac pressure, cardiac output and blood pressure, reducing cardiac preload and afterload and myocardial oxygen demand.

(3) Isoamyl nitrite is a liquid that easily vaporizes. It is contained in a small ampoule. When using it, wrap it in a handkerchief, crush it, and immediately cover your nose and inhale it. The effect is fast and short. This drug has the same effect as nitroglycerin, and its effect in lowering blood pressure is more obvious, so it should be used with caution. Another similar preparation is octyl nitrite.

When using the above drugs, sedatives may be considered.

2. Treatment during remission

It is advisable to avoid various inducements as much as possible. Adjust your diet, especially do not eat too much; avoid smoking and drinking. Adjust daily life and workload to reduce mental burden; maintain appropriate physical activity, but not to the extent that pain symptoms occur; bed rest is generally not required. Patients who have their first attack (initial onset) or frequent and severe attacks (exacerbated type), or those with supine type, variant type, intermediate syndrome, post-infarction angina, etc., suspected to be a prelude to myocardial infarction, should rest for a period of time. Use long-acting anti-anginal drugs to prevent angina attacks. The following long-acting drugs can be used alone, alternately, or in combination.

The three basic principles of drug therapy during remission are: selectively dilating diseased coronary arteries; lowering blood pressure; and improving atherosclerosis.

(1) Nitrate preparations ① Isosorbide dinitrate. ②Pentaerythritol tetranitrate. ③Long-acting nitroglycerin preparations: Taking long-acting tablets allows nitroglycerin to be released continuously and slowly. Apply or stick 2% nitroglycerin ointment or patch preparation to the skin on the chest, the effect can last for 12 to 24 hours.

(2) Beta-blockers (β-blockers) block the stimulatory effects of sympathomimetic amines on heart rate and cardiac contractility receptors, slowing the heart rate, lowering blood pressure, reducing myocardial contractility and oxygen consumption, and thus relieving the onset of angina pectoris. In addition, it also reduces the hemodynamic response during exercise, reducing myocardial oxygen consumption at the same level of exercise; it shrinks the small arteries (resistance vessels) in the non-ischemic myocardial area, allowing more blood to flow into the ischemic area through the extremely dilated collateral circulation (transport vessels). The dosage should be large. Adverse reactions include prolonged ventricular ejection time and increased cardiac volume, which may aggravate myocardial ischemia or cause heart failure, but its effect of reducing myocardial oxygen consumption far outweighs its adverse reactions. Commonly used preparations include: ① propranolol, gradually increasing doses; ② oxprenolol; ③ alpranolol; ④ pindolol; ⑤ sotalol; ⑥ metoprolol; ⑦ atenolol; ⑧ acebutolol; ⑨ nadolol, etc.

Beta-blockers can be used in combination with nitrates, but please note: ① Beta-blockers and nitrates have synergistic effects, so the dosage should be small, and the initial dose should be especially reduced to avoid causing adverse reactions such as orthostatic hypotension; ② When discontinuing beta-blockers, the dosage should be reduced gradually, as sudden discontinuation may induce myocardial infarction; ③ It is not suitable for patients with heart failure, bronchial asthma, and bradycardia.

(3) Calcium channel blockers: This class of drugs inhibits the entry of calcium ions into cells and also inhibits the utilization of calcium ions in the excitation-contraction coupling of myocardial cells. It inhibits myocardial contraction and reduces myocardial oxygen consumption; dilates coronary arteries, relieves coronary artery spasm, and improves blood supply to the subendocardial myocardium; dilates peripheral blood vessels, lowers arterial blood pressure, and reduces cardiac load; it also reduces blood viscosity, resists platelet aggregation, and improves myocardial microcirculation. Commonly used preparations include: ① Verapamil. Adverse reactions include dizziness, nausea, vomiting, constipation, bradycardia, prolonged PR interval, decreased blood pressure, etc.; ② Nifedipine. Adverse reactions include headache, dizziness, fatigue, decreased blood pressure, increased heart rate, etc.; ③ Diltiazem. Adverse reactions include headache, dizziness, insomnia, etc. New preparations include nicardipine, nisoldipine, amlodipine, felodipine, bepridil, etc.

Calcium channel blockers are the most effective treatment for variant angina. This type of drug can be taken with nitrates, among which nifedipine can be taken with beta-blockers, but there is a risk of excessive cardiotonic suppression when verapamil and diltiazem are taken with beta-blockers. When discontinuing this type of drug, it is also advisable to gradually reduce the dosage and then stop taking it to avoid coronary artery spasm.

(4) Coronary artery dilators can theoretically increase coronary blood flow, improve myocardial blood supply, and relieve angina pectoris. However, due to the complexity of coronary artery lesions in coronary heart disease, some vasodilators, such as dipyridamole, may dilate arteries without lesions or with mild lesions far more significantly than arteries with severe lesions, reducing blood flow in the collateral circulation and causing the so-called "coronary steal", which increases the blood supply to the normal myocardium and reduces the blood supply to the ischemic myocardium. Therefore, they are no longer used to treat angina pectoris. The ones still in use include: ① Molsidomide. Adverse reactions include headache, facial flushing, gastrointestinal discomfort, etc.; ②Amiodarone. It is also used to treat rapid arrhythmia. Adverse reactions include gastrointestinal reactions, drug rash, corneal pigmentation, bradycardia, thyroid dysfunction, etc.; ③ Ethoxyflavone; ④ Carbomer; ⑤ Oxyfildrine; ⑥ Aminophylline; ⑦ Papaverine, etc.

(5) Antioxidant: The core cause of atherosclerosis is oxidative stress and inflammatory response. Oxidative stress is caused by the oxidation of low-density lipoprotein (LDL) to Ox-LDL. Ox-LDL is the starting point of atherosclerosis. Therefore, it is particularly important to prevent the oxidation of LDL to Ox-LDL. The more certain treatment now is effective anti-oxidation. For example, natural antioxidants such as ASTA astaxanthin and anthocyanins have become the first choice for the prevention and treatment of coronary heart disease in the United States and other countries. Astaxanthin can significantly reduce the inflammatory factor CRP (C-reactive protein) and prevent thrombosis in atherosclerosis. There are also reports that this substance can significantly increase high-density lipoprotein HDL to improve atherosclerosis. So much so that MASON of Harvard Research Institute said that astaxanthin will most likely set off the third wave of preventive drugs after statins and antiplatelet drugs.

3. Other treatments

Low molecular weight dextran or hydroxyethyl starch injection is used to improve microcirculatory perfusion and can be used for frequent attacks of angina pectoris. Anticoagulants such as heparin, thrombolytics, and antiplatelet drugs can be used to treat unstable angina. Hyperbaric oxygen therapy increases the body's oxygen supply and can improve stubborn angina pectoris, but the therapeutic effect is not easy to consolidate. External counterpulsation therapy can increase coronary blood supply and may also be considered. For patients with early heart failure, fast-acting digitalis preparations should be used while treating angina pectoris.

4. Surgical treatment

It mainly involves performing aortic-coronary artery bypass grafting under extracorporeal circulation, using the patient's own great saphenous vein as the bypass graft material, with one end anastomosed to the aorta and the other end anastomosed to the distal end of the diseased coronary artery segment; or the free internal mammary artery is anastomosed to the distal end of the diseased coronary artery, diverting blood flow from the aorta to improve the blood supply to the myocardium supplied by the diseased coronary artery.