When the blood flow through the coronary arteries is sufficiently restricted to cause angina, there are two basic ways of helping: either the needs of the heart can be reduced so that and inadequate blood supply becomes adequate, or the arteries themselves can be treated to increase the blood supply. The former method is achieved with medicines and the latter, usually, with surgery.
The medicines work by lowering the hearts needs. They do this by slowing the heart rate, reducing the blood pressure (hence the “resistance” into which the heart has to pump) and also the force with which the heart contracts. There are three groups of drugs which are effective in this way; they are called beta-blockers, nitrates and calcium antagonists. To a minor extent they may dilate narrowed coronary arteries where “spasm” has narrowed them over and above the thickening in the walls.
When these medicines are ineffective or inadequate in reducing angina some form of direct intervention with the arteries themselves may be considered. This is usually achieved with surgery, when veins, taken from the legs, are used to bypass obstructed coronary arteries.
This, of course, requires major surgery but has now become a standard and perfectly accepts able form of treatment that, unfortunately, is not offered to many patients who stand to benefit. How severe the angina should be before contemplating this form of surgery will vary from individual to individual and will depend a great deal on age. Pain that is acceptable for an elder patient may be les of for the younger.
Catheter techniques which dilate narrowed arteries have become available in recent years. A narrowed artery may be opened available in recent years. A narrowed artery may be opened up with the aid of a balloon on the tip of a catheter introduced from an artery in the arm or the groin. It is suitable only for a minority of patients but avoids the trauma of major surgery.
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