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Angina Treatment

Angina is the pain or tightness that some people experience in their chest, often extending to the arms, back or jaw, when the heart is working beyond its oxygen supply. It is similar to the pain athletes get in their muscles after an extreme workout. This comes about when the arteries supplying blood to the heart get constricted due to fatty deposits, and can gradually worsen if not treated.

Treatment options for controlling angina are many. At The Online Surgery we offer a wide range of options to help control angina. These can be grouped in different categories depending on how they work, ranging from Nitrates that dilate the heart’s blood vessels to encourage better blood flow, such as GTN (or Nitrolingual) spray or Isosorbide; Calcium channel blockers that reduce how hard the heart is working, such as Amlodipine, Diltiazem, Felodipine, Nifedipine and Verapamil; Beta Blockers that slow down the heart beat, such as Metoprolol, Bisoprolol, Atenolol and Propranol; and Vasodilators that are used much less and tend to be used only in patients with difficult angina to control, such as Nicorandil.

It is a common condition among older adults, estimatedly one in every twelve men and one in every thirty women between 55 and 64 years of age have angina.

Angina > Betablockers

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Atenolol 25mg, 50mg and 100mg tablets: It is primarily used to treat cardiovascular diseases.

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Bisoprolol Fumarate Tablets - Bisoprolol is used to cure high blood pressure and angina pectoris.

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Buy Propranolol online - Propranolol is a popular medication used to treat high blood pressure, or hypertension.

Angina > Calcium channel blockers

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Adizem SR (Diltiazem SR)

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Adizem XL

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Amlodipine 5mg, 10mg tablets contains the active substance amlodipine maleate. It used to treat high blood pressure and angina.

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Diltiazem hydrochloride

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Buy Dilzem SR 60, 90 and 120mg Prolonged-release Hard Capsules (diltiazem hydrochloride)

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Felodipine XL

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Nifedipine is in a group of drugs called calcium channel blockers. It works by relaxing the muscles of your heart and blood vessels.

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Verapamil belongs to a group of medicines called calcium-channel blockers which interfere with the electrical signals in the heart muscle and blood vessels.

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Verapamil SR

Angina > Nitrates


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Isosorbide dinitrate

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Isosorbide mononitrate

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Buy Nitrolingual Pump Spray - Nitrolingual is a sublingual spray consists of 400 micrograms of glyceryl trinitrate.

What is Angina?

The heart, responsible for circulating blood throughout the body, requires oxygen rich blood for energy. When the coronary arteries, responsible for supplying blood to the heart’s muscles are constricted, the heart is unable to function properly due to the reduced blood flow, which may result in chest pain, known as angina. It may feel like dull pain, crushing pressure or tightness in the chest, that may spread to the arm, neck, jaw or back.

Angina is triggered usually with exercise, stress or other physically strenuous activities that require the heart to work harder, and usually gets better with rest. The condition is more common in men than in women. Symptoms are expressed differently for different people and may often be confused with other conditions such as indigestion. However if left undiagnosed and untreated, the hardening of arteries continues to progress, and is a major risk factor for coronary heart disease. It is estimated that one in every twelve men and one in every thirty women between 55 and 64 years of age have angina.

There are two main types of angina, stable and unstable;

Stable angina
Stable angina is when the pain is brought on by an obvious trigger, such as exercise. It lasts for a short time and improves soon enough with medication and rest. It is not life-threatening but is a serious warning of your increased risk of developing a heart-disease or stroke.

Unstable angina
Unstable angina is when angina attacks are more unpredictable, occurring without an obvious trigger and continues despite rest. You may develop it after having stable angina, or without any history of angina at all. This should be treated as an emergency as it signifies sudden deterioration of your heart’s functioning, increasing your risk of having a heart attack or stroke.
It is important to consultant a physician if you are having recurrent or prolonged pain in the chest.

The severity, duration and type of angina varies from person to person, and it’s symptoms can often be confused with other conditions such as indigestion. Moreover, symptoms might change as the condition develops or progresses. It is therefore important to recognise the symptoms of angina and it’s types.

Common symptoms associated with stable and unstable angina include;
- Chest pain or discomfort
- Pain spreading from your chest to your arms, neck, jaw and back.
- May also experience;
- Breathlessness
- Nausea
- Unusual fatigue
- Dizziness
- Restlessnes
- Sweating

Triggers for stable and unstable angina differ. Stable angina is triggered when the heart is forced to work harder, such as any form of physical activity or stress. Pain can also develop after eating a meal or in cold weather. Unstable angina, on the other hand, develops without obvious triggers and persists.

Triggers for stable and unstable angina differ. Stable angina is triggered when the heart is forced to work harder, such as any form of physical activity or stress. Pain can also develop after eating a meal or in cold weather. Unstable angina, on the other hand, develops without obvious triggers and persists.

Angina is caused when the coronary arteries, supplying blood to the heart muscles, narrow and harden due to a build up of fatty cholesterol plaque. It gradually builds on the inner lining of the coronary arteries, restricting the amount of blood flow to the heart, known as atherosclerosis. The lack of sufficient oxygen to the heart, deters it from being able to function efficiently.

When you exercise or feel stressed, your heart muscles have to work harder to meet the energy demands, but when enough blood doesn’t reach the heart it triggers symptoms of angina. Over time fatty deposits could completely block the arteries, cutting off blood supply to the heart, resulting in a heart attack.

There a number of risk factors associated, that cause the coronary arteries to narrow;

Advanced age: Arteries are more likely to narrow over time

Smoking: Can damage walls of the arteries and decreases blood cells’ ability to carry oxygen around the body, increasing chances of a blood clot.

Lack of exercise: Can cause obesity and raise blood pressure

Diet high in saturated fats: Results in a build up of fatty substances that deposit as plaque.

High Blood Pressure: Arteries get damaged due to the strain on the heart.

Diabetes: Poorly controlled diabetes result in excess glucose in the blood that can damage the arterial walls.

Your GP will diagnose the condition based on a number of factors, such as your medical and family history and pattern of your symptoms.

You will be assessed based on your blood pressure, weight, waist size, blood cholesterol levels, blood glucose levels, liver function test and urine test, to determine if you are at an increased risk of developing atherosclerosis.

Further diagnosis may be made based on a cardiology test, which include;

Electrocardiogram (ECG)
Small metallic electrodes are placed on your arms, legs and chest, connected to a machine that records the rhythms and electrical activity of your heart. An abnormal ECG might indicate the heart muscles not receiving enough blood.

Exercise Tolerance Test (ETT)
This involves an ECG recording while you are made to exercise on a bike or treadmill, to assess how much exercise your heart is able to tolerate. This test often indicates the severity of the angina.

Myocardial Perfusion Scintigraphy (MPS)
An alternative to ETT, if you are unable to exercise. A small amount of radioactive substance is injected into your blood, a special camera is used to track the substance as it moves through the blood vessels and into the heart.

Coronary angiography
An angiography determines the severity of blockages. A catheter is passed into a vein or artery and x-rays guide it to the coronary arteries. A dye is then injected into the catheter to highlight arteries supplying blood to the heart. This test is not done commonly or at first, but only if the diagnosis remains unclear.

It is important to timely diagnose and treat angina, as it is a leading risk factor for developing coronary heart disease and stroke. In addition to necessary lifestyle changes, we at The Online Surgery offer a range of treatment options to relieve the symptoms of angina, reduce the number of attacks, and reduce the risk of a heart attack or stroke.

A number of medications can be prescribed, while some are taken everyday, others are taken only when needed.

Nitrates provide immediate relief by dilating the heart’s blood vessels and increasing blood supply to the heart. It can be used as a preventative measure before exercising. These include Glyceryl Trinitrate (GTN) spray or Isosorbide.

Calcium channel blockers
They work to reduce how hard the heart works by relaxing the heart’s muscles, preventing angina attacks. These include Amlodipine, Diltiazem, Felodipine, Nifedipine and Verapamil.

Beta Blockers
They make the heart beat slower and with less force, so the heart needs less blood and oxygen, lowering the frequency of attacks. These include Metoprolol, Bisoprolol, Atenolol and Propranolol

Vasodilators are used the least, only for patients whose angina is especially difficult to control. This includes Nicorandil.

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