Patient information from BMJ

Unstable angina: what are the treatment options?

Last published:Sep 20, 2021

Unstable angina is a medical emergency. It's a severe pain in your chest that happens if your heart is not getting enough oxygen. This is because the blood flow in your coronary arteries is partly blocked (the coronary arteries carry blood of your heart muscle).

There are good treatments for unstable angina, but if it happens it's important to go to hospital straight away, as it can lead to a heart attack.

You can use our information to talk to your doctor and decide which treatments are best for you. To learn more about the causes and symptoms of unstable angina, see the leaflet Unstable angina: what is it?

Treatments for unstable angina

If you get treatment quickly for unstable angina you have a good chance of avoiding having a heart attack. You’ll have emergency treatment in hospital to prevent a heart attack. You might need an operation to widen your artery.

When you go home you’ll need to carry on taking medicines to help prevent another attack of unstable angina, or of having a heart attack.

Emergency medicines

You might need tablets, injections, or an intravenous (IV) drip into your bloodstream. Medicines work faster when they're put directly into your bloodstream.

To relieve your chest pain you’ll probably be given nitrates, which relax the walls of your arteries so that your blood can flow more easily. You will probably have a nitrate in an IV drip, for at least 24 hours.

Nitrates might give you some mild side effects, including headaches, feeling dizzy, and redness in the face. 

You might also take medicines called beta-blockers, which slow your heart down. This means that it needs less oxygen. The beta-blockers should reduce your chest pain. They might also reduce your chance of having a heart attack.

Beta-blockers come as tablets or injections. You might have injections at first followed by tablets.

There are many different medicines that can help prevent a heart attack. They work by making your blood less likely to clot. This means that the clot that caused your unstable angina shouldn’t get bigger.

The most commonly used medicine your doctor might prescribe to help prevent blood clots is aspirin. Most people think of aspirin as a painkiller. But it also works as an antiplatelet. This means that it stops blood cells sticking together to form clots.

If you have unstable angina, taking aspirin can reduce your chances of having a heart attack or of dying.

Aspirin has side effects. But the benefits are probably worth the risks if you have unstable angina. The two most common side effects are bleeding and an upset stomach.

If your doctor advises you not to take aspirin, there are other antiplatelets that can help.

You will probably also be given a medicine called an anticoagulant. This is another type of medication that helps prevent blood clots. Most of these medicines are just used for a few days when you first have treatment. They are usually given as IV drips or as injections.

Some of these drugs increase your chances of serious bleeding, so you will be monitored closely.

Surgery

Coronary angioplasty is an operation that widens your coronary arteries so blood can flow more easily to your heart. Doctors might suggest this soon after you've had an attack of unstable angina.

A surgeon feeds a thin, deflated balloon into your heart artery, through a tube in a blood vessel in your groin.

When the balloon is in the right place, the surgeon inflates it so that it widens the artery. Then it’s taken out again. Sometimes a small metal tube (called a stent) is inserted, to keep the artery open.

All operations carry some risks. The main risk with angioplasty is excessive bleeding. So you will be carefully monitored.

Long-term treatments

Once you get over your bout of unstable angina, your doctor will talk to you about how you can improve your health and stop your angina getting worse.

You will probably go home from hospital with a lot of new medicines. This can be confusing. If you’re not sure what they all are, ask your doctor. The medicines you are most likely to need are listed below. You will probably need to take them for many months, and maybe for years.

You will probably need to keep taking some of the medicines you started in hospital, including low-dose aspirin and beta-blockers. You will probably be given nitrate tablets or a spray to take if you get angina pain.

There are other medicines you might need to lower your risk of having a heart attack. These could include statins to lower the amount of cholesterol in your blood, and ACE inhibitors to lower your blood pressure.

How you can help yourself

Medicines are important in preventing heart problems. But for many people it's changes to their lifestyle that will make the biggest difference.

If you smoke, try hard to stop. Smoking narrows the arteries and makes you more likely to have a heart attack. Get help from a health professional, such as your doctor. There are treatments that can help you stop smoking.

If you are overweight, try to lose weight. This might involve making changes to your diet and taking more exercise.

Eating healthily can help protect your heart. A healthy diet should include at least five servings of fruit and vegetables every day, and not too much fat and sugar. Eating oily fish, such as salmon, once a week is also recommended.

Exercise helps keep your heart healthy, improves stamina and strength, and makes you feel good. Talk to your doctor about what kind of exercise and how much is safe for you.

Limit how much alcohol you drink. Talk to your doctor about how much is OK.