Patient information from BMJ

Unstable angina: what are the treatment options?

Last published:Apr 15, 2025

Unstable angina is a medical emergency. It's a severe pain in your chest that happens if your heart is not getting enough oxygen. It can be a warning sign of a heart attack.

There are treatments for unstable angina, so if it happens it's important to go to hospital straight away.

This information is about treatments you may be given in hospital and when you go home. To learn more about the causes and symptoms of unstable angina, see our patient information 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. In hospital you’ll have emergency treatment to prevent it. This might include an operation to help improve blood flow to your heart.

When you go home you’ll need to carry on taking medicines to help prevent another attack of unstable angina, and lower your risk of a heart attack.

Emergency medicines

To relieve your chest pain you’ll probably be given nitrates. This type of medicine relaxes the walls of your arteries so that your blood can flow more easily. You may be given a nitrate as a tablet that dissolves under your tongue, or as an IV drip.

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

The other medicine you’ll probably be given immediately is aspirin. Most people think of aspirin as a painkiller. But it also helps to stop blood cells sticking together to form clots. Taking aspirin helps stop the clot that caused your unstable angina from getting bigger. This can reduce your chances of having a heart attack.

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.

You may 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

If medicines are not enough to help control your angina, doctors might recommend you have a surgical procedure. Coronary angiography is a procedure that allows doctors to look at your coronary arteries and see how serious the blockage is. They may be able to do an operation at the same time that widens the arteries so blood can flow more easily to your heart. This is called angioplasty. Or you might hear it called stenting.

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

After your unstable angina improves, your doctor will talk to you about how to stay healthy and stop your angina getting worse.

You will probably go home from hospital with a lot of new medicines. If you’re unsure about any of them, ask your doctor. Below is a list of the medicines you are most likely to need. You will probably need to take them for many months, and some of them for the rest of your life. 

You will need to continue 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 again.

It is important to note if you are taking nitrates you must talk to your doctor before taking any medicines for erectile dysfunction such as sildenafil (viagra). There are other medicines that can affect how your nitrates work or make side effects worse if they are taken together. Examples include some antidepressants and some medicines for migraines. Always tell your doctor about any other medicines you are taking.

Your doctor might prescribe you other medicines to lower your risk of having a heart attack. These could include:

• another antiplatelet medicine as well as aspirin (or instead of aspirin if you are unable to take aspirin)

• statins to lower the amount of cholesterol in your blood

• ACE inhibitors to lower your blood pressure.

What happens next?

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

For example, it will be important to control your blood pressure. You should take any blood pressure medicines prescribed by your doctor. If you have diabetes you will need to be extra careful about managing your blood sugar levels. Keeping your weight within a healthy range is also important.

If you smoke, talk to your doctor about ways to try and stop. Smoking narrows the arteries and makes you more likely to have a heart attack. There are treatments that can help you stop smoking. You can also read our patient information on Stopping smoking.

Eating healthily can help protect your heart whether you want to lose weight or not. 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 you should do and how much is safe for you. If you have just started to exercise again you should think about building up your activity level gradually. You should also keep your angina medicine close by so you can use it quickly if needed.

Treating depression can help reduce the risk of heart problems. If you often have a very low mood or think you might be depressed, talk to your doctor. There are treatments such as therapy and antidepressant medicines that can help.

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