Anti-Anginal Medications: Treating Chest Pain
Angina is chest discomfort caused by reduced blood flow to the heart. Learn how the medications used to treat angina work, what side effects to expect, and what options exist when medications alone aren't enough.
What is Angina?
Angina is chest pain, pressure, or tightness that happens when the heart muscle doesn't get enough oxygen-rich blood. It is most often caused by narrowed or blocked coronary arteries — the blood vessels that supply the heart. Angina typically comes on with physical activity or emotional stress and eases with rest.
Angina is a symptom of an underlying problem, usually coronary artery disease. Treating angina means both relieving the discomfort and addressing the disease behind it.
Goals of Anti-Anginal Therapy
Anti-anginal medications are prescribed with two main goals in mind:
Fewer Symptoms
Reduce how often angina happens and how severe it is, so you can stay active and do the things you enjoy
Protection
Reduce the heart's workload and, together with other heart medications, lower the risk of heart attack and other complications
Most patients take these medications alongside other therapies — such as aspirin, cholesterol-lowering medications, and blood pressure control — as part of a complete treatment plan.
Important Safety Note
Never stop or change your medications without talking to your doctor first. Stopping some of these medications suddenly — especially beta blockers — can be dangerous.
If you have chest pain that is severe, lasts more than a few minutes, or doesn't go away with rest or your prescribed medication, call 911. Do not drive yourself to the hospital.
Beta Blockers
Beta blockers slow the heart rate and reduce how forcefully the heart squeezes. This lowers the heart's demand for oxygen, which means less angina during activity. They are often the first medication prescribed for angina, and they also help protect the heart after a heart attack.
Common Examples
- •Metoprolol (Lopressor, Toprol-XL)
- •Carvedilol (Coreg)
- •Atenolol (Tenormin)
Common Side Effects
Fatigue, a slower heart rate, lightheadedness, and cold hands or feet. Many of these improve as your body adjusts.
Do not stop a beta blocker abruptly. Suddenly stopping can cause a rebound in heart rate and blood pressure and may trigger angina or even a heart attack. Your doctor will taper the dose gradually if it needs to be stopped.
Calcium Channel Blockers
Calcium channel blockers relax and widen blood vessels, which improves blood flow to the heart and lowers blood pressure. Some types also slow the heart rate. They are especially useful when angina is caused by artery spasm, or when beta blockers alone aren't enough or aren't tolerated.
Common Examples
- •Amlodipine (Norvasc)
- •Diltiazem (Cardizem, Cartia XT)
Common Side Effects
Ankle or leg swelling, flushing, headache, and dizziness. Diltiazem can also slow the heart rate and cause constipation in some people.
Nitrates
Nitrates relax and widen blood vessels, reducing the heart's workload and improving blood flow to the heart muscle. They come in two forms: fast-acting nitroglycerin for relieving an angina episode, and long-acting nitrates for preventing episodes.
Short-Acting: Nitroglycerin (Nitrostat, NitroMist)
Sublingual (under-the-tongue) nitroglycerin tablets or spray act within minutes to relieve an angina episode. If you have been prescribed nitroglycerin, keep it with you at all times. How to use it:
Headache is a very common side effect — usually not dangerous, and it often improves over time. Dizziness and flushing can also occur.
Long-Acting: Isosorbide Mononitrate (Imdur)
Long-acting nitrates are taken daily to prevent angina episodes. The body can become tolerant to nitrates if they are in the bloodstream around the clock, which makes them stop working. To prevent this, long-acting nitrates are scheduled to allow a daily nitrate-free interval — a stretch of hours (usually overnight) without the medication. This is why your doctor may tell you to take it at a specific time of day. Headache and lightheadedness are the most common side effects.
Never Combine Nitrates with ED Medications
Nitrates must never be taken with erectile dysfunction medications such as sildenafil (Viagra) or tadalafil (Cialis). The combination can cause a sudden, dangerous drop in blood pressure that can be life-threatening. Tell every doctor who treats you — and emergency personnel — if you take either type of medication.
Ranolazine (Ranexa)
Ranolazine works differently from the other anti-anginal medications — it improves how the heart muscle uses energy rather than changing heart rate or blood pressure. It is typically added when angina persists despite beta blockers, calcium channel blockers, or nitrates, and it can be a good option for patients whose blood pressure or heart rate is already low.
Common side effects include dizziness, headache, constipation, and nausea.
Drug interactions matter with ranolazine. It interacts with a number of common medications, including certain antibiotics, antifungals, and heart medications, and with grapefruit juice. Make sure your doctor and pharmacist have a complete list of everything you take.
When Medications Aren't Enough
For some patients, angina continues to limit daily life even on well-chosen medications. When that happens, restoring blood flow directly to the heart may be the next step.
Percutaneous coronary intervention (stenting) opens narrowed coronary arteries using a small balloon and a stent, usually through a small puncture in the wrist. For arteries that are completely blocked, specialized chronic total occlusion (CTO) procedures can often reopen blockages that were previously considered untreatable. Dr. Bleszynski performs both, and can help you understand whether a procedure is right for you.
When Chest Pain is an Emergency
Call 911 immediately if you experience:
- •Chest pain that is new, severe, or different from your usual angina
- •Chest pain that occurs at rest or lasts more than a few minutes
- •Pain that doesn't improve with rest or your prescribed nitroglycerin
- •Chest pain with shortness of breath, sweating, nausea, lightheadedness, or pain spreading to the arm, neck, jaw, or back
These can be signs of a heart attack. Minutes matter — do not drive yourself to the hospital.
Medications at a Glance
- Beta Blockers
- Slow the heart, reduce oxygen demand
- Calcium Channel Blockers
- Relax and widen blood vessels
- Nitrates
- Relieve and prevent episodes
- Ranolazine
- Added for persistent angina
Call 911 If
- • Chest pain lasts more than a few minutes
- • Pain occurs at rest or is worse than usual
- • Nitroglycerin doesn't relieve the pain
- • Shortness of breath, sweating, or nausea
Never stop or change your medications without talking to your doctor.
Still Having Chest Pain?
If angina is limiting your life despite medications, Dr. Bleszynski can review your treatment plan and discuss whether a procedure could help restore blood flow.
Schedule Consultation(702) 805-5678