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Unstable Angina: Treatment, Procedure, Cost and Side Effects

Last Updated: May 06, 2022

What is the treatment?

Unstable angina is a kind of condition where your heart rarely gets very less oxygen or blood flow. This can lead to a heart attack in severe cases. Angina is a form of chest discomfort which is caused due to less blood supply through the coronary vessels (blood vessels) of the myocardium (heart muscle). Unstable angina is caused due to many factors, the most common being coronary artery disease due to a condition known as atherosclerosis. This condition is caused because of the build-up of fatty material along the artery walls. It makes the arteries less flexible and narrow. The narrowing in turn interrupts the blood flow to the heart and causes immense chest pain. Some major risk factors of unstable angina include, smoking, old age, obesity, not exercising enough, low HDL cholesterol, high LDL cholesterol, high blood pressure, diabetes and family history of Unstable angina.

Usually blood thinners are given to the patients to prevent Unstable angina from occurring and resulting to a heart attack. This medication includes a drug called clopidogrel or aspirin. During Unstable angina you can get herparin which is a blood thinner or nitroglycerin through IVF. Sometimes the blood vessel gets blocked or narrowed down due to unstable angina, in such cases Angioplasty is recommended to open the blood vessel. This treatment is the most common treatment to cure coronary artery disease due to unstable angina.

What are the symptoms of Unstable Angina?

Unstable angina is accompanied by unexpected chest pain. It occurs without giving any warning signs. Its onset is associated with mild physical activity or the state of rest, relaxation, or sleeping. Important symptoms of the condition include:

  • Chest pain may be tight or crushing or even spread to the other surrounding regions
  • Stress and anxiety
  • Sweating accompanied by shortness of breath
  • Pain in the chest that may arise even with mild physical activity
  • Chest pain which does not subside by taking medicine
Summary: Unstable angina is accompanied by unexpected chest pain which occurs even with mild physical activity or during the state of rest, relaxation, or sleeping. It has certain dangerous health consequences including heart attack.

What is the difference between stable angina and unstable angina?

Stable angina is the type of angina or chest pain that happens with moderate or severe forms of physical activity. Its onset is usually associated with physical exertion. The symptoms experienced in this condition often subside with proper rest or medicines.

On the other hand, unstable angina is the type of chest pain that occurs during mild physical activity or even during the state of rest, relaxation or sleeping. The symptoms experienced in this type of angina do not resolve after having the medicines.

Unstable angina is more dangerous than stable angina as it puts an individual at the risk of a heart attack. Stable angina may gradually transform into unstable angina.

Summary: Stable angina is comparatively less dangerous than unstable angina. The former is associated with the overexertion of the body and subsides with rest and medications. The latter does not go away even with medicines and occurs without any warning signs.

What causes Unstable Angina?

Unstable angina is the condition during which the heart is unable to get sufficient oxygen due to the blockages in the coronary arteries.

These blockages may be due to the deposition of fat or cholesterol inside the arteries which disrupts the blood flow in them. Important factors responsible for this are:

  • High blood cholesterol
  • High blood pressure
  • Sedentary lifestyle
  • Obesity
  • Diabetes
  • Old age
  • Being a male
  • The genetic trend of heart disease in the family
Summary: Unstable angina is mainly caused due to disrupted blood flow to the heart due to blockages in the coronary arteries. These blockages are mainly due to the deposition of fat or cholesterol inside the blood vessels.

How are Unstable Angina diagnosed?

The diagnosis of unstable angina should be performed under the supervision of a cardiologist. Important steps involved in it include:

  • Physical examination: In this step, the patient is properly examined to check for the symptoms. Then, blood pressure along with other vitals is checked and measured.
  • Other tests: Following physical examination, some tests are performed for the confirmation of unstable angina. Those tests include electrocardiogram, stress tests, blood tests, coronary angiography, and echocardiogram.
Summary: The diagnosis of unstable angina mainly starts with a proper physical examination of the patient, followed by confirmatory tests such as electrocardiogram, stress tests, blood tests, coronary angiography, and echocardiogram.

Does unstable angina show up on ECG

ECG or electrocardiogram is the most important test during the diagnosis of unstable angina. It gives the confirmation of the condition based upon its certain features. An ECG should be performed within ten minutes of presentation.

The important changes observed in it include the depression of ST-segment, ST-segment elevation, and T-wave inversion. These changes are transient or short-lived.

Summary: There are certain changes in the electrocardiogram of the patient presented with the symptoms of unstable angina. These changes are transient but important for the diagnosis of unstable angina.

How to prevent Unstable Angina?

The prevention of unstable angina is quite possible. Important preventive measures may include the following:

  • Quitting habits like smoking
  • Doing regular physical exercises
  • Having a healthy and well-balanced food
  • Maintaining a healthy body weight
  • Limiting alcohol consumption
Summary: Unstable angina can be prevented by implementing healthy lifestyle choices which may include doing regular physical exercises, maintaining a healthy body weight, quitting smoking or drinking, etc.

Can Unstable Angina go away on its own?

Unstable angina is the condition of a medical emergency. The affected individual should be rushed to the hospital as soon as possible. There he/she is treated in the emergency room under the supervision of a well-specialized cardiologist.

Stabilizing the patient’s condition is the first line of treatment which mainly involves the application of analgesics, blood-thinners (e.g aspirin), nitroglycerine capsule, and oxygen to support breathing. In other words, unstable angina cannot be resolved spontaneously and it is followed by emergency medical care.

Summary: The condition of unstable angina cannot be resolved on its own since it is a medical emergency and must be accompanied by taking the patient to the emergency department of the hospital.

How is the treatment done?

Angioplasty is the most effective procedure performed on people who have unstable angina which may or has already led to a heart attack. Angioplasty is also known as percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI). It is performed using a soft and thin tube called a catheter. This catheter is inserted inside a blood vessel in the wrist or groin. The doctor then pushes and guides the catheter till it reaches the coronary arteries of the heart. The blockages or the narrowing inside the coronary arteries is then located and this is done by putting a dye in the body which contains iodine. This helps the coronary artery become visible in the X-ray screen. This procedure is known as Cardiac catherterization.

Another type of angioplasty can be performed with or without a stent. If there is blockage in the artery, the catheter is moved to the narrow artery and a small balloon is used to open the artery. This balloon is inflated for some time and then removed after being deflated. The surgeon can also use this balloon to keep a stent inside the artery so that it remains open.

Should I go to urgent care for Unstable Angina?

Unstable angina is accompanied by symptoms like tightness or crushing pain in the chest which may arise without any warning even during sleeping or state of rest. It gets progressively worse, hence urgent medical care and attention are needed for managing such conditions.

As soon as any symptom of unstable angina is encountered in an individual, he/she should be immediately rushed to the emergency department of the hospital. Under the supervision of a specialized team of doctors, the first line of treatment is given to stabilize the patient’s condition.

This includes giving analgesics, blood thinners like aspirin, nitroglycerine capsules, and oxygen support to the patient.

Summary: Unstable angina should always be followed by emergency medical care and attention as it is a dangerous and life-threatening health condition. The first line of treatment to stabilize the patient’s condition should be given as early as possible.

Who is eligible for the treatment? (When is the treatment done?)

Patients who experience unexplained or sudden chest pain that become unbearable and interferes with your daily activity should seek medical help and get the treatment as soon as possible. If the pain doesn’t reduce after consuming more than three doses of nitroglycerin, an angioplasty treatment is recommended. People who feel fatigue more often or feel light headed most of the times are perfect candidates for an angioplasty procedure. You should also opt for this treatment if your heart is not steady and beats really slow.

Who is not eligible for the treatment?

Angioplasty should not be performed on people who have no evidence of decreased blood flow to the heart or if the blood vessels are not extremely narrowed down or blocked. Blood thinner medicines should not be taken if you get a stent in your blood vessel. Those who do not have a suitable anatomy of the artery should not get angioplasty done as it may lead to complications or even death. Therefore, it is important to consult your doctor before getting this procedure.

Are there any side effects?

If the angioplasty procedure is a success there are no serious side effects. However, there can be certain risks during the procedure such as an artery collapse when stenting cannot be performed, damage or bleeding to the blood vessel during insertion of the catheter or an allergic reaction to the stent or the dye. If there are a lot of complications in the arteries, stroke or heart attack can also occur. After the procedure, side effects such as fatigue or light headedness can also occur from consuming medications.

What are the post-treatment guidelines?

Angioplasty takes about 30 to 90 minutes to finish. However, time is needed to recover from this procedure completely. After this procedure your heart rate, blood pressure and pulse will be monitored and the site where the catheter was inserted will be checked for any signs of bleeding. After you are discharged from the hospital, you should abstain from lifting heavy objects or doing strenuous physical exercise. You should also not drive for quite some days after the procedure. Antiplatelet medicines can be given to prevent a stroke or a heart attack. After angioplasty, it is recommended to attend a cardiac rehabilitation program for building healthy habits which will aid you in the future, towards a healthy heart.

How long does it take to recover?

This procedure generally takes less than an hour or 2 to 3 hours depending upon the complications. However, patients who have gone through angioplasty can do their daily activities with ease in a period of 1 to 2 weeks while taking the prescribed medication.

What is the price of the treatment in India?

In India, angioplasty treatment can vary from 1 lakh to 3 lakh depending upon the type of room, hospital and the stent. The cost of the surgery may go up depending upon the number of stents used.

Are the results of the treatment permanent?

If proper care is taken after the angioplasty procedure, the results of this treatment are usually permanent. However, medications should be consumed as per prescribed and healthy food habits should be exercised for a healthy body.

What to eat in Unstable Angina?

Our heart health is always affected by diet. Thus, it is important to ensure a proper nutritional intake as far as cardiac health is concerned. Good nutrition helps to prevent or control certain risk factors associated with heart diseases. Food items preferred in such conditions mainly include:

  • Fresh fruits and vegetables
  • Whole grain wheat and cereals
  • Dairy products such as skimmed milk, low-fat cheese, and yogurt which contain low fat
  • Low-sodium foods
  • Lean proteins like skinless chicken, beans, and fishes
Summary: A healthy diet is essential for maintaining heart health. It should consist of fresh fruits and vegetables, low-fat dairy products, low sodium food items, and sources of healthy unsaturated fats.

What not to eat in Unstable Angina?

Certain food items are unhealthy for the heart as they increase the risks of heart diseases. Hence, it is better to avoid those foods to prevent such risks. Examples include:

  • Alcohol
  • Foods containing high-sodium content
  • Sources of unhealthy fats or saturated fatty acids like fried and processed foods
  • Dairy products with high-fat content
  • Foods containing cheese, cream, or eggs in one or another form
Summary: Food items that are considered unhealthy for the heart must be avoided as they may increase the risks of unstable angina. Those mainly include foods with high content of sodium, fat, saturated fatty acids, etc.

Can you exercise with unstable angina?

Exercises are considered to be completely safe for patients who suffer from unstable angina. Preferred forms of exercises during such conditions may include:

  • Basic stretching and warm-up exercises
  • Walking or light jogging
  • Mild forms of aerobics such as swimming, cycling, etc.
  • Yoga

Regular exercises enhance the body’s capability to breathe in and utilize oxygen, thus helping to minimize the angina-related symptoms such as shortness of breath, pain in the chest, etc. They can reduce the risks of consequences of unstable angina such as heart attack, stroke, etc.

Summary: Exercises are considered to be beneficial during conditions like unstable angina. They enhance the body’s ability to breathe in and utilize oxygen and help to minimize the associated risks including heart attack or stroke.

Which is the best medicine for Unstable Angina?

Unstable angina is accompanied by emergency medical care and treatment under the supervision of a well-specialized team of doctors. The treatment starts with providing the patient first line of treatment which mainly includes:

  • Analgesics or pain-killers
  • Blood-thinners like aspirin
  • Oxygen support to help facilitate easier breathing
  • Nitroglycerine capsules which are mouth-dissolvable and dilate the coronary arteries

It is followed by the second line of treatment that includes:

  • Anticoagulant medicines like heparin, aspirin, clopidogrel etc.
  • Blood pressure-lowering medicines.
  • Statins, to lower blood cholesterol levels.
Summary: The treatment of unstable angina mainly includes the application of painkillers, blood thinners like aspirin and nitroglycerine capsules initially, followed by medicines to lower blood pressure and blood cholesterol levels.

What are the alternatives to the treatment?

Unstable angina can have other alternative treatments other than angioplasty such as consuming blood thinners like clopidogrel or aspirin. Some medications and drugs can also be prescribed to reduce symptoms of angina such as anxiety, unhealthy cholesterol levels and unstable blood pressure levels.

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Written ByDr. Rahul Gupta MD - Internal Medicine,MBBS,DM - Cardiology,Fellow European Society of CardiologyCardiology
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