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Your doctor says your chest pain (angina) is caused by blockages in your heart arteries and that you need to get those blockages taken care of. What are your options?

First, it's important to determine what type of angina you have. Different types of angina may need different treatments. Common types of angina are chronic stable angina — a type of angina that occurs when your heart is working hard — and unstable angina, which is new chest pain or chest pain that is getting worse.

Other types of angina include variant angina — a rare type of angina caused by a spasm in the coronary arteries — and microvascular angina, which can be a symptom of disease in the small coronary artery blood vessels.

Unstable angina is a serious situation and requires emergency treatment. Treatment for unstable angina involves hospitalization with medications to stabilize your condition. Some people with unstable angina may require a procedure called angioplasty (also known as percutaneous coronary intervention), usually combined with the placement of a small metal tube called a stent. In some cases of unstable angina, heart surgery (coronary bypass surgery) may be needed.

Generally, if you have mild stable angina that is controlled by medications, you may not need further treatments. If you're experiencing symptoms of chronic stable angina even after taking medications and making lifestyle changes, or if you're at higher risk of serious heart disease, your doctor may recommend angioplasty or coronary bypass surgery.

Making a decision on how to treat your angina can be difficult, but knowing the benefits and risks of stents and medications may help you decide.

Why are there different treatments for each type of angina?

Angina is pain, discomfort or pressure in the chest, and doctors usually describe it as chronic stable angina or unstable angina.

What are the treatment options for chronic stable angina?

Angioplasty and stenting

During an angioplasty (AN-jee-o-plas-tee), your doctor inserts a tiny balloon in your narrowed artery through a catheter that's placed in an artery, generally in your groin. Your doctor inflates the balloon to widen the artery, and then he or she may insert a small metal tube (stent) to keep the artery open. Some stents are bare metal, some are covered with a synthetic fabric, and others are coated with medications to help keep your artery open (drug-eluting stents).

Angioplasty and stenting involve some risks. These include a risk of blockages re-forming after a stent is implanted, a risk of a blood clot forming in the stent, as well as small risks of having a heart attack, stroke, or life-threatening bleeding during or after the procedure.

You should consider that even if you have a stent placed, you'll likely need to take aspirin for the rest of your life. You may also need to take additional medications to prevent blood clots.

You'll probably remain hospitalized for at least a day while your heart is monitored and your vital signs are checked frequently. You can generally return to work or your normal routine soon after angioplasty.

Many doctors consider angioplasty with stent placement to be a good angina treatment option for blocked arteries and chronic stable angina. Some reasons that it may be considered a good treatment option are that it's less invasive than open-heart surgery and generally has good results.

Medications

If you have stable angina, you may be able to treat it with medications and lifestyle changes alone, and you may not need angioplasty with stenting. Several medications can improve angina symptoms, including:

If you try drug treatment and lifestyle changes and you still have symptoms that are limiting you, an angioplasty with stenting or coronary bypass surgery may be an option, depending on your condition and the cause of your angina.

Enhanced external counterpulsation therapy (EECP) therapy

EECP therapy may be recommended for some people with angina. During this therapy, a doctor places cuffs on your legs and applies air pressure to your legs in rhythm with your heartbeats. This therapy may help improve blood flow to your heart and may improve angina.

Lifestyle changes: Part of all treatments

Regardless of which angina treatment you choose, your doctor will recommend that you make healthy lifestyle changes.

Because heart disease is often the underlying cause of most forms of angina, you can reduce or prevent angina by working on reducing your heart disease risk factors and making healthy lifestyle changes. These risk factors may include:

So which angina treatment is better — angioplasty and stenting or medications?

Your medical condition will determine whether having angioplasty and stenting or taking medications will work better for you. Talk to your doctor about which angina treatment is best for your situation. Consider this:

What if your angina treatment doesn't work?

If you try medication and lifestyle changes first, but they don't relieve your angina, angioplasty and stenting may be another option. In some cases coronary bypass surgery may be needed. It might be reasonable to try more-conservative steps first — medications and lifestyle therapy — before considering angioplasty and stenting or other treatments.

Research is ongoing in new therapies and medications to treat angina. Discuss with your doctor if other therapies may be appropriate for you.

Talk to your doctor if you're concerned that medications or stents aren't controlling your angina. Remember that with any treatment plan, lifestyle changes are important.