Relieve heart pain in angina pectoris
Over five million people in Germany suffer from coronary heart disease (CHD). In CAD, the coronary arteries narrow and circulatory disorders occur, as a result of which the heart muscle is no longer sufficiently supplied with oxygen. This is manifested in those who are affected by a feeling of tightness in the chest, as well as burning pain, which occurs especially during exercise. The German research team has now summarized treatment options that can alleviate heart pain.
A working group from Würzburg, Essen and Mainz put together current forms of treatment for angina pectoris. According to researchers, there is no drug that can prolong the lives of people with chronic coronary syndrome, but heart pain associated with the disease can be alleviated. The results were recently presented in the well-known journal Nature Reviews.
Compass for the treatment of angina pectoris
Based on the latest findings, a team of cardiologists has created a compass for angina pectoris therapies, which should serve doctors to help make decisions. The review wants to help you use the right combination of medications at the right time.
There is no “good” or “bad” for available medications
First of all, the team has bad news for those who have coronary artery disease: although the range of pharmaceutical treatment options for angina pectoris is growing, there is currently no drug that can prolong a patient’s life. In addition, there is no cure that stands out from the rest. Whether the drug can improve the quality of life of patients depends on how well the drug suits the person in question. The compass is intended to make it easier to decide which medicine is best for which person.
Classic medicines for chest pain
The classic drugs for chest pain are therefore beta blockers, calcium channel blockers and nitrates. “They reduce the heart’s consumption of oxygen, dilate blood vessels and thus improve blood flow to the heart muscle,” the working group explains.
A new generation of drugs
According to researchers, the new generation of drugs includes active ingredients such as ranolazine, trimetazidine and ivabradine. While ivabradine slows the heart, ranolazine and trimetazidine intervene in the heart’s metabolism.
Patients benefit from personalized medicine
As the research team points out, there is currently no evidence that the currently available drug improves the prognosis of CHD. Large studies with classical drugs would be lacking, and major research work with new active ingredients would not prove prolongation of life.
The bottom line is that no one drug is significantly better than another. “Unless you take the cause of the disease and the pathophysiology of each individual patient as the basis for making treatment decisions,” explains Christoph Maack, head of translational research at the German Heart Failure Center Würzburg (DZHI).
Blood pressure and heart rate as a basis for decision making
Important parameters when choosing the right medicine are the patient’s blood pressure and pulse. According to Maack, the combination of these values is particularly crucial: “If the blood pressure is higher than 140 to 80 mmHg and the pulse is higher than 70 beats per minute, beta-blockers and nitrates are recommended, for example if the minute minute volume decreases, with beta-blockers ivabradine may also be given, a calcium channel blocker is preferred if sputum is preserved. “If heart rate and blood pressure are low, ranolazine and trimetazidine intake is recommended.
Utilization of cardiac metabolism
According to the research group, the heart alone metabolizes 70 to 80 percent of ingested fatty acids and 10 to 20 percent of sugars. “When glucose is metabolized, the mitochondria, the power plants of our cells, need less oxygen for energy than for the processing of fatty acids,” the researchers explain.
It could be used for the treatment of heart pain, because “the active ingredients ranolazine and trimetazidine block the metabolism of fatty acids.” The heart automatically switches to glucose metabolism.
Ranolazine also reduces the influx of sodium into the cells, which in turn has a beneficial effect on calcium balance. As a result, the heart muscle relaxes due to a decrease in calcium and blood flow improves.
Medications for people with diabetes
The use of ranolazine is particularly effective in people with diabetes, because the improved intake of sugar into the cells simultaneously reduces blood sugar levels. According to the working group, statins are also recommended for diabetics with CHD, because this group of people has a higher risk of events such as heart attack.
“Statins lower cholesterol, stabilize the inner layer of blood vessels, and thus protect against heart attack, which is often caused by an acute rupture of the inner layer of blood vessels,” the research team explains.
Researchers also point to the positive and well-documented effects of a healthy lifestyle. Are the foundations of this
- Nicotine abstinence,
- healthy diet,
- regular exercise,
- achieving and maintaining a normal body weight.
How useful are catheters and stents?
As part of the study, the research team also assessed whether it was desirable to dilate a narrowed coronary artery with a catheter or to insert a stent. According to researchers, this should depend on the situation of those affected. “In the case of CHD in a stable situation, catheter treatment usually improves symptoms, but also does not prolong survival,” Maack points out. A customized treatment plan can often be a reasonable alternative to a catheter.
“A little stress can also be good for the heart”
Because medications help the heart muscle to bypass bottlenecks. “A little stress can also be good for the heart,” Maack explains. Here comes into consideration a mechanism called in medicine a prerequisite. “The heart activates the molecular mechanisms of self-defense and optimizes its metabolism so that it becomes more resistant to oxygen deficiency,” explains the study leader. (vb)
Author and source information
This text is in accordance with the requirements of the specialist medical literature, medical guidelines and current studies and has been verified by medical professionals.
Diploma Editor (FH) Volker Blasek
- Würzburg University Hospital: What helps against heart pain? (published: 15.07.2021.), ukw.de
- Edoardo Bertero, Gerd Heusch, Thomas Münzel, Christoph Maack. Pathophysiological compass for personalizing antianginal drug treatment; in: Nat Rev Cardiol (2021)., nature.com
This article is for general guidance only and is not intended for use in self-diagnosis or self-medication. It cannot replace a visit to the doctor.