Should I have angioplasty for stable angina?

Introduction

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.
Key points in making your decision
This information is only for people who have mild heart disease and stable angina. If you have severe heart disease or unstable angina, this Decision Point is not for you.
You may decide to use only medical therapy. This is a daily plan of medicines, healthy eating, and exercise. Or you may decide to have angioplasty along with taking medicines and making lifestyle changes. Your doctor will help guide you on which is best for you.
Consider the following when making your decision:
Medical therapy and angioplasty work about the same at preventing heart attacks and helping people live longer. Angioplasty will not help you live any longer than medical therapy.
Angioplasty can get rid of chest pain if medical therapy has not stopped your pain. This may help you have a more active life.
If you choose angioplasty, you still need to make lifestyle changes. This will give you the best chance for a longer, healthier life.
Angioplasty carries the risk of heart attack, stroke, and even death. These rarely happen. But you may not want to take even the small risk of dying from the procedure if you have an equally small risk of dying without it.
If you decide to try medical therapy now, you can still have angioplasty later if your chest pain bothers you too much.
If you choose medical therapy, you might need to take five or more medicines every day. You may have side effects from them. If you have angioplasty, you will still need to take some medicines, but you may not have to take as many.
The benefits of angioplasty may not last. The repaired artery can become blocked again over time. You may need another procedure.
Medical Information

Who has the option of choosing angioplasty?
Choosing a treatment may seem like a decision that your doctor should make. But you can take part in this important choice if:
You have mild heart disease. This means that you do not have too much narrowing of the arteries that give blood and oxygen to your heart (coronary arteries). It also means that your risk of having a heart attack is not too high.
You have stable angina. This is chest pain that occurs only with emotional or physical stress and goes away when you rest or after you take nitroglycerin.
Your doctor can tell you if you meet these conditions.
You will want to talk to your doctor about angioplasty before you have an angiogram test. During the test, you will not be able to take part in the decision about angioplasty because you will be sleepy from medicines. So, before the test, talk with your doctor about what the test might show and what the doctor's options are in each case. You can tell the doctor what you would prefer based on the test results.
How is angioplasty done?
During angioplasty, the doctor puts a thin, flexible tube called a catheter into an artery in your groin or arm. The doctor guides the tube into the narrowed artery. He or she inflates a small balloon at the end of the tube. This widens the artery to allow blood to flow. The doctor may put a small wire-mesh tube called a stent in the artery to keep it open. See a picture of angioplasty with stent placement .
What are the risks of this procedure?
Angioplasty has some rare but serious risks. They are:
The need for emergency open-heart surgery during the procedure.
Heart attack.
Stroke.
Death.
Most people recover from angioplasty fairly quickly. They usually go home after an overnight stay in the hospital. They can return to normal activities within a few days. After angioplasty, they need to follow a heart-healthy diet and exercise. They also need to quit smoking if they smoke. Taking their medicines is also important.
Keep in mind that the chances of having a serious problem with this procedure are higher if you are older than 70.
What is medical therapy for stable angina?
Medical therapy includes making lifestyle changes and taking medicines. Lifestyle changes play a big role in helping you live longer. They include eating a healthy diet, not smoking, and getting daily exercise. Changing your habits may not be easy, but it could keep your heart disease from getting worse. It could even reverse some of the damage.
Your doctor will ask you to:
Exercise almost every day. The American Heart Association suggests that you exercise for at least 30 minutes on all or most days of the week.
Eat a heart-healthy diet. This includes lots of fruits and vegetables, whole grains, and lean protein. Try to eat fish at least 2 times a week.
Know your numbers. Keep track of your blood pressure and cholesterol, and take your medicines to keep your numbers in a healthy range.
Stay at a healthy weight.
Keep your blood sugar as close to normal as possible if you have diabetes.
Stop smoking. Quitting smoking can greatly lower your chance of having a heart attack and dying.
Whatever choice you make about angioplasty, making these lifestyle changes will give you the best chance of keeping heart disease from getting worse. These changes are important for all people who have heart disease.
Taking medicines every day is another key part of medical therapy. You may need to take:
Medicines, such as statins, to help lower cholesterol.
Beta-blockers to keep your heart from working too hard. The medicine slows the heart rate and lowers blood pressure. It can help make chest pain better and may prevent it.
ACE inhibitors to lower blood pressure and the risk of heart attack.
Aspirin or other medicines to reduce the risk of blood clots and heart attacks.
Nitrates, such as nitroglycerin, to stop chest pain.
Calcium channel blockers to increase blood flow to the heart. They also can improve or prevent chest pain. This medicine is sometimes added to the other medicines.
What are the side effects of these medicines?
All medicines have side effects. Your doctor may lower the dose or give you another drug if side effects bother you.
Statins: The most common side effects include an upset stomach, gas, constipation, belly pain or cramps, and feeling more tired than usual. Rarely, statins can cause liver problems or muscle pain and damage.
Beta-blockers: Side effects include dizziness, feeling more tired than usual, losing your sex drive or having trouble getting an erection, and depression. People with asthma may not be able to take beta-blockers.
ACE inhibitors: Side effects include a dry cough, nausea, diarrhea, and swelling of the face and hands.
Aspirin and other medicines to reduce the risk of blood clots: They can cause an upset stomach and bleeding.
Nitrates: Normal, temporary side effects of nitroglycerin include a warm or flushed feeling, a headache, dizziness, or lightheadedness. You may also have a burning feeling when you put the pill under your tongue.
Calcium channel blockers: The most common side effects include headaches, dizziness, constipation, and weakness.
Even if you choose to have angioplasty, you may need to take at least some of these medicines.
How well does medical therapy or angioplasty work for stable angina?
Medical therapy and surgery can both stop chest pain. They also can make it easier for you to exercise, which is a key part of keeping your heart healthy.
Many people try medical therapy first. But it doesn't always work. You may decide to have angioplasty if you still have chest pain and can't exercise even after you have taken medicines and made lifestyle changes.
While angioplasty can ease chest pain, it has not been proven to help you live any longer than medical therapy. Also, angioplasty does not lower the risk of having a heart attack any more than medical therapy.¹
If you need more information, see the topic Coronary Artery Disease.
Your Information

Your choices are:
Take medicines and make lifestyle changes to treat your chest pain.
Have angioplasty for chest pain, along with taking medicines and making healthy lifestyle changes.
The decision whether to have angioplasty takes into account your personal feelings and the medical facts.
Deciding about angioplasty for chest pain

Reasons to have angioplasty

Reasons to try medical therapy

You have chest pain that keeps you from exercising and enjoying your life.
Medical therapy hasn't stopped your chest pain.
You may be able to take fewer medicines than with medical therapy.
You feel that angioplasty can give you the best treatment.

Are there other reasons you might want to have angioplasty?

Your chest pain doesn't bother you too much.
You want to try medical therapy first to control your chest pain.
You are concerned about the risks of having angioplasty.
You have not had a recent heart attack. Angioplasty doesn't prevent a heart attack or death any better than medical therapy in people who have not had a recent heart attack.

Are there other reasons you might want to try medical therapy?

These personal stories may help you make your decision.
Wise Health Decision

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about this decision. Discuss the worksheet with your doctor.
Circle the answer that best applies to you.
I don't want to have angioplasty if it won't help me live longer. Yes No Unsure
I want angioplasty because I can't exercise with my chest pain. Yes No Unsure
My doctor says angioplasty is the best option for me. Yes No NA*
I don't want angioplasty because I don't want to go through even a short recovery time. Yes No Unsure
My doctor says medical therapy is the best option for me. Yes No NA
I have been eating right, exercising, and taking my medicines. But they haven't helped my chest pain enough. Yes No Unsure
I know I can have angioplasty later, so I think I'll try medical therapy first. Yes No Unsure
I don't want to take all of the medicines in medical therapy because of the side effects. Yes No Unsure
I know that making lifestyle changes will help me live longer, so I'm going to try making those changes and taking medicines. Yes No Unsure
I want to try everything I can to feel better, so I'm going to have angioplasty. Yes No Unsure
The risks of angioplasty, although small, are too big for me. Yes No Unsure
*NA=Not applicable
Use the following space to list any other important concerns you have about this decision.

What is your overall impression?
Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to decide for or against angioplasty.
Check the box below that represents your overall impression about your decision.

Leaning toward having angioplasty

Leaning toward NOT having angioplasty

Return to the topic Coronary Artery Disease.
Related Information

Coronary Artery Disease


Author:	Robin Parks, MS	Last Updated May 29, 2007
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Robert A. Kloner, MD, PhD - Cardiology Ruth Schneider, MPH, RD - Diet and Nutrition
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