How is microvascular angina treated?
“In my armamentarium, I use drugs to dilate the coronary arteries: long-lasting nitrates such as the nitroglycerin patch; then calcium-channel blockers such as verapamil [brand names include Calan, Covera, Isoptin, and Verelan] or diltiazem [brand names include Cardizem, Cartia, Dilacor, Diltia, and Tiazac]. “Then the other new drug which is really promising is Ranexa, which works by a totally different mechanism on the metabolism of the heart. It is an incredible anti-angina drug but does not have FDA approval for that indication. I have shifted a lot toward use of Ranexa for these patients. [O’Neill has no financial link to the makers of this drug]. “Exercise is also a good thing to do. What I tell people is to exercise to the threshold of symptoms, then cut back. So if you get angina after running three miles on the treadmill, cut back to two miles, then gradually build up. The more you exercise, the more you are able to exercise.
