Angina

Angina

Angina (sometimes called angina pectoris) occurs when your heart doesn’t get as much blood and oxygen as it needs because of a blockage of one or more of the heart’s arteries (coronary arteries). This blockage causes pain in the chest. People who have angina describe the pain as a squeezing, suffocating or burning feeling.

What is angina?

Angina is not a heart attack. It is a warning signal that you are at increased risk of a heart attack, cardiac arrest or sudden cardiac death. Usually, the pain will go away with rest or medication, but it is your heart telling you that your body is working too hard and needs to slow down. Angina is a warning to you to stop what you are doing and rest. If you experience this kind of chest pain, see your doctor to determine the cause and get treatment if necessary.

What causes angina?

Angina is the pain you feel when one or more of your coronary arteries becomes damaged, blocked or narrowed and isn’t able to bring enough oxygen-rich blood to your heart. The pain may occur during physical activity, exercise, stress, periods of extreme cold or hot temperatures, after heavy meals or while drinking alcohol or smoking

Angina is most often caused by:

  • Coronary artery disease as a result of atherosclerosis, a buildup of fatty deposits that block the flow of blood through the coronary arteries.
  • Coronary artery spasm, when one of the blood vessels supplying the heart muscle vigorously contracts, causing blood flow to the part of the heart supplied by the artery to decrease or even stop, resulting in a heart attack.

In some cases angina can be caused by uncontrolled high blood pressure, or other heart conditions such as narrowing of one of the valves in the heart (aortic stenosis) or an enlarged heart (hypertrophic cardiomyopathy). Sometimes, people can have chest pain that is the result of other health conditions such as lung problems, muscle problems or bone problems.

What are the symptoms of angina?

Angina is usually a symptom of coronary artery disease and puts you at risk of having a heart attack. Symptoms of angina are often experienced after exertion or emotional stress and are relieved with rest or medication. Symptoms of angina include:

  • Pain that starts in the centre of your chest, but spreads to your left arm, neck, back, throat or jaw.
  • Tightness, pressure, squeezing and/or aching feeling in your chest or arm(s).
  • Feeling of moderate to severe indigestion that is persistent.
  • Sharp, burning or cramping pain.
  • An ache starting in, or spreading to, your neck, jaw, throat, shoulder, back or arm(s).
  • Discomfort in your neck or upper back, particularly between the shoulder blades.
  • Numbness or a loss of feeling in your arms, shoulders or wrists.

If you experience one or more of these symptoms, see your doctor right away. If your pattern of angina changes, call your doctor as soon as possible.

What should I do?

Get immediate medical attention.

Usually angina only lasts a few minutes, but if the pain lasts longer, it may mean that you have a sudden, total blockage of a coronary artery or that you may be having a heart attack and you need to get help immediately. If you are experiencing chest pain or pressure that is not relieved with rest or nitroglycerin after 15 minutes, you may be having a heart attack. Don’t delay. Call 9-1-1 or your local emergency response number immediately.

What are the types of angina?

  • Stable angina usually follows a predictable pattern. The pain generally happens at about the same point when you are exercising or under emotional stress. The pain is usually relieved with rest or medication. If you have stable angina, try to track how long it lasts and what helps ease the pain. This will help you notice any change in the pattern, which could mean you have developed unstable angina.
  • Unstable angina causes chest pain that is unexpected and may happen when you are at rest or without stimulating activity. If you have chest pain that is new, worsening or constant, you are at greater risk of having a heart attack, an irregular heartbeat (arrhythmia), and even sudden death. See your doctor as soon as possible.
  • Variant angina, also called Prinzmetal’s angina, usually happens spontaneously, and unlike stable angina, it nearly always happens while you are at rest. It doesn’t follow physical exertion or emotional stress. Attacks may be very painful and usually happen between midnight and 8 a.m. It is caused by coronary artery spasm. About two-thirds of people with variant angina have severe atherosclerosis in at least one major coronary artery and the spasm usually happens very close to the blockage.
  • Microvascular angina causes chest pain but without any apparent blockage in a coronary artery. The pain is caused by an improper functioning of the tiny blood vessels that feed your heart. (This condition may also be referred to as Cardiac Syndrome X, not to be confused with metabolic syndrome, which is also known as Syndrome X.)
  • Atypical angina is where you may not experience typical symptoms of angina and instead may feel a vague chest discomfort, shortness of breath, fatigue, nausea, back or neck pain or burning indigestion. Women are more likely to experience atypical symptoms such as vague chest discomfort.

How is angina diagnosed?

Your doctor will probably review your medical history and give you a complete physical exam. Then, he or she may want to run a few tests before recommending treatment. These tests may include:

  • Angiography
  • Electrocardiogram (ECG/ EKG)
  • Echocardiogram
  • Exercise electrocardiogram (Stress test)
  • Thallium or cardiolite scan
  • Transesophageal echocardiogram (TEE)

 

How is angina treated?

Lifestyle changes and medications are the most common ways to treat and control angina. Sometimes, surgery may be necessary.

Lifestyle changes

Although exercise may bring on angina, you’ll still need to stay physically active, as long as your doctor approves. You could live more comfortably and with fewer angina attacks by controlling your risk factors such as blood pressure, diabetes and high blood cholesterol, and by eating a healthy diet, being smoke-free, limiting alcohol use and reducing stress.

Medications

Certain medications may help prevent or relieve the symptoms of angina.

  • Anti-platelets
  • Beta-blockers
  • Calcium channel blockers
  • Nitroglycerin