Angina

An Overview

Angina is chest pain that happens because there isn’t enough blood going to part of your heart. It can feel like a heart attack, with pressure or squeezing in your chest. It’s sometimes called angina pectoris or ischemic chest pain. Angina, also called angina pectoris, is often described as squeezing, pressure, heaviness, tightness or pain in your chest. Some people with angina symptoms say angina feels like a vise squeezing their chest or a heavy weight lying on their chest. Angina may be a new pain that needs to be checked by a doctor, or recurring pain that goes away with treatment. Angina usually goes away quickly. Still, it can be a sign of a life-threatening heart problem.

Types of Angina

There are different types of angina:

Stable Angina. This is the most common. Physical activity or stress can trigger it. It usually lasts a few minutes, and it goes away when you rest. It isn’t a heart attack, but it can be a sign that you’re more likely to have one. Tell your doctor if this happens to you. Exertion in cold weather or after a large meal is more likely to bring on angina. The symptoms should quickly subside once the person rests and relaxes.

Unstable Angina. You can have this while you’re at rest or not very active. The pain can be strong and long-lasting, and it may come back again and again. It can be a signal that you’re about to have a heart attack, so see a doctor right away. The discomfort may last and be intense. You should seek medical care immediately if this occurs, even if the chest pain has resolved.

Micro vascular Angina. With this type, you have chest pain but no coronary artery blockage. Instead, it happens because your smallest coronary arteries aren’t working the way they should, so your heart doesn’t get the blood it needs. The chest pain usually lasts more than 10 minutes. This type is more common in women.

Prinzmetal’s angina. This type is rare. It might happen at night while you’re sleeping or resting. Your heart arteries suddenly tighten or narrow. It can cause a lot of pain, and you should get it treated.

Symptoms for Angina

Angina symptoms include chest pain and discomfort, possibly described as pressure, squeezing, burning or fullness. Angina usually feels like a pressing, burning or squeezing pain in the chest. The main pain usually is under the breastbone. The pain may spread up toward the throat and into the jaw. You may also have pain in your arms, neck, jaw, shoulder or back.

Other symptoms that you may have with angina include:

  • Dizziness
  • Fatigue
  • Nausea
  • Shortness of breath
  • Discomfort in the neck, jaw or back
  • Stabbing pain instead of chest pressure
  • Anxiety
  • Sweating

These symptoms need to be evaluated immediately by a doctor who can determine whether you have stable angina, or unstable angina, which can be a precursor to a heart attack.

Causes of Angina

Angina is caused by reduced blood flow to your heart muscle. Your blood carries oxygen, which your heart muscle needs to survive. When your heart muscle isn’t getting enough oxygen, it causes a condition called ischemia. The most common cause of reduced blood flow to your heart muscle is coronary artery disease (CAD). Your heart (coronary) arteries can become narrowed by fatty deposits called plaques. Your arteries can become narrow and hard when plaque (a substance made of fat, cholesterol, calcium and other substances) builds up inside the artery walls

Diagnosis

The doctor will check your blood pressure and pulse, and listen to your heart and lungs. You may need one or more diagnostic tests to determine if you have coronary artery disease. Possible tests include:

  • Electrocardiogram (EKG). An EKG is a record of your heart’s electrical impulses. It can identify problems with heart rate and rhythm. Sometimes it can show changes indicating a blocked artery.
  • Stress test. If your EKG is normal and you are able to walk, you’ll be sent for an exercise stress test will be ordered. You’ll walk on a treadmill while your heart rate is monitored. Other stress tests use medications to stimulate the heart, inject dyes to look for blockages and take ultrasound pictures to provide more information.
  • Angiography. a type of X-ray that allows your doctor to see your blood vessels and measure blood flow to your heart.
  • Coronary angiogram. These X-rays of the coronary arteries are the most accurate way to measure the severity of coronary disease. A thin, long, flexible tube (called a catheter) is inserted into an artery in the forearm or groin.

Treatment

When angina is caused by coronary artery disease, treatment usually includes:

  • Lifestyle changes. Changes include weight loss for obese patients, therapy to quit smoking, medications to lower high cholesterol, a program of regular exercise to lower high blood pressure and stress reduction techniques.
  • Nitrates. Including nitroglycerin Nitrates are medications that widen blood vessels (vasodilators). They increase blood flow in the coronary arteries and make it easier for the heart to pump blood to the rest of the body.
  • Aspirin. Because aspirin helps to prevent blood clots from forming inside narrowed coronary arteries, it can reduce the risk of heart attacks in people who already have coronary artery disease.
  • Surgery: A minimally invasive procedure called angioplasty is often used to treat stable angina. During this procedure, a surgeon places a small balloon inside your artery. The balloon is inflated to widen the artery, and then a stent (tiny wire mesh coil) is inserted.

Risk factor

  • Tobacco use. Chewing tobacco, smoking and long-term exposure to secondhand smoke damage the interior walls of arteries including arteries to your heart allowing deposits of cholesterol to collect and block blood flow.
  • Diabetes. Diabetes increases the risk of coronary artery disease, which leads to angina and heart attacks by speeding up atherosclerosis and increasing your cholesterol levels.
  • High blood pressure. Over time, high blood pressure damages arteries by accelerating hardening of the arteries.

You may continue to struggle with chest pain if you’re unable to transition to a healthier lifestyle. You also might be at an increased risk for other types of heart disease. Possible complications of stable angina include heart attack, sudden death caused by abnormal heart rhythms and unstable angina.

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