Angina
What Is Angina?
Angina (an-JI-nuh or AN-juh-nuh) is chest pain or discomfort that occurs when your heart muscle does not get enough blood. Angina may feel like pressure or a squeezing pain in your chest. The pain may also occur in your shoulders, arms, neck, jaw, or back. It may also feel like indigestion.
Angina is a symptom of , the most common type of heart disease. CAD occurs when plaque builds up in the coronary arteries. This buildup of plaque is called . As plaque builds up, the coronary arteries become narrow and stiff. Blood flow to the heart is reduced. This decreases the oxygen supply to the heart muscle.
Types of Angina
The two types of angina are stable and unstable. It is very important to know the differences among the types.
- Stable angina
-
Stable angina is the most common type. It occurs when the heart is working harder than usual.
- There is a regular pattern to stable angina. After several episodes, you learn to recognise the pattern and can predict when it will occur.
- The pain usually goes away in a few minutes after you rest or take your angina medicine.
- Stable angina is not a heart attack but makes it more likely that you will have a heart attack in the future.
- Unstable angina
- Unstable angina is a very dangerous condition that requires emergency treatment. It is a sign that a heart attack could occur soon. Unlike stable angina, it does not follow a pattern. It can occur without physical exertion and is not relieved by rest or medicine.
Not all chest pain or discomfort is angina. Chest pain or discomfort can be caused by a heart attack, lung problems (such as an infection or a blood clot), heartburn, or a panic attack. However, all chest pain should be checked by a doctor.
What Are the Signs and Symptoms of Angina?
Pain and discomfort are the main symptoms of angina. These symptoms
- Are often described as pressure, squeezing, burning, or tightness in the chest
- Usually start in the chest behind the breastbone
- May also occur in the arms, shoulders, neck, jaw, throat, or back
- May feel like indigestion
Some people say that angina discomfort is hard to describe or that they can't tell exactly where the pain is coming from. Symptoms such as nausea, fatigue, shortness of breath, sweating, light-headedness, or weakness may also occur.
Symptoms vary based on the type of angina.
Stable Angina
The pain or discomfort:
- Occurs when the heart must work harder, usually during physical exertion
- Is expected, and episodes of pain tend to be alike
- Usually lasts a short time (5 minutes or less)
- Is relieved by rest or angina medicine
- May feel like gas or indigestion
- May feel like chest pain that spreads to the arms, back, or other areas
Unstable Angina
The pain or discomfort:
- Often occurs at rest, while sleeping at night, or with little physical exertion
- Is unexpected
- Is more severe and lasts longer (as long as 30 minutes) than episodes of stable angina
- Is usually not relieved with rest or angina medicine
- May get continuously worse
- May signal that a heart attack will happen soon
Chest pain that lasts longer than a few minutes and is not relieved by rest or angina medicine may mean you are having—or are about to have—a heart attack. Call 0-0-0 right away.
To find out if you have angina, your doctor will:
- Do a physical exam
- Ask about your symptoms
- Ask about your risk factors and your family history of coronary artery disease (CAD) or other heart disease
Sometimes, your doctor can diagnose angina by noting your symptoms and how they occur. Your doctor may order one or more tests to help make a diagnosis of angina. The tests your doctor may order include:
- This test measures the rate and regularity of your heartbeat. Some people with angina have a normal ECG
- Some heart problems are easier to diagnose when the heart is working hard and beating fast. During stress testing, a patient exercises, or is given medicine, to make the heart work harder and beat fast while heart tests are performed. During exercise stress testing, blood pressure and ECG readings are monitored while the patient runs on a treadmill or pedals a bicycle.
In addition to an ECG, other heart tests, such as nuclear heart scanning or echocardiography, can also be done at the same time. During nuclear heart scanning, radioactive dye is injected into the bloodstream, and a special camera shows the flow of blood to the heart muscle. Echocardiography uses sound waves to show blood flow through the chambers and valves of the heart and to show the strength of the heart muscle. If a person is unable to exercise, a medicine can be injected into the bloodstream to make the heart work harder and beat fast. Nuclear heart scanning or echocardiography is then done.
Two newer tests that are being done with stress testing are magnetic resonance imaging (MRI) and positron emission tomography (PET) scanning of the heart. MRI shows detailed images of the structures and beating of the heart. PET scanning shows blood flow to the heart muscle and areas of damaged heart muscle.
- A chest x ray takes a picture of the organs and structures inside your chest. These include your heart, lungs, and blood vessels.
- This test shows blood flow to the heart and any damage to the heart muscle. A radioactive dye (technetium or thallium) is injected into your bloodstream. A special camera can see the dye and find areas where blood flow is reduced. Nuclear heart scans are often taken while you are at rest and again after exercise. If you cannot exercise, a medicine is given to increase the workload of the heart. The before-and-after exercise scans are compared.
- This test uses sound waves to create a picture of the heart. The picture is more detailed than an x-ray image. The test shows how well your heart chambers fill with blood and pump it to the rest of the body. An echocardiogram also can help identify areas of poor blood flow to the heart, areas of heart muscle that are not contracting normally, and previous injury to the heart muscle caused by poor blood flow. An echocardiogram can also be used with a stress test.
- A thin flexible tube (catheter) is passed through an artery in the groin (upper leg) or arm to reach the coronary arteries. Your doctor can determine pressure and blood flow in the heart's chambers, collect blood samples from the heart, and examine the arteries of the heart by x ray.
- This test is done during cardiac catheterization. A dye that can be seen by x ray is injected through the catheter into the coronary arteries. Your doctor can see the flow of blood through your heart and the location of blockages.
Your doctor may also order blood tests, such as:
- to check your cholesterol levels.
- Fasting glucose test to check your blood sugar level.
- A test to check for low hemoglobin in your blood. Hemoglobin is the part of red blood cells that carries oxygen to all parts of your body.
How Is Angina Treated?
Treatment for angina includes lifestyle changes, medicine, special procedures, and cardiac rehabilitation. The main goals of treatment are to:
- Reduce the frequency and severity of symptoms
- Prevent or lower the risk of heart attack and death
Lifestyle changes and medicine may be the only treatments needed if your symptoms are mild and are not getting worse. Unstable angina is an emergency condition that requires treatment in the hospital.
Lifestyle Changes
The first thing that you need to do is change your living habits to avoid bringing on an episode of angina.
- Slow down or take rest breaks, if angina comes on with exertion.
- Avoid large meals and rich foods that leave you feeling stuffed, if angina comes on after a heavy meal.
- Try to avoid situations that make you upset or stressed, if angina comes on with stress. Learn techniques to handle stress that can't be avoided.
You can also make other lifestyle changes, for example:
- Eat a healthy diet to prevent or reduce , , and
- Quit smoking,
- Be physically active, as directed by your doctor
- Lose weight, if you are .
- Follow your doctor's orders and take all medicines as directed, especially if you have diabetes
Medications
are the most commonly used medicines to treat angina. Fast-acting preparations are taken when angina occurs or is expected to occur. Nitrates relax and widen blood vessels, allowing more blood to flow to the heart while reducing its workload.
You can use nitrates in different forms to:
- Relieve an episode that is occurring by using the medicine when the pain begins
- Prevent an episode from occurring by using the medicine just before pain or discomfort is expected to occur
- Reduce the number of episodes that occur by using the medicine regularly on a long-term basis
Nitroglycerin is the most commonly used nitrate for angina. is used to relieve an angina episode. Nitroglycerin in the form of and is used to prevent attacks of angina. These forms of nitroglycerin act too slowly to relieve pain during an angina attack.
Other medicines can be used to treat angina:
- slow the heart rate and lower blood pressure. They can delay or prevent the onset of angina.
- relax blood vessels so that more blood flows to the heart, reducing pain from angina. Calcium channel blockers also lower blood pressure.
- lower blood pressure and reduce the strain on the heart. They also reduce the risk of a future heart attack and heart failure.
People who have angina may also use:
- Oral antiplatelet (an-ty-PLAYT-lit) medicines (such as and ), taken daily, to stop platelets from clumping together to form blood clots. Platelets are small blood cells that circulate through your blood vessels and help stop bleeding by sticking together to seal small cuts or breaks in tiny blood vessels. Antiplatelet medicines may not be appropriate for some people because they increase the risk of bleeding. Discuss the benefits and risks with your doctor before starting therapy with aspirin or the other antiplatelet medicines.
- Glycoprotein IIb-IIIa inhibitors are potent antiplatelet medicines that prevent clots from forming in your arteries. They are given intravenously in hospitals for the treatment of angina or during and after angioplasty.
- (an-ty-ko-AG-u-lants) to prevent clots from forming in your arteries and blocking blood flow.
Special Procedures
When medicines and other treatments do not control angina, special (invasive) procedures may be needed. Two commonly used procedures are:
- Angioplasty
- This procedure opens blocked or narrowed coronary arteries. It can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack. Sometimes a stent is placed in the artery to keep it propped open after the procedure.
- Coronary artery bypass surgery
- This procedure uses arteries or veins from other areas in your body to bypass your blocked coronary arteries. Bypass surgery improves blood flow to your heart, relieves chest pain, and can prevent a heart attack.
Key Points
- Angina is chest pain or discomfort that occurs when your heart muscle does not get enough blood. Angina may feel like pressure or a squeezing pain in your chest. The pain may also occur in your shoulders, arms, neck, jaw, or back.
- Most people with angina have coronary artery disease, with narrowed arteries due to atherosclerosis. When arteries are narrowed, blood flow to the heart is reduced.
- More than 6 million people in the United States have angina.
- The most common types of angina are stable angina and unstable angina. A less common type of angina is called variant angina.
- Stable angina is chest pain or discomfort that occurs when the heart is working harder than usual. Pain from stable angina goes away when you rest or take your angina medicine. Angina medicine, such as nitroglycerin, helps widen and relax the arteries so that more blood can flow to the heart.
- Unstable angina is a very dangerous condition that requires emergency treatment. Unstable angina is a sign that a heart attack could occur soon. Unstable angina can occur without physical exertion. It is not relieved by rest or medicine.
- Doctors diagnose angina based on your health history, your family’s health history, a physical exam, and the results of various tests.
- Angina is usually treated with medicines such as nitrates (nitroglycerin). People with angina may need to take other medicines to lower their blood pressure or cholesterol. They also may take medicine to prevent blood clots.
- To prevent and treat angina, it is important to make changes to improve your health. Get regular physical activity, maintain a healthy weight, don't smoke, and eat a healthy diet that is low in saturated fat and cholesterol. A cardiac rehab program can be helpful for many people with angina.
- When medicines and lifestyle changes do not control angina, special procedures may be needed. Angioplasty and coronary artery bypass surgery are two common procedures used to treat angina.
- If you have angina, it is important to know the pattern of your angina, about your medicine, how to control your angina, and the limits on your physical activity. You should know how and when to seek medical help.