What Is It?
Angina, also called angina pectoris, is discomfort or pain in the chest that happens when not enough oxygen-rich blood reaches the muscle cells of the heart. Angina is not a disease, but a symptom of a more serious condition, usually coronary artery disease, an illness in which the vessels that supply blood to the heart become narrow or blocked. Coronary artery disease is usually caused by atherosclerosis, a condition in which fatty deposits (called plaque) build up along the inside walls of blood vessels. Although angina most commonly affects males who are middle-aged or older, it can occur in both sexes and in all age groups.
People usually experience angina as a pressing, burning or squeezing pain in the chest. The pain typically centers under the breastbone, but it also can spread to the throat, arms, jaws, between the shoulder blades or downward to the stomach. Other symptoms that can go along with angina include nausea, dizziness or light-headedness, difficulty breathing or shortness of breath, and sweating.
Doctors divide angina into two types:
- Stable angina — Chest pain follows a specific pattern, occurring when someone engages in hard physical activity or experiences extreme emotion. Other situations that bring on angina include smoking a cigarette or cigar, cold weather, a large meal and straining in the bathroom. The pain usually goes away when the pattern or trigger ends.
- Unstable angina — Symptoms are less predictable and should prompt an immediate call to a health professional. This chest pain occurs at rest, during sleep or very often with minimal exertion. The discomfort may last and be intense.
Your doctor may suspect that you have angina based on the pattern of your symptoms and your risk of coronary artery disease. The doctor will ask about your history of smoking, diabetes and high blood pressure, and about your family’s medical history. Your doctor will review your cholesterol, including LDL (bad) and HDL (good) cholesterol. The doctor will check your blood pressure and pulse, and listen to your heart and lungs with a stethoscope. After this physical exam, 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 abnormalities in 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, then an Exercise stress test is 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.
- 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 threaded into an artery in the forearm or groin. The doctor guides the catheter toward the heart using a special camera. Once the catheter is in position, dye is injected to show blood flow inside the coronary arteries, and to identify any areas that are narrow or blocked.
An angina attack usually lasts less than five minutes. Pain that lasts longer than that or is severe may signal a more significant decrease in the heart’s blood supply. This can happen when someone is having a heart attack or unstable angina.
You can help to prevent angina caused by coronary artery disease by controlling your risk factors for clogged arteries:
- High cholesterol — Follow your doctor’s guidelines for eating a diet low in fats and cholesterol and, if necessary, take medication to decrease your cholesterol.
- High blood pressure — Follow your doctor’s recommendations for changing your diet and taking your medication.
- Smoking — If you smoke, quit. If you don’t smoke, don’t start.
- diabetes — Monitor your blood sugar frequently, follow your diet, and take your insulin or oral medication as your doctor has prescribed.
It’s also wise to exercise regularly and to maintain an ideal weight. If angina attacks are triggered by emotional stress, learning stress management or relaxation techniques may be helpful.
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 (for example, meditation and biofeedback ).
- Nitrates, including nitroglycerin — Nitrates are vasodilators (medications that widen blood vessels). They increase blood flow in the coronary arteries, and make it easier for the heart to pump blood to the rest of the body.
- Beta-blockers, such as atenolol (Tenormin) and metoprolol (Lopressor, Toprol-XL) — These medications decrease the heart’s workload by slowing the heart rate and reducing the force of the heart’s contractions, especially during exercise.
- Calcium channel blockers, such as nifedipine (Adalat, Procardia), verapamil (Calan, Isoptin, Verelan), diltiazem (Cardizem, Tiazac), amlodipine (Norvasc) — These medications may help to improve the efficiency of heart-muscle function and may decrease the number and severity of episodes of chest pain.
- 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.
When lifestyle changes and drugs fail to ease angina, or when the risk of a heart attack is great, balloon angioplasty or coronary artery bypass surgery may be recommended.
When To Call A Professional
Call your doctor if you experience chest pains, even if there is no history of heart problems in your family and you think you are too young to have angina. Your doctor will recommend the next steps based upon how you describe your symptoms in the context of your risk factors. New chest pain should always prompt a conversation with a health professional.
In patients with coronary artery disease, the prognosis depends upon many factors, including the location and severity of the narrowing, and the number of coronary arteries involved. Proper treatment has greatly improved the outlook for patients with coronary artery disease.
by Martin A. Harms, M.D.
All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.