Angina

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.

Symptoms

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.

Diagnosis

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.