What is angina?
The heart is the pump responsible for circulating blood throughout the body. Myocardium (myo=muscle + cardium=muscle) is the heart muscle that contracts to pump that blood and like any other muscle, it requires oxygen rich blood for energy. Angina pectoris describes the pain, discomfort, or other symptoms that occur when blood flow to heart muscle cells is not enough to meet its energy needs.
The classic description of angina is a crushing pain that radiates across the chest, sometimes down the arm, into the neck, jaw or teeth, or into the back. It may be associated with shortness of breath, nausea, vomiting, sweating, and weakness.
Many patients do not use pain as a description for angina, instead describing the sensation as a fullness, tightness, burning, squeezing, or ache. The discomfort may be felt in the upper abdomen, between the shoulders, or in the back. The pain may be felt just in an arm, right, left or both, and may or may not be associated with other symptoms.
Angina is often brought on by exercise and activity and gets better with rest. When the body requires the heart to pump more blood, the heart muscle is asked to do more work and that can cause it to outstrip its energy supply. When the body rests, angina should start to subside.
Angina tends to progress slowly over time and patients may not recognize that their symptoms are due to heart disease. It may be fatigue and exercise intolerance, the gradually inability to perform work or other activities that had once been easier to do. It may be shortness of breath with activity like walking up steps or uphill. It is worrisome when the pain comes on at rest or at sleep, since it means that little activity is causing enough stress to cause angina symptoms.
This is the same situation that occurs when muscles in the leg or arm fatigue because of overuse and they begin to ache. The difference is that one can stop lifting or running but the heart cannot stop beating to rest. The other difference is that the symptoms of angina are felt in different ways by different patients and may not be recognized as coming from the heart.
Unfortunately for some patients, they may have no symptoms at all, even with significant narrowing of their coronary arteries, and they may first present for care in the midst of a myocardial infarction or heart attack. This is especially true for women who may have atypical angina symptoms including fatigue, malaise, weakness, and dizziness.
Angina is a warning sign that the heart muscle is not getting adequate blood supply and oxygen. If unheeded it may lead to a heart attack or myocardial infarction (myo=muscle + cardium=heart + infarct=death).
What are the symptoms for angina?
Angina symptoms include:
- Chest pain or discomfort, possibly described as pressure, squeezing, burning or fullness
- Pain in your arms, neck, jaw, shoulder or back accompanying chest pain
- Shortness of breath
These symptoms need to be evaluated immediately by a doctor who can determine whether you have stable angina, or unstable angina that may indicate a possible heart attack.
Stable angina is the most common form of angina. It usually happens when you exert yourself and goes away with rest. For example, pain that comes on when you're walking uphill or in the cold weather is often angina.
Characteristics of stable angina
- Develops when your heart works harder, such as when you exercise or climb stairs
- Can usually be predicted and the pain is usually similar to previous types of chest pain you've had
- Lasts a short time, perhaps five minutes or less
- Disappears sooner if you rest or use your angina medication
The severity, duration and type of angina can vary. New or different symptoms may signal a more dangerous form of angina (unstable angina) or a heart attack.
Characteristics of unstable angina (a medical emergency)
- Occurs even at rest
- Is a change in your usual pattern of angina
- Is unexpected
- Is usually more severe and lasts longer than stable angina, maybe 30 minutes or longer
- May not disappear with rest or use of angina medication
- Might signal a heart attack
There's another type of angina, called variant angina or Prinzmetal's angina. This type of angina is rarer. It's caused by a spasm in your heart's arteries that temporarily reduces blood flow.
Characteristics of variant angina (Prinzmetal's angina)
- Usually happens when you're resting
- Is often severe
- May be relieved by angina medication
Angina in women
A woman's angina symptoms can be different from the classic angina symptoms. These differences may lead to delays in seeking treatment. For example, chest pain is a common symptom in women with angina, but it may not be the only symptom or the most prevalent symptom for women. Women may also experience symptoms such as:
- Shortness of breath
- Abdominal pain
- Discomfort in the neck, jaw or back
- Stabbing pain instead of chest pressure
When to see a doctor
If your chest pain lasts longer than a few minutes and doesn't go away when you rest or take your angina medications, it may be a sign you're having a heart attack. Call 911 or emergency medical help. Arrange for transportation. Only drive yourself to the hospital as a last resort.
If chest discomfort is a new symptom for you, it's important to see your doctor to find out what's causing your chest pain and to get proper treatment. If stable angina gets worse or changes, seek medical attention immediately.
What are the causes for 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. This is called atherosclerosis.
This reduced blood flow is a supply problem — your heart is not getting enough oxygen-rich blood. You may wonder why you don't always have angina if your heart arteries are narrowed due to fatty buildup.
This is because during times of low oxygen demand — when you're resting, for example — your heart muscle may be able to get by on the reduced amount of blood flow without triggering angina symptoms. But when you increase the demand for oxygen, such as when you exercise, this can cause angina.
- Stable angina. Stable angina is usually triggered by physical exertion. When you climb stairs, exercise or walk, your heart demands more blood, but it's harder for the muscle to get enough blood when your arteries are narrowed. Besides physical activity, other factors such as emotional stress, cold temperatures, heavy meals and smoking also can narrow arteries and trigger angina.
Unstable angina. If fatty deposits (plaques) in a blood vessel rupture or a blood clot forms, it can quickly block or reduce flow through a narrowed artery, suddenly and severely decreasing blood flow to your heart muscle. Unstable angina can also be caused by blood clots that block or partially block your heart's blood vessels.
Unstable angina worsens and isn't relieved by rest or your usual medications. If the blood flow doesn't improve, your heart is deprived of oxygen and a heart attack occurs. Unstable angina is dangerous and requires emergency treatment.
- Prinzmetal's angina. This type of angina is caused by a spasm in a coronary artery in which the artery temporarily narrows. This narrowing reduces blood flow to your heart, causing chest pain. Emotional stress, smoking and use of the illegal drug cocaine may trigger this type of angina.
What are the treatments for angina?
Treatment for angina depends upon the cause and may include behavior modification, exercise, medication, and surgery.
Should the cause be ASHD, medications are used to help minimize progression of artery narrowing and plaque buildup. Medications can be also be used to decrease the oxygen requirements of the heart and to allow the heart muscle to function more efficiently.
Aspirin may be recommended to make platelets less sticky to prevent clot formation and prevent heart attack.
Long-acting nitroglycerin medications (Imdur, Nitropaste) may be prescribed to dilate coronary arteries and increase blood flow to the heart muscle. As well, nitroglycerin may be used to abort an episode of angina. In this case it may be taken as a tablet or spray under the tongue.
The best treatment for angina is prevention, especially if the cause is ASHD. Lifelong control of blood pressure, cholesterol, and diabetes will help prevent the development of plaque buildup within arteries not only in the heart but also the brain and peripheral arteries as well. Smoking cessation is mandatory.
What are the risk factors for angina?
The following risk factors increase your risk of coronary artery disease and angina:
- 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 is the inability of your body to produce enough or respond to insulin properly. Insulin, a hormone secreted by your pancreas, allows your body to use glucose, which is a form of sugar from foods. 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. Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. Over time, high blood pressure damages arteries by accelerating hardening of the arteries.
- High blood cholesterol or triglyceride levels. Cholesterol is a major part of the deposits that can narrow arteries throughout your body, including those that supply your heart. A high level of the wrong kind of cholesterol, known as low-density lipoprotein (LDL) cholesterol (the "bad" cholesterol), increases your risk of angina and heart attacks. A high level of triglycerides, a type of blood fat related to your diet, also is undesirable.
- Family history of heart disease. If a family member has coronary artery disease or has had a heart attack, you're at a greater risk of developing angina.
- Older age. Men older than 45 and women older than 55 have a greater risk than do younger adults.
- Lack of exercise. An inactive lifestyle contributes to high cholesterol, high blood pressure, type 2 diabetes and obesity. However, it is important to talk with your doctor before starting an exercise program.
- Obesity. Obesity raises the risk of angina and heart disease because it's associated with high blood cholesterol levels, high blood pressure and diabetes. Also, your heart has to work harder to supply blood to the excess tissue.
- Stress. Stress can increase your risk of angina and heart attacks. Too much stress, as well as anger, also can raise your blood pressure. Surges of hormones produced during stress can narrow your arteries and worsen angina.
Is there a cure/medications for angina?
Angina, also known as ischemic chest pain, is a result of a deficient flow of blood to the heart. It can be a symptom of coronary artery disease. Patients describe this pain as recurrent or sudden squeezing, pressure, heaviness and tightness in the chest. A primary cause could be fatty substances building up in the arteries supplying blood to the heart.
Cure/medication for Angina
A healthy fusion of behavior modifications, exercises, medications and surgery, depending on the cause, can treat Angina.
1. Aspirin: Used to lessen the stickiness of platelets to prevent the formation of clots and risks of a heart attack.
2. Imdur and Nitropaste: They are long-acting nitroglycerin medications prescribed to help in the dilation of coronary arteries and improve blood flow to the muscles of the heart.
3. Nitroglycerin: It can also be used to abort an angina episode. For episodes, nitroglycerin is taken as a tablet or a spray underneath the tongue.
4. Antianginal: Helps to reduce chest pain and pressure
5. Antihypertensive drug: Controls blood pressure
6. Calcium channel blocker: Helps in relaxing blood vessels
7. Anticoagulant: A blood thinner reduces blood coagulation and prolongs blood clotting time.
Burning,Fullness,Pressure,Squeezing,Pain may also be felt in the arms, neck, jaw, shoulder or back,Dizziness,Fatigue,Nausea,Shortness of breath,Sweating
A type of chest pain caused by reduced blood flow to the heart
Nitrates,Aspirin,Clot-preventing drugs,Beta blockers,Statins,Calcium channel blockers,Other blood pressure medications,Ranolazine (Ranexa)