Angina

What is the main cause of Angina?

Angina is a common symptom of coronary artery disease that occurs when the heart muscle does not receive enough oxygen-rich blood. It manifests as chest pain or discomfort and can be a warning sign of a more serious heart problem. Understanding the symptoms, types, and treatment options for angina is crucial in managing this condition and reducing the risk of heart attacks or strokes.

The most common cause is coronary heart disease. This is when the arteries that supply your heart muscle with blood and oxygen are narrowed by a fatty substance called plaque. It means less blood flows to your heart muscle and can cause angina symptoms. Common triggers for angina pain include physical activity, emotional stress, cold weather, and eating a meal. Symptoms will usually stop after a few minutes.

What is Angina?

Angina, also known as angina pectoris, is a symptom characterized by chest pain or discomfort caused by reduced blood flow to the heart muscle. It occurs when the coronary arteries, which supply blood to the heart, become narrowed or blocked by a build-up of fatty deposits called plaques (atherosclerosis). This reduction in blood flow leads to a lack of oxygen to the heart muscle, resulting in angina pain. Angina is not a disease itself but rather a symptom of an underlying heart condition, typically coronary heart disease (CHD) or coronary artery disease (CAD).

Symptoms of Angina

The primary symptom of angina is chest pain, which is often described as pressure, tightness, squeezing, or burning in the chest. This discomfort may also radiate to the shoulders, arms, neck, jaw, back, or stomach. Other accompanying symptoms may include fatigue, dizziness, sweating, feeling sick, and shortness of breath. It’s important to note that some individuals may experience atypical symptoms, such as indigestion or a feeling of fullness in the chest.

Types of Angina

Stable Angina

Stable angina is the most common type of angina and typically occurs during physical exertion or emotional stress. The pain or discomfort follows a predictable pattern and can be relieved with rest or medication, such as nitroglycerin. Stable angina usually lasts for a short duration, typically less than five minutes.

Unstable Angina

Unstable angina is a more serious form of angina that can occur even at rest. It is characterized by unpredictable and prolonged episodes of chest pain that do not resolve with rest or medication. Unstable angina is considered a medical emergency and requires immediate attention, as it may indicate an increased risk of a heart attack.

Unstable angina is a serious and potentially life-threatening condition characterized by chest pain or chest discomfort due to reduced blood flow and oxygen to the heart. Here, we aim to provide you with an in-depth overview of unstable angina, including its causes, symptoms, risk factors, diagnostic methods, and available treatment options.

Variant Angina

Variant angina, also known as vasospastic or Prinzmetal’s angina, is a rare form of angina caused by coronary artery spasms. These spasms lead to a temporary narrowing or tightening of the arteries, reducing enough blood flow to the heart. Variant angina often occurs at rest and can cause severe chest pain. Medications that relax the arteries, such as calcium channel blockers, are commonly used to treat this type of angina.

Microvascular Angina

Microvascular angina, also known as cardiac syndrome X, affects the smallest coronary arteries and is more common in women. It is characterized by chest pain or discomfort that occurs during physical exertion or periods of emotional stress. The chest pain in microvascular angina is caused by spasms or abnormalities in the function of the tiny blood vessels supplying the heart. This type of angina may not be easily detected by traditional diagnostic tests.

Risk Factors for Angina

Several risk factors increase the likelihood of developing angina and coronary heart disease. These include high blood pressure, high cholesterol levels, smoking, obesity, diabetes, a sedentary lifestyle, family history of heart disease, increasing age, and certain underlying health conditions. Managing these risk factors through lifestyle modifications and medical interventions can help reduce the risk of angina and its complications. Other common triggers for angina pain, include physical activity, emotional stress, cold weather, and eating a meal.

Diagnosis of Angina

To diagnose angina, healthcare providers evaluate the patient’s symptoms, and medical history, and perform various diagnostic tests. These may include an electrocardiogram (ECG), stress test, cardiac catheterization, coronary angiography, and blood tests to assess heart function and rule out other potential causes of chest pain.

Angina treatment options

The treatment of angina aims to relieve symptoms, prevent future episodes, and reduce the risk of heart attacks and strokes. Your treatment will depend on the type of angina you have, your symptoms, your risk of complications, and your test results. Unstable angina requires immediate treatment as it is a medical emergency.

If your symptoms of angina are not getting worse, you may be able to manage angina with changes in your lifestyle or medication. If you can not manage your angina with lifestyle changes or medication, you may need to improve blood flow, through medical procedures, to relieve your symptoms. Angina pain occurs when the heart muscle does not receive enough oxygen-rich blood. Treatments for angina will either:

• Increase blood flow to your heart muscle, giving it enough oxygen to work properly
• Or, reduce the workload on your heart so that it needs less oxygen

Lifestyle changes

Making healthy lifestyle modifications is essential in managing angina. These changes include adopting a healthy balanced diet low in saturated fats and cholesterol, engaging in regular physical activity, losing and maintaining a healthy weight if you’re overweight, quitting smoking, reducing alcohol intake, managing stress levels, and controlling underlying health conditions such as high blood pressure and diabetes.

Medications

Various medications are used to treat angina and manage its underlying causes. The choice of medication will depend on the type of angina you have. These may include:

• Beta-blockers are used to reduce your heart rate and blood pressure. Side effects include headache, lightheadedness, dizziness, and an upset stomach. Beta-blockers may make angina pain worse if you have vasospastic angina
• Nitrates, such as nitroglycerin, help to widen and relax your blood vessels, reducing your heart’s workload and increase blood flow to the heart muscle. These are used if you cannot take beta-blockers. Nitrates or nitroglycerin sprays work quickly, relieving angina pain. Taking nitrates just before any activity that triggers angina pain may help to delay or prevent any angina pain. You may receive IV nitrates if you are hospitalized for chest pain, to relieve your angina pain as fast as possible. Side effects of nitrates may include headaches and dizziness
• Calcium channel blockers are used to relax your heart muscle cells and your blood vessels. Calcium channel blockers are an option if you cannot take beta-blockers or nitrates, and may be prescribed if you have vasospastic angina. Side effects of calcium channel blockers include ankle swelling, headaches, drowsiness, and an upset stomach
• Antiplatelets prevent blood clots. You may need to use aspirin to reduce your chances of complications of heart disease if you have stable or unstable angina. Your healthcare provider may also prescribe aspirin in combination with clopidogrel or other antiplatelets
• Anticoagulants or blood thinners such as warfarin, slow down blood clotting and reduce your chances of future complications
• Statins slow down coronary heart disease by preventing plaque from forming. Statins also relieve blood vessel inflammation or spasms, reducing risks of complications after emergency treatment
• Ranolazine may stop angina symptoms from occurring as often. Ranolazine when taken with other medications may increase how much physical activity you can do without angina pain occurring. Side effects include nausea, dizziness, headache, and constipation. Ranolazine may be prescribed for refractory or microvascular angina that has not responded to other treatments and may be used instead of nitrates for men who have stable angina who are also using medication for erectile dysfunction
• Morphine may be used to relieve pain and relax muscles in your blood vessels. Morphine may be prescribed if you are in a lot of pain and other treatments have not helped with angina pain

Medical procedures

If lifestyle changes and medications do not help manage your angina, medical procedures may be necessary to improve blood flow to the heart and alleviate angina symptoms. These procedures can include:

• Coronary artery bypass grafting (CABG) – this may help to treat coronary heart disease and relieve angina pain. CABG may relieve chest pain, improve blood flow to your heart, and prevent a heart attack
• Percutaneous coronary intervention (coronary angioplasty) can be used to open up narrowed or blocked blood vessels that supply blood to the heart. Your healthcare provider may also put a stent in your artery to keep the artery open. Using percutaneous coronary intervention with certain drugs that help to widen coronary arteries can help to relieve vasospastic angina

Living with Angina

With proper management and adherence to treatment plans, individuals with angina can lead fulfilling lives and continue to do normal activities. It is important to follow recommended lifestyle modifications, take prescribed medications as directed, attend regular check-ups, and communicate any changes in symptoms to healthcare providers. Cardiac rehabilitation programs can also provide support, education, and exercise training to improve heart health.

Angina in women

Angina symptoms can differ between men and women. Women may experience atypical symptoms such as shortness of breath, nausea, fatigue, or pain in areas other than the chest. These differences can sometimes lead to delayed diagnosis and treatment. It is crucial for women to be aware of these potential variations and seek medical attention if they experience any concerning symptoms.

Prevention of Angina

Prevention plays a vital role in reducing the risk of angina and coronary heart disease. Maintaining a healthy lifestyle, managing risk factors, and regularly monitoring blood pressure, cholesterol levels, and blood sugar can help prevent the development or progression of angina. Additionally, staying up to date with vaccinations, following a heart-healthy diet, and engaging in regular physical activity are essential preventive measures.

When to seek medical help

It is important to recognize when to seek medical help for angina symptoms. If you experience chest pain that lasts longer than a few minutes, worsens over time, or is accompanied by shortness of breath, dizziness, or other concerning symptoms, it is crucial to seek immediate medical attention. Prompt medical intervention can help prevent complications and ensure appropriate treatment.

Researching chest pain

Understanding the difference between angina and other causes of chest pain is essential. While angina is a symptom of an underlying heart condition, chest pain can also be caused by other factors, including gastrointestinal issues, musculoskeletal problems, or anxiety. It is important to consult a healthcare provider for an accurate diagnosis and appropriate management.

Conclusion

Angina is a symptom of reduced blood flow to the heart muscle, typically caused by coronary heart disease. Recognizing the symptoms, understanding the different types of angina, and seeking appropriate medical help are crucial in managing this condition. By adopting a heart-healthy lifestyle, taking prescribed medications, and following recommended treatment plans, individuals with angina can lead fulfilling lives while reducing the risk of heart attacks and strokes. Regular communication with healthcare providers and proactive management of risk factors are key to effectively managing angina and maintaining heart health.

Sources

• Cleveland Clinic – Angina
• WebMD – Angina (Ischemic Chest Pain)
• MedlinePlus – Angina
• Heart.org – Angina Pectoris (Stable Angina)
• NHLBI – What is Angina?