Angina

Cardiovascular

If you have ever been rushed to the hospital with a crushing pain in your chest only to be told you did not have a heart attack, you may be suffering from a condition known as angina pectoris. Angina is chest pain that occurs due to a lack of blood flow to the heart. Usually, the chest pain occurs upon exertion or during times of stress and then is relieved when the patient rests or relaxes. Many things can bring on an attack of this type of chest pain, from coronary artery spasms to an irregular heartbeat. However, coronary artery disease (CAD) is the most common cause of angina due to plaque buildup in the arteries limiting blood supply to the heart. About 10 million Americans suffer from angina. There are around 500,000 new cases of angina diagnosed every year.

The difference between an actual heart attack and angina is that the blood flow is cut off only temporarily. While both heart attacks and angina have the same cause, angina is less likely to cause damage to the heart muscle. Angina should not be ignored and needs to be worked up by a doctor since it is a symptom of coronary artery disease and can progress to a heart attack in the future.

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Symptoms

The most prominent symptom of angina pectoris is chest pain. There may also be other symptoms including chest pressure, squeezing feeling, tightness, and burning. It most commonly starts in the middle of the chest under the sternum.Angina pain can sometimes be felt in the jaw, neck, or shoulders. Often, people think they have heartburn or do not even know exactly where the pain is. This is known as referred pain. Women usually feel this and men usually experience classic “middle of the chest” type pain.There can be other symptoms such as severe tiredness, trouble breathing, cold sweats, dizziness, weakness, and nausea.If any of the above symptoms persist for more than just a few minutes, call 9-1-1 immediately. Do not attempt to drive yourself to the hospital. Below are the symptoms listed by type of angina:

Stable Angina

  • Happens during exercise/physical work or stressed emotional states
  • Comes on gradually and repeatedly
  • Lasts less than 5 minutes
  • Relieved by rest
  • Feels like indigestion
  • Radiates to back, arms, or neck

Unstable Angina

  • Comes on during rest or physical/emotional activity
  • Comes on suddenly
  • Severe pain that can last up to 30 minutes
  • Not relieved by rest
  • Gets worse with each episode
  • May precede a heart attack

Variant Angina

  • Happens when resting (night or morning)
  • Severe pain
  • Medication relieves it

Microvascular Angina

  • Tends to last longer than other angina
  • More severe than other angina
  • Occurs with shortness of breath, tiredness, low energy
  • Happens during daily work or stressful situations

Types

Stable angina/angina pectoris. This is the most common type of angina with pain occurring upon exertion.

Unstable angina. Also known as acute coronary syndrome. Unstable angina is characterized by chest pain that occurs while resting.

Variant angina/Prinzmetal’s angina. This type of angina is rare and usually occurs at rest.

Microvascular angina. Usually, a symptom of coronary microvascular disease – a type of heart disease that affects the smallest blood vessels of the heart.

Risk Factors

Since angina is a symptom of heart disease, the risk factors usually coincide with a person’s risk for heart disease. Here are the risk factors for angina and heart disease:

  • High cholesterol
  • High blood pressure
  • Tobacco use
  • Diabetes
  • Obesity
  • Lack of exercise
  • Poor dietary choices
  • Age over 45 in men and over 55 in women
  • Family history of coronary artery disease

Diagnosis

If you have chest pain, you need to see a doctor right away. They will take a family and personal medical history, along with a list of medications you are taking. The following tests will be ordered right away to rule out a heart attack:

Electrocardiogram (EKG). This test is performed by hooking up electrodes to your chest, arms, and legs. It picks up irregular heartbeats and checks for heart muscle damage.

Chest x-ray. They can look to see if your heart is enlarged.

Blood testing. If you have symptoms of angina or a heart attack, they will check the levels of cardiac enzymes in the blood.

Heart catheterization. To rule out acute heart attacks, you may need to have a catheter inserted into an artery in the leg. This catheter (small plastic tube) is threaded from the leg into the heart vessels. They inject dye into the arteries to check for blockage. This test can tell doctors if you have heart disease and how severe it is. If it is severe, a doctor may reopen the blocked vessel with a small balloon at the end of the catheter. This is usually followed by placing a stent (small metal tube), which helps to prevent the artery from becoming blocked again.

If an acute heart attack isn’t the issue, the doctor will schedule you for other tests to find the cause of your angina including stress testing on a treadmill, echocardiogram, nuclear stress testing, and/or a cardiac CT scan.

Treatments

If you have chest pain, you need to see a doctor right away. They will take a family and personal medical history, along with a list of medications you are taking. The following tests will be ordered right away to rule out a heart attack:

Electrocardiogram (EKG). This test is performed by hooking up electrodes to your chest, arms, and legs. It picks up irregular heartbeats and checks for heart muscle damage.

Chest x-ray. They can look to see if your heart is enlarged.Blood testing. If you have symptoms of angina or a heart attack, they will check the levels of cardiac enzymes in the blood.

Heart catheterization. To rule out acute heart attacks, you may need to have a catheter inserted into an artery in the leg. This catheter (small plastic tube) is threaded from the leg into the heart vessels. They inject dye into the arteries to check for blockage. This test can tell doctors if you have heart disease and how severe it is. If it is severe, a doctor may reopen the blocked vessel with a small balloon at the end of the catheter. This is usually followed by placing a stent (small metal tube), which helps to prevent the artery from becoming blocked again.

If an acute heart attack isn’t the issue, the doctor will schedule you for other tests to find the cause of your angina including stress testing on a treadmill, echocardiogram, nuclear stress testing, and/or a cardiac CT scan.

Lifestyle Changes

The first attack of angina needs to be immediately evaluated in the emergency room. Once your doctor gives you the all-clear there are certain things you can do at home in addition to any medical treatment to help reduce angina attacks. These include:

Stop and rest. If you feel an attack coming on, sit or lie down and rest. Sometimes attacks will go away with just a position change.

Find ways to relieve stress. Try meditation or breathing exercises. Turn on some soft music or try aromatherapy for relaxation.

Omega-3 fatty acids. Check with your doctor first, but these have been found to reduce the risk of heart disease. Use caution if you are on a blood thinner. Make sure you are eating cold-water fatty fish at least two times a week.

Eat garlic. Eating the amount equivalent to a clove of garlic a day can help bring down cholesterol levels. It can also help as a blood thinner. Find creative ways to use garlic in your cooking.

Eat smaller, more frequent meals. Large meals increase the work done by your heart. More work means more blood is needed to provide oxygen which may not be possible because of blocked arteries, hence triggering an attack. Try eating smaller meals and rest after eating.

Avoid extreme cold. Cold weather can shrink blood vessels and bring on angina.

With your doctor’s approval, if you have a prolonged angina attack and need to call 9-1-1 chew 300 mg of aspirin, and swallow with a sip of water while waiting for the ambulance. This could save your life if you are having a heart attack.

References

Albrecht, Suzanne. (2013, February 20) The pathophysiology and treatment of stable angina pectoris. U.S. Pharmacist, 38(2). Retrieved from https://www.researchgate.net/publication/288247415_The_pathophysiology_and_treatment_of_stable_angina_pectoris

American Heart Association. (2015, July 31). Angina (Chest Pain). Retrieved from heart.org: https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain

Harvard Medical School. (2018, July 06). Angina: Symptoms, diagnosis, and treatments. Harvard Health Publishing. Retrieved from https://www.health.harvard.edu/heart-health/angina-symptoms-diagnosis-and-treatments

Kohan, Luke C. (2015, May 28). Clinical outcomes of patients with stable angina. Retrieved from American College of Cardiology: https://www.acc.org/latest-in-cardiology/articles/2015/05/28/09/03/clinical-outcomes-of-patients-with-stable-angina

Mayo Clinic. (2020, June 12). Angina. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/angina/symptoms-causes/syc-20369373

Medline Plus. Angina. Retrieved from Medline Plus https://medlineplus.gov/angina.html

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