Causes, Symptoms, Diagnosis and Treatment of Angina
Angina pectoris is the pain or pressure in the chest, shoulders, jaw, neck or back caused by the small arteries not carrying enough oxygen and nutrients to the heart muscle. Angina can sometimes be mistaken for an upset stomach. Angina is often a symptom of coronary heart (or artery) disease. Coronary heart disease is the most common form of heart disease and it is caused by build-up on the walls of your coronary arteries. Plaque can clog the arteries and reduce the flow of blood causing chest pain. Other results of plaque are heart attacks and coronary microvascular disease. The latter is more prevalent in women.
Fast Facts about Angina
- Nearly seven million people in the United States (men and women equally) have documented cases of angina. Certain types, such as microvascular angina, occur more often in women, with 70 percent of the cases occurring around the time of menopause.
- Angina is a pressure or a squeezing pain usually occurring when your heart muscle does not get enough blood. It usually occurs in your chest but it can also affect your shoulders, arms, neck, back or jaw. Nausea, shortness of breath, fatigue, weakness, light-headedness and sweating also may occur.
- Not all chest discomfort is a sign of a heart problem. However, chest pain should always be checked by a doctor. Angina can be a symptom of an underlying heart condition such as coronary heart disease or coronary microvascular disease. Other conditions can also cause chest pain, such as pulmonary embolism, a lung infection, pericarditis, aortic dissection or a panic attack.
- In order to diagnose angina, your doctor will have to do a physical exam and ask you about symptoms, potential risk factors and family history of heart disease. You may need several tests to confirm a diagnosis.
- Treatments for angina consist of lifestyle changes, medicines and medical procedures and enhanced therapy.
Types of Angina
Different symptoms require different treatments so it is important to know what kind of Angina you are suffering from.
Stable Angina is the most common, occurs upon exertion and has a predictable pattern. Once you establish the pattern, you can control your symptoms with medications. This type of angina can signal a future heart attack.
Unstable Angina is an unpredictable form and medications or rest do not always help. It is very serious and requires immediate medical attention.
Variant (Prinzmetal’s) Angina is rare and can be relieved with medications. The pain is acute and occurs at rest, usually between midnight and early morning.
Microvascular Angina lasts longer than all other types and medications do not always relieve it. This form of angina is a symptom of coronary microvascular disease.
Ruling out a heart attack is the most important thing. Your physician will establish what type of angina you have, if any, to rule this out. You can expect a physical exam and questions related to your symptoms. They will also need to know if there is a family history of heart disease. If there is reason for concern they will likely order one of the following:
EKG (Electrocardiogram) is a simple, painless test which detects and records the heart’s activity and can show if the heart has any damage.
Stress Testing is done on a patient after their heart rate is elevated by exercise or medications. Sometimes imaging is used during these tests while other times it is just a monitor.
Chest X-Ray is an actual picture of inside your chest showing all organs and structures. An x-ray alone is not enough to diagnose angina or coronary heart disease.
Coronary Angiography and Cardiac Catherization uses dye and x-rays to inspect the insides of your arteries for blockage. The catherization is used to release the dye into your blood stream.
Blood tests can be used to check for abnormal levels of fats, cholesterol, sugar and proteins, such as C-reactive protein (CRP), in your blood. These can all be risk factors for coronary heart disease. They also check for abnormally low levels of hemoglobin which would put you at high-risk for Anemia.
Treatment Options for Angina
Lifestyle changes can have a big impact and often help with symptoms. All of the following are recommended by physicians:
- Avoid stress or take steps to manage it more effectively.
- Reduce the effects of physical activity by taking breaks.
- Quit smoking if you smoke. Also avoid secondhand smoke.
- Lose weight if you are overweight, avoid overeating and/or eat smaller meals to avoid triggering angina. Controlling your weight will help you avoid heart disease and many other life-threatening conditions.
Medicines are prescribed to help with angina and the most common are nitrates because they relax and widen blood vessels. Nitroglycerin is the most common of these nitrates but others include beta blockers, ACE inhibitors, calcium channel blockers, oral antiplatelet medicines and anticoagulants. All of these drugs lower blood pressure, slow the heart rate, relax blood vessels, prevent blood from clotting and reduce strain on the heart.
Medical procedures are often relied upon when lifestyle changes and medicines do not help relieve angina. The two most common are:
- Angioplasty, which opens blocked or nearly blocked coronary arteries. This procedure involves threading a thin tube with balloon into the artery and when it is blown up, it pushes any obstruction through, thereby clearing the artery for blood flow. A stent can be placed permanently inside the artery to keep it open after surgery.
- Coronary artery bypass grafting is a technique when healthy arteries are used to bypass the narrowed or blocked arteries. This is commonly referred to as bypass surgery.
Cardiac rehabilitation is commonly recommended after the medical procedures listed above or after a heart attack. This is a medically supervised program for people with documented heart problems. There are two main parts of cardiac rehabilitation:
- Exercise training will teach you how to exercise safely to improve strength, muscles and stamina while keeping in mind your personal needs and interests.
- Education, counseling and training will teach you how to understand your heart condition and how to avoid risks in the future, while helping you cope with all the adjustments your new lifestyle brings.
Enhanced external counterpulsation therapy is also available. This procedure is helpful to some patients with angina. It consists of large cuffs (similar to blood pressure cuffs) which are applied to your legs and inflated and then deflated according to your heart rate. This therapy is commonly applied in 35 one-hour treatments over the course of seven weeks.
Prevention of Angina
Angina can be avoided by some of the same means as those used for treating it: Lifestyle changes (like those we discussed earlier) and treatments for existing conditions that aggravate it, such as high cholesterol, high blood pressure, diabetes and obesity.
Coping with Angina
Angina may not signal a future heart attack but it increases your chances. Therefore, you should pay attention to the following:
- The usual pattern for your angina. Stable angina will have a pattern. Know what causes your pain, what the pain feels like, how long it lasts and whether medications relieve the pain. Knowing these factors will help you establish if your angina is worsening and warrants further attention.
- Keep a list of your medications and dosages. Being aware of the indications of your medications and their possible side effects is important, especially when you are dealing with medications like nitroglycerin. Some medicines can cause serious reactions when mixed with other medications. Make sure you discuss any side effects you are experiencing immediately with your doctor.
- Know your limits in terms of physical activity. If stress or physical activity triggers your angina, you should learn how to control your exertion and take steps to relieve the harshness of each occurrence.
- Know when to seek emergency assistance. If pain is not relieved with proven methods or lasts longer than usual, you should immediately seek medical help.