HEART DISEASES AND ANGINA PECTORIS

The most common symptom of coronary artery disease is 

angina or "angina pectoris," also known simply as chest pain. 

Angina can be described as a discomfort, heaviness, 

pressure, aching, burning, fullness, squeezing, or painful feeling 

due to coronary heart disease. Often, it can be mistaken for 

indigestion.

Angina is usually felt in the chest, but may also be felt in the 

shoulders, arms, neck, throat, jaw, or back.

If you experience these symptoms, take notice. If you've never 

been diagnosed with heart disease, you should seek treatment 

immediately. If you've had angina before, use your angina 

medications as directed by your doctor and try to determine if 

this is your regular pattern of angina or if the symptoms are 

worse. 

What Causes Angina?

Angina is caused when blood flow to an area of the heart is 

decreased, impairing the delivery of oxygen and vital nutrients 

to the heart muscle cells. When this happens, the heart muscle 

must use alternative, less efficient forms of fuel so that it can 

perform its function of pumping blood to the body. The 

by-product of using this less efficient fuel is a compound called 

lactic acid that builds up in the muscle and causes pain. Some 

medications used to treat angina work by inhibiting the use of 

this fuel source.

What Are the Types of Angina?

The types of angina are:

• Stable angina. The pain is predictable and present only 
• during exertion or extreme emotional distress, and it 
• disappears with rest.
• 
  
• Unstable angina. This may signal an impending heart 
• attack. Unstable angina is angina pain that is different from 
• your regular angina pain or pain that occurs while at rest. The 
• angina may occur more frequently, more easily at rest, feel 
• more severe, last longer, or come on with minimal activity. 
• Although this type of angina can often be relieved with 
• medication, it is unstable and may progress to a heart attack. 
• Usually more intense medical treatment or a procedure is 
• required.

• 
  
• Prinzmetal's angina. This is when angina occurs at rest, 
• when sleeping, or when exposed to cold temperatures. In 
• these cases, the symptoms are caused by decreased blood 
• flow to the heart muscle from a spasm of the coronary artery. 
• The majority of people with this type of angina also have 
• coronary artery disease. These spasms occur close to the 
• blockage.

Can Angina Occur Without Coronary Disease?

Angina can occur in the absence of any coronary disease. Up 

to 30% of people with angina with a heart valve problem called 

aortic stenosis, which can cause decreased blood flow to the 

coronary arteries from the heart. People with severe anaemia 

may have angina because their blood doesn't carry enough 

oxygen. People with thickened heart muscles need more 

oxygen and can have angina when they don't get enough.

How Is Angina Evaluated?

To evaluate your angina, your doctor will first ask you a series 

of questions to determine what your symptoms are and what 

triggers them. After examining you, your doctor will order one or 

more of a series of tests to determine the underlying cause of 

the angina and the extent of coronary artery disease, if present. 

These tests include:

• Exercise Stress Test
• 
  
• Electrocardiogram ( ECG/ EKG)
• 
  
• Stress imaging tests, such as nuclear tests or stress 
• 
  
• echo-cardiography, to accurately localize the part of the heart 
• 
  
• that has decreased blood flow
• 
  
• Echocardiogram
• 
  
• Cardiac catheterization

How Is Angina Treated?

Your angina treatment depends on the severity of the 

underlying problem, namely, the amount of damage to the 

heart. For most people with mild angina, a combination of 

drugs and lifestyle changes can control the symptoms. Lifestyle 

changes include: eating a heart-healthy diet, lowering 

cholesterol, getting regular exercise,quitting smoking, and 

controlling diabetes and high blood pressure.

Some drugs used to treat angina work by either increasing the 

amount of oxygen delivered to the heart muscle or reducing the 

heart's need for oxygen. These medicines include:

• Beta-blockers
• 
  
• Nitrates
• 
  
• Calcium channel blockers
• 
  

Other angina drugs work to prevent the formation of blood 

clots, which can further block blood flow to the heart muscle. 

These medicines include:

• Antiplatelet medications

For people with more serious or worsening angina, your doctor 

may recommend treatment to open blocked arteries. These 

include:

• Angioplasty
• 
  
• Stenting
• 
  
• Coronary artery bypass grafting (CABG) surgery
• Enhanced External Counterpulsation (EECP)

What Should I Do if I Have Angina?

With any type of angina, stop what you are doing and rest.

If you have been prescribed a medication called nitroglycerin to 

treat your angina, take one tablet and let it dissolve under your 

tongue. If using the spray form, spray it under your tongue. Wait 

five minutes.

If you still have angina after five minutes, take another dose of 

nitroglycerin. Wait another five minutes and if angina is still 

present, take a third dose.

If you still have angina after taking a third dose of nitroglycerin 

and resting for 15 minutes, call for emergency help (dial 911 in 

most areas) or have someone take you to the local emergency 

room.

If you think you are having a heart attack, do not delay. Call for 

emergency help right away. Do not drive yourself to the 

hospital. Consider taking an aspirin. Quick treatment of a 

heart attack is very important to lessen the amount of damage 

to your heart.

Why Shouldn't I Drive Myself or Have Someone Drive Me 

to the Hospital?

When the ambulance arrives, the emergency personnel can 

begin to give you heart-saving care right away. They can start 

an IV to give you important drugs and give you oxygen to help 

improve the flow of oxygen-rich blood to your heart. Should 

problems occur, they are there to provide life-saving help as 

well.

Something to Remember About Angina

If you have angina, carry nitroglycerin with you at all times; you 

never know when you will need it. Nitroglycerin must be kept in 

a dark container. Keep it away from heat or moisture. Check 

the expiration date on the container. Once the container of 

nitroglycerin tablets is opened, it must be replaced every three 

months. The spray form has a longer shelf life and should be 

replaced every 2 years.