Angina — causes, risk factors, symptoms, diagnosis and treatment

Do you often feel a nagging pain in your chest? It’s time you stop blaming indigestion and heart burn for the same. You could have an angina attack.
What is angina?
Angina is the medical term used to describe chest pain originating from the circulatory system and the heart. It is not a disease or condition by itself. It is rather a crucial symptom that indicates an underlying heart disease.
Causes and types of angina
‘Angina is chest discomfort caused due decreased oxygen supply to a part of the heart muscle. It is caused due to partial or complete obstruction to arteries supplying the heart,’ says a consultant cardiologist.
Depending on the type of pain and the duration for which it lasts, angina is classified into 4 different types:

• Stable angina: It occurs when the heart muscle has to work harder in order to pump blood. Situations like emotional stress, physical exertion and cold temperature may cause angina by interrupting the blood flow to the heart. This type of angina lasts for a short while and is relieved with medicines and rest.
• Unstable angina: It is also called angina pectoris. It can occur without any exertion, while you’re at rest. Building plaque and obstruction of main coronary arteries usually is the primary reason causing unstable angina. The pain may last for 10-15 minutes.
• Prinzmetal angina/Variant angina: It occurs due to spasms in the coronary arteries. Pain occurs at rest, particularly between midnight and early morning.    
• Microvascualar angina: It is mild pain that usually lasts for longer than 10 minutes and may continue for 30 minutes or more. It occurs due to interrupted blood flow through the smallest coronary arteries.

Signs of angina
Dr.  explains a few feature of angina that differentiates it from regular chest pain due to other reasons not originating from the heart.
‘Angina is usually felt as pressure, heaviness, tightening, squeezing or aching across the chest, particularly behind the breastbone. This pain often radiates to the neck, jaw, arms, back or even the teeth. Patients may also suffer from indigestion, heart burn, weakness, sweating, nausea and shortness of breath.’
‘Any chest pain or discomfort which occurs at rest and continues for more than 10 minutes requires medical attention if it is associated with:

• Profuse sweating
• Giddiness
• Weakness
• Nausea
• Light headedness

‘The threshold to consult a doctor should be low if the subject has risk factors for atherosclerosis (fat acculumation in arteries) like advanced age, smoking,diabetes, hypertension, family history of heart disease and obesity/sedentary life style,’ he explains.
Diagnosis of angina:
According to the Dr., angina can be difficult to differentiate from chest pain arising from other systems of the body. Therefore he suggests that it is best for you to let the doctor decide the cause of chest pain because self diagnosis could be misleading and may result in complications.
‘Chest pain can occur from almost any organ in chest other than heart like lungs, ribs, esophagus (food pipe), aorta (largest artery of body) and pericardium (layers of heart).  Any chest pain which typically precipitates on exertion and gets relieved on rest favours heart origin. A well localised pain, varying with phases of respiration or posture and any chest pain which is reproducible on palpation are unlikely to be coming from heart.
Depending on your explanation of chest pain and physical examination your doctor may recommend you the following tests to confirm angina and its underlying cause.

• Blood tests: Certain blood markers like cholesterol and triglycerides can help identify the chances the artery blockage and plaque formation causing angina
• ECG: Electrocardiogram is used to check the electrical activity of your heart using an ECG device
• Echocardiography: It is a test that helps the doctor to visualise the heart real time to analyse how effectively it works
• Coronary angiography: In this test, a specific dye is injected in the blood stream to check the rate at which blood flows through the arteries. It is an important test to identify CHD.
• Stress test: A simple exercise test can determine the electrical activity and functioning of your heart while you’re exercising.

Treatment and prevention:
‘An untreated angina can result into full blown heart attack with severe damage to heart muscle. It can also result into shock like state resulting into irreversible damage to heart and abnormal heart rhythms,’ says the Dr. Therefore, early medical attention is important to get appropriate treatment at the right time. Here are some medicines that your doctor may prescribe you:
Medicines for unstable angina:

• Blood thinning agents like heparin and nitroglycerin may be prescribed to improve blood blow though narrow arteries
• Aspirin and clopidrogel may be prescribed to prevent blood clotting and reduce the chances of heart attack
• Medicine to control blood pressure may be required if you are hypertensive
• Statins may be prescribed to lower cholesterol

Medicines for stable angina:

• Nitrates are given to prevent angina
• Nitroglycerin, aspirin and clopidrogel may be prescribed to prevent blood clotting and improve blood flow through the arteries
• Beta blockers may be given to lower heart rate and help it work smoothly

Surgical procedures
Angioplasty- It is the most common surgery performed to open up blocked arteries using a small device called stent.A stent is a small device that is placed in the blocked artery to open it up and improve blood flow.
Bypass surgery: In this procedure, a healthy blood vessel (called a graft) is used to form a bypass or another route to supply blood to the heart .
Since, heart disease is the underlying cause of angina, preventative measures include controlling risk factors that could lead to heart disease.

• Eating healthy food, avoid junk is the mainstay for controlling cholesterol levels and maintaining a good lipid profile
• Exercising regularly, at least 30 minutes every day, will help you lose weight, boost your good cholesterol levels and improve your heart function.
• Smoking is the main cause of atherosclerosis that can lead to angina. So if you smoke, you should quit now                
  

  THIS IS ONLY FOR INFORMATION, ALWAYS CONSULT YOU PHYSICIAN BEFORE HAVING ANY PARTICULAR FOOD/ MEDICATION/EXERCISE/OTHER REMEDIES.   
  

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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.