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                
  

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What Every Woman Should Know About Heart Failure

One thing that we have discovered is that many aspects of heart failure differ between men and women. For both sexes, heart failure comes about as a result of coronary artery disease, or chronic hypertension (high blood pressure). Usually, the symptoms of heart failure, and the treatment of it, are similar in men and women, but there are some differences.
 
There are a few aspects of heart failure that pertain especially to women. These include the causes of heart failure in women, the age of women who develop heart failure, the symptoms caused by the heart failure, and how doctors treat heart failure in women. If you’re a woman who has heart failure, you should make sure you know these differences.

Causes of Heart Failure That Are Especially Important in Women
Hypertension The most common medical problems that lead to heart failure are hypertension and coronary artery disease (CAD). Of these, hypertension is the leading cause in both sexes. However, hypertension is substantially more likely to cause heart failure in women than in men. Hypertension increases the risk of developing heart failure by 300% in women, but “only” 200% in men. Among women with heart failure, hypertension is the underlying cause in 59% of cases in women, compared to 39% in men. So while it’s important for anyone with hypertension to be treated adequately, it’s even more so for women.

Diastolic Heart Failure In diastolic heart failure, cardiac function deteriorates because the heart muscle becomes stiff, and the heart has difficulty filling with blood. As a result, the amount of blood that is pumped around the body with each beat is significantly reduced (making you tired and exercise intolerant), and the blood that is unable to fill the heart “backs up” into the lungs (producing pulmonary congestion). While this condition can occur in anyone, it’s more prominent in women than men.

Diabetes Diabetes by itself doesn’t cause heart failure, but people with diabetes have a high incidence of conditions that do, such as CAD and hypertension. Furthermore, for reasons that are not understood, women with diabetes are twice as likely to develop heart failure than men with diabetes.

Obesity 

Women who are obese have a high risk of developing heart failure that is 50% higher than women who are normal weight. Obese men also have a higher risk of heart failure, but the excess risk from obesity is not thought to be as high in men as it is in women.

Chemotherapy Certain drugs used for chemotherapy can cause cardiac toxicity that can lead to heart failure. Women tend to be exposed to these chemotherapy agents a lot more often than men, in particular, for the treatment of breast cancer.

Stress Cardiomyopathy Stress cardiomyopathy, also known as “broken heart syndrome,” is a form of sudden, severe heart failure that is triggered by extreme emotional trauma. While this condition can be found in either sex, it’s far more common in women, and may be related to microvascular angina – a condition that is more common in women.

 

Age of Women with Heart Failure Women who develop heart failure usually do so at an older age than men who develop heart failure. Unfortunately, as past clinical trials tended to exclude people over the age of 65, this means that relatively little data has been collected from clinical trials showing how older women with heart disease respond to treatment. Recently, researchers have been including a sufficient number of elderly women in their clinical trials, and this shortcoming is slowly being rectified.

Symptoms of Heart Failure in Women
As mentioned previously, the symptoms of heart failure in men and women are largely the same – gradually worsening fatigue, dyspnea, exercise intolerance, and edema. However, some scientific studies suggest that women with heart failure are more likely to experience significant dyspnea and edema than men.

Response to Treatment in Women 

As stated, clinical trials evaluating the treatment of heart failure have tested considerably more men than women. Nevertheless, the data that is available strongly suggests that women with heart failure respond to treatment just as favorably as men.

Differences in How the Hearts of Men and Women Respond to Cardiac Stress
In studies with animals and in clinical trials, evidence is accumulating to suggest that the heart muscles of men and women react differently to various kinds of physiologic stress. Several animal studies have looked at how the hearts of males and females react to experimental conditions that have been designed to produce heart failure. These studies have consistently shown that female cardiac muscle tends to respond by making various adaptions that help to prevent heart failure, whereas male cardiac muscle fails more quickly.

Clinical trials on people have shown the same thing. In those with aortic stenosis (a narrowing of the aortic valve, which greatly increases the pressure and stress in the left ventricle), premenopausal women develop cardiac hypertrophy (thickening of the heart muscle) more readily than men. This hypertrophy reduces wall stress, delays the onset of dilated cardiomyopathy and thus, reduces the risk of heart failure. Interestingly, postmenopausal women do not show this same adaption, and they develop heart failure at the same rate as men, suggesting that female hormones may play a part. However, clinical trials evaluating this have given contradictory results.

These findings may help to explain why women develop heart failure later than men, and why women who have heart failure tend more often to have diastolic heart failure than men.
Still, having said this, all we can say with confidence at the moment is that the hearts of men and women respond somewhat differently to various kinds of physiological stress.

Outcome of Heart Failure in Women 

Evidence suggests that, even though they usually develop heart failure at a later age than men, women with heart failure tend to survive longer than men.

This relatively good news for women who have heart failure is counter-balanced by some clinical evidence that suggests that doctors tend to be less aggressive when treating women with heart failure when compared with men. One reason for this may be that women may tend to minimize their cardiac symptoms when talking to their doctors. Those doctors who do not push their patients for a full accounting of symptoms may not be aware of just how sick their female patients actually are.

Therefore, it’s very important for anyone, male or female, who has symptoms of heart failure – especially worsening fatigue or dyspnea – to make sure their doctors are aware of it. But, maybe women need a little extra reminding of how important it is.

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