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Angina pectoris, a specific type of chest pain, is caused by reduced blood supply to the heart. It is also considered a symptom of coronary artery disease.
Common adjectives to describe angina pain include squeezing, pressure, heaviness, tightness, and pain in the chest. Some people may also feel as if there is a substantial weight on their chest. Angina can cause either a new episode of chest pain that has to be checked out by a doctor or a recurrent pain that gets better with treatment.
Coronary artery disease can lead to angina and heart attacks. However, angina doesn’t harm your heart permanently. A heart attack does. That’s because angina indicates that your heart’s blood flow has temporarily decreased. A heart attack results in a more prolonged decrease in blood flow. Your heart muscle starts to deteriorate throughout that period.
The discomfort of indigestion, for example, can be difficult to distinguish from angina, despite the fact that it is a rather common type of chest pain. Seek immediate medical attention if you experience inexplicable chest pain.
Types
Angina manifests in various forms, which are determined by the underlying cause and whether symptoms are relieved by rest or medication.
- Stable angina. The most typical type of angina is stable angina. Exertion usually triggers it, and it normally subsides with rest or angina medicine. Angina, for instance, may cause pain while you’re walking uphill or in chilly weather.
Discomfort from stable angina is predictable and frequently comparable to chest discomfort from earlier bouts. The average duration of the chest pain is five minutes or less.
- Unstable angina. Unpredictable and occurring while at rest, unstable angina. Or the angina pain is getting worse and happens with less exertion. It usually lasts for at least 20 minutes and is more severe than stable angina. Neither relaxation nor the typical angina drugs relieve the agony. If the blood flow doesn’t get better, the heart becomes oxygen-starved and suffers a heart attack. An urgent medical response is necessary for unstable angina.
- Prinzmetal angina. Prinzmetal angina, another name for variant angina, doesn’t result from coronary artery disease. It is brought on by a spasm in the arteries of the heart, which momentarily lowers blood flow. The primary symptom of variant angina is severe chest discomfort. It usually happens in cycles, usually while you’re sleeping or at rest. Medication for angina may be able to reduce the pain.
- Refractory angina. Despite a mix of drugs and lifestyle modifications, angina attacks are frequent.
Symptoms
Pain and discomfort in the chest are angina symptoms. The discomfort or pain in the chest could feel like it’s full, squeezing, burning or pressurized.
The arms, neck, jaw, shoulder, or back may all experience pain.
Additional symptoms of angina include:
- Nausea
- Dizziness
- Exhaustion
- Sweating
- Difficulty of breathing
Angina can vary in severity, duration, and type. If new or different symptoms arise, it might indicate unstable angina, which is a more dangerous form of angina and could lead to a heart attack. If you experience any new or worsening angina symptoms, it is crucial to seek immediate medical attention. A doctor can diagnose and differentiate between stable and unstable angina to provide appropriate treatment.
Women’s angina
Women’s angina symptoms can differ from typical angina symptoms. Delays in getting treatment could be caused by these distinctions. For instance, although chest discomfort is frequently experienced by women with angina, it may not be the sole symptom or the one that affects them the most. Women may also experience symptoms like:
- Nausea
- Difficulty of breathing
- Pain in the back, neck, jaw, or teeth
- Abdominal pain
- A stabbing ache as opposed to chest pressure
It may be an indication of a heart attack if your chest discomfort persists for more than a few minutes and doesn’t go away after you rest or take your angina treatments. Contact emergency medical services. If there is no other way to get there, only drive yourself to the hospital.
It’s crucial to consult your doctor if chest discomfort is a new symptom for you in order to identify the cause and receive the right treatments. If you have stable angina and it worsens or changes, you should visit a doctor very away.
Causes
Reduced blood supply to the heart muscle is what causes angina. The oxygen that the heart muscle requires to survive is carried by blood. Ischemia is the medical term for the disorder that results from the heart muscle not receiving enough oxygen.
Coronary artery disease (CAD) is the most frequent reason why the blood supply to the heart muscle is diminished. The fatty buildups known as plaques can cause the heart’s arteries (coronary) to constrict. Atherosclerosis is the term for this.
A blood clot or plaque rupture in a blood vessel can abruptly restrict or obstruct blood flow through a constricted artery. Blood flow to the heart muscle may suddenly and significantly drop as a result.
The heart muscle may be able to function on the lower amount of blood flow when there is little oxygen demand, such as while one is at rest, without experiencing angina symptoms. Angina, however, can happen when the need for oxygen increases, as it does during exercise.
Risk factors
The risk of angina may be raised by the following factors:
- History of heart disease in the family. If your mother, father, or any of your siblings have ever suffered from heart disease or a heart attack, let your doctor know.
- Old age. Individuals aged 60 and above are especially vulnerable to angina.
- Tobacco use. The lining of the arteries can be harmed by smoking, chewing tobacco, and prolonged exposure to secondhand smoke, which makes it possible for cholesterol deposits to build up and obstruct blood flow.
- High blood pressure. By promoting artery hardening over time, high blood pressure harms arteries.
- Diabetes. Diabetes raises the risk of coronary artery disease which causes angina and heart attacks, by accelerating atherosclerosis and raising cholesterol levels.
- High cholesterol or triglycerides. Atherosclerosis can be brought on by having too much low-density lipoprotein (LDL) in the blood. Angina and heart attacks are more likely in people with high LDL levels. Triglyceride levels that are too high in the blood are likewise unhealthy.
- Inactive lifestyle. Obesity, type 2 diabetes, high blood pressure, and high cholesterol are all consequences of a sedentary lifestyle. The kind and volume of exercise that is appropriate for you should be discussed with your healthcare physician.
- Being overweight or obese. Angina can be brought on by heart disease, which is at risk due to obesity. The heart has to work harder to pump blood throughout the body when a person is overweight.
- Cold temperatures. Cold exposure has the potential to cause Prinzmetal angina.
- Emotional stress. Blood pressure can be increased by excessive stress and anger. Stress-related hormone surges can cause artery narrowing and exacerbate angina.
- Medications. Prinzmetal’s angina may be brought on by blood vessel-tightening medications, such as some migraine medications.
- Drug abuse. Angina can be brought on by cocaine and other stimulants that cause blood vessel spasms.
- Other health problems. The risk of angina is increased by chronic renal disease, peripheral artery disease, metabolic syndrome, and a history of stroke.
Diagnosis
Your doctor will do a physical examination and question you about your symptoms in order to identify angina. Additionally, any risk factors, such as a family history of heart disease, will be discussed with you.
The following tests are used to identify and confirm angina:
- Electrocardiogram. The electrical activity of the heart is measured by this rapid and painless examination. Electrodes are applied to the chest, and occasionally the arms and legs in the form of sticky patches. The electrodes are connected by wires to a computer, which shows the test findings. If the heart is beating too quickly, too slowly, or not at all, an ECG might reveal this. In order to determine whether blood flow through the heart has been slowed down or interrupted, your healthcare professional may also look for patterns in cardiac rhythm.
- Chest X-ray. The health of the heart and lungs can be seen on a chest X-ray. To find out if other illnesses are causing chest pain symptoms and to check for an enlarged heart, a chest X-ray may be performed.
- Blood tests. When the heart muscle is harmed, as in a heart attack, certain heart enzymes enter the bloodstream. These chemicals can be found via a blood test for cardiac enzymes.
- Stress test. When the heart is working harder, diagnosing angina might occasionally be simpler. Usually, a stress test entails using a treadmill or stationary cycle while having the heart rate monitored. A stress test could be conducted concurrently with another test. In situations where physical exercise is not feasible, healthcare providers may opt to prescribe medications that replicate the effects of exercise on the heart.
- Echocardiogram. In an echocardiogram, sound waves are used to produce images of the beating heart. The blood flow through the heart can be seen in these pictures. A stress test could include an echocardiography.
- Nuclear stress test. Blood flow to the heart muscle is measured during a nuclear stress test both at rest and under stress. Similar to a standard stress test, a nuclear stress test involves injecting a radioactive tracer into the patient’s blood. How the tracer travels via the cardiac arteries is visible with a specialized scanner. Low or absent tracers in certain areas imply inadequate blood flow.
- Cardiac Computerized Tomography (CT). You normally recline on a table within a doughnut-shaped machine for this test. The device’s internal X-ray tube spins around the body to gather images of the chest and heart. A cardiac CT scan might reveal any heart enlargement or narrowing of any heart arteries.
- Cardiac Magnetic Resonance Imaging (MRI). This examination produces detailed pictures of the heart using radio waves and magnetic fields. Usually, you will be lying on a table within a long, tube-like machine that creates precise images of the blood vessels and the structure of the heart.
- Coronary angiography. X-ray imaging is used in coronary angiography to look within the heart’s blood arteries. It belongs to the broader category of operations known as cardiac catheterization.
In order to inject dye into a cardiac artery, a doctor threads a thin tube (catheter) through a blood vessel in the arm or groin. The dye enhances the visibility of the cardiac arteries on an X-ray. Your doctor may refer to this kind of X-ray as an angiogram.
Treatment
Treatment options for angina include:
- Medications
- Modification of lifestyle
- Angioplasty and stenting
- Coronary bypass surgery
The treatment objectives for angina are to reduce its frequency and severity, while also minimizing the risk of mortality and heart attack.
If you encounter unstable angina or experience angina pain that is different from your typical pain, it is essential to seek immediate emergency medical attention.
Medications
Medication may be required if lifestyle modifications, such as eating well and exercising, fail to improve heart health and reduce angina pain. Among the medications used to treat angina:
- Nitrates. Angina is frequently treated with nitrates. So that more blood can flow to the heart, nitrates relax and widen the blood vessels. Nitroglycerin is the kind of nitrate that is most frequently used to treat angina. Under the tongue is where the nitroglycerin tablet is put. Your doctor may advise taking a nitrate as a long-term prophylactic measure or before to activities that frequently cause angina (such as exercise).
- Aspirin. Because aspirin lessens blood clotting, blood can flow more easily through constricted heart arteries. Blood clot avoidance can lower the risk of a heart attack. Never begin taking an aspirin everyday without first consulting your doctor.
- Blood thinners. Blood doesn’t clot because certain drugs, including clopidogrel, prasugrel, and ticagrelor, reduce the likelihood that blood platelets will adhere to one another. If you can’t take aspirin, one of these medicines might be advised.
- Beta blockers. Beta blockers effectively reduce blood pressure by inducing a decrease in both the heart rate and the force of each heartbeat. Additionally, these drugs relax blood vessels which help increase the blood flow.
- Statins. Drugs known as statins are used to decrease blood cholesterol. A risk factor for heart disease and angina is high cholesterol. The chemical the body requires to produce cholesterol is blocked by statins. They aid in preventing blood vessel obstructions.
- Calcium channel blockers. Calcium antagonists, also known as calcium channel blockers, relax blood vessels and increase blood vessel width to promote blood flow.
- Other blood pressure medications. Angiotensin-Converting Enzyme (ACE) inhibitors and Angiotensin II Receptor Blockers (ARBs) are additional medications for lowering blood pressure. Your doctor could advise one of these medications if you have high blood pressure, diabetes, heart failure signs, or chronic renal disease.
- Ranolazine. For chronic stable angina that doesn’t improve with other drugs, this medicine may be administered. It can be taken either by alone or in combination with other angina drugs such calcium channel blockers, beta blockers, or nitroglycerin.
Therapies
To improve blood flow to the heart, a non-drug approach termed Enhanced External Counterpulsation (EECP) may occasionally be suggested. Cuffs that resemble blood pressure monitors are wrapped around the pelvis, thighs, and calves during EECP. Multiple treatment sessions are necessary for EECP. People who experience frequent, uncontrolled angina (refractory angina) may find relief from their symptoms with EECP.
Surgery and other procedures
To address angina pain and coronary artery disease, medical professionals may consider catheter procedures or open-heart surgery when lifestyle modifications, medications, or other treatments prove insufficient. The following surgeries and methods are utilized for treatment:
- Angioplasty with stenting. A very small balloon is put into the constricted artery during an angioplasty, also known as a Percutaneous Coronary Intervention (PCI). A small wire mesh coil (stent) is typically introduced after the balloon has been inflated to expand the artery in order to keep it open.
Angina is lessened or completely eliminated after an angioplasty with stenting. If lifestyle modifications and medicines are ineffective at treating chronic, stable angina, angioplasty with stenting may be a useful alternative.
- Open-heart surgery (coronary artery bypass surgery). A blocked or narrowed heart artery is bypassed during coronary artery bypass surgery using a vein or artery from another part of the body. The heart receives more blood after bypass surgery. It can be used to treat stable angina as well as unstable angina that has not responded to conventional therapies.
