Angina Pectoris

By:    Published: July 31, 2012

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Angina pectoris, or simply angina, is a type of chest pain and is one of the symptoms of coronary artery disease. The pain is a result of an area of muscle surrounding the heart that is not receiving enough oxygen. Angina is a common condition that is difficult to differentiate from other health issues that cause chest pain and can be an indication that a heart attack will occur. If you have any chest pain that is not easily explained, seek medical attention immediately.

Definition

Angina is characterized as a tightening pressure or heaviness within the chest that could come on suddenly or severely (unstable angina), or it can be recurring pain in the chest (stable angina). Angina itself is not a medical disease, rather a symptom of another issue with the heart. Typically, angina is a symptom of coronary artery disease, the most common heart disease among adults.

Symptoms

Symptoms of angina can range from mild to severe and may change in duration. It is important to identify your symptoms and distinguish any new symptoms or changes in prior symptoms. If chest pain is something that you have not experienced before, it is important to seek medical attention to determine the underlying cause of the problem. Should your chest pain be severe and sudden, seek emergency medical attention immediately.

General angina symptoms include:

  • Discomfort and pain within the chest
  • Additional or simultaneous pain in the neck, jaw, arms or back
  • Nausea or vomiting
  • Fatigue
  • Difficulty breathing
  • Feelings of anxiety
  • Sweating
  • Dizziness

Signs and symptoms indicative of stable angina include:

  • Brought on when the body is overexerted
  • Pain can typically be predicted and is generally similar to the last episode
  • Duration is short, possibly 5 minutes or less
  • Will subside with rest or angina medication
  • May feel similar to indigestion
  • Could be felt in the arms and back
  • Can be triggered by emotional stress or mental anguish

Signs and symptoms indicative of unstable angina include:

  • Can occur even when the body is at rest
  • Is a marked change in your typical angina
  • Comes on unexpectedly
  • Is more severe and lasts longer than stable angina; up to 30 minutes
  • May not respond to rest or angina medication
  • May indicate a heart attack is imminent

Causes

The most common, underlying cause for angina is the presence of coronary artery disease. Therefore, the causes associated with coronary artery disease are the causes for angina:

  • High blood pressure
  • High cholesterol
  • Smoking
  • Diabetes or elevated blood sugar

Such factors can lead to the development of plaque in the arteries, also known as atherosclerosis. This build-up of plaque lines the arteries, narrowing the path that blood flows through on the way to the heart muscle. When the heart muscle experiences a decrease of blood and oxygen, chest pain or angina is the result.

Causes or triggers that contribute to stable angina include:

  • Physical exertion
  • Emotional stress
  • Cold temperatures
  • Big meals
  • Smoking

Causes or triggers that contribute to unstable angina include:

  • Blood clots
  • Blood vessel rupture
  • Severe anemia

Risk Factors

Certain behaviors, lifestyle choices and medical conditions can increase the risk for developing coronary artery disease and angina. Those risk factors include:

  • Smoking or long-term exposure to secondhand smoke can cause damage to the arteries
  • Diabetes, which can cause atherosclerosis and angina
  • Hypertension (high blood pressure) can, overtime, cause narrowing of the arteries which leads to decreased blood flow to the heart muscle
  • High cholesterol and high triglycerides can cause build-up in the arteries restricting the flow of blood and oxygen to the heart
  • A personal or family history of heart disease
  • Advanced age – men over 45 and women over 55 have a higher risk of developing angina
  • Lack of exercise
  • Obesity
  • Stress and anger
  • Unhealthy diet

Diagnostic Tests

If you are complaining of chest pain, your doctor will need to determine if your chest pain is angina and whether it is stable or unstable to determine if you are about to suffer a heart attack. Your doctor will likely ask you questions such as what you were doing when the pain started and how long you have been experiencing this pain. If your doctor suspects angina or that you may be at risk of a heart attack, he will likely order one or more of the following tests:

  • EKG (Electrocardiogram). This test monitors the heart’s electrical rhythm and how fast the heart is beating, as well as whether the beats are normal or irregular.
  • Exercise stress testing. During this test you are asked to exercise while your heart is being monitored.
  • Chest X-ray. A chest X-ray will take a picture of the heart to check for any abnormalities of the heart or other organs.
  • Echocardiogram. This test uses sound waves to take images of the heart. These pictures can then be used to spot any damage to the heart.
  • Coronary angiography and cardiac catheterization. Coronary angiography is the use of dye within the arteries to view them more precisely on an X-ray. Cardiac catheterization refers to the dye being injected into the arteries via a catheter through your groin, arm or neck.
  • Blood tests. These tests will check for cardiac enzymes in the blood, which can indicate a problem with the heart or damage from a heart attack.
  • Cardiac CT scan. This test allows images to be taken of the heart to show any narrowing of the arteries, or enlargement of the heart.

Treatment Options

There are a variety of treatments for angina, including certain lifestyle changes, medications and medical or surgical procedures. If you have mild or stable angina, lifestyle changes alone may work well for you.

If lifestyle changes don’t seem to do the trick, medications can be helpful in relieving symptoms. However, if you are experiencing unstable angina or a sudden change of usual symptoms, you will need to seek emergency medical treatment at a hospital.

Commonly used angina medications include:

  • Aspirin, which can increase blood flow when taken daily. Consult a doctor before using; to learn more, see How Aspirin Can Help Prevent Heart Attacks.
  • Nitrates that can soothe and open narrowed blood vessels.
  • Beta Blockers which can make the heart beat a bit slower by blocking the effects of adrenaline.
  • Statins, to help to lower cholesterol.

Medical Procedures and Surgery:

  • Angioplasty and stenting. A small balloon is expanded to help widen the artery while a small coil or stent is inserted to keep the artery open. This helps to increase blood flow by clearing narrowed arteries.
  • Coronary artery bypass surgery. During this surgical procedure, an artery is taken from another area of the body and used to repair a narrowed or blocked artery by bypassing it. This treatment method is used for unstable angina and stable angina that has not been remedied through other treatments.

Home Remedies

Home remedies that can be helpful in treating angina include many lifestyle changes that are considered effective treatment options for both stable and unstable angina, as well as many preventive measures. Lifestyle/home remedies include:

  • Quit smoking
  • Consider weight loss options
  • Control diabetes
  • Don’t over exert yourself, take breaks if necessary
  • Don’t eat large meals
  • Find ways to relax and deal with stress in a positive way
  • Eat a healthy, balanced diet
  • Consult your doctor about a safe exercise plan

The best way to prevent angina is to follow the guidelines for making positive lifestyle changes. For more information, read 4 Simple Ways To Prevent Heart Disease. In addition to making lifestyle changes, all underlying medical conditions that may contribute to the onset of angina should be treated.

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