Description

Angina (an-JIE-nuh or AN-khuh-nuh) is a type of chest pain caused by reduced blood flow to the heart. Angina is a symptom of coronary artery disease.

Angina, also called angina.

Angina is often described as squeezing, pressure, heaviness, tightness or pain in the chest. It can feel like a heavy weight lying on the chest. Angina may be a new pain that needs to be examined by a health care professional, or it may be recurrent pain that goes away with treatment.

Angina is relatively common. But some people may not be able to distinguish it from other types of chest pain, such as heartburn. If you have chest pain, get medical help right away.

Types of

There are different types of angina. The type depends on the cause and if the rest or the medicine relieves the symptoms.

  • Stable angina.Stable angina is the most common form of angina. It usually happens during the activity, it is also called effort. Goes away with rest or angina medicine. The pain that starts when you're walking uphill or in cold weather can be angina. Stable angina is predictable. It is generally similar to the earlier episodes of pain in the chest. The chest pain usually lasts a short time, perhaps five minutes or less.
  • Unstable angina, which is a medical emergency. Unstable angina is unpredictable and occurs at rest. Or the pain is getting worse and occurs with less physical effort. Unstable angina is typically severe and lasts longer than stable angina, maybe 20 minutes or more. The pain does not go away with rest or with the custom of the angina pectoris drugs. If the blood flow doesn't improve, the heart does not receive enough oxygen. A heart attack occurs. Unstable angina is dangerous and in need of emergency treatment.
  • Variant angina, also called Prinzmetal's angina. This type of angina is not due to coronary artery disease. It is caused by a spasm in the arteries of the heart. The spasm temporarily reduces the flow of blood. Severe chest pain is the main symptom of variant angina. It occurs with greater frequency in cycles, usually at rest and during the night. The pain can be relieved by angina medicine.
  • Refractory angina. Episodes of Angina are frequently despite a combination of medication and lifestyle changes.

Stable angina. Stable angina is the most common form of angina. It usually happens during the activity, it is also called effort. Goes away with rest or angina medicine. The pain that starts when you're walking uphill or in cold weather can be angina.

Stable angina is predictable. It is generally similar to the earlier episodes of pain in the chest. The chest pain usually lasts a short time, perhaps five minutes or less.

Symptoms

Angina symptoms include chest pain and discomfort. The chest pain or discomfort can feel like:

  • Burning.
  • The fullness.
  • Pressure.
  • Tighten.

The pain may also be felt in the arms, neck, jaw, shoulder or back.

Other symptoms of angina include:

  • The dizziness.
  • Fatigue.
  • Nausea.
  • Shortness of breath.
  • Sweating.

The severity, duration, and type of angina can vary. New or different symptoms can be a sign of unstable angina or a heart attack.

Any new or worsening of symptoms of angina needs to be examined immediately by a health care professional. The health care team can determine if you have stable or unstable angina.

Angina in women

The symptoms of angina in women can be different of the classic symptoms of angina. These differences may lead to delays in seeking treatment. For example, pain in the chest can't be the only symptom or the most common symptom. Other symptoms of angina in women can include:

  • The discomfort in the neck, jaw, teeth, or back.
  • Nausea.
  • Shortness of breath.
  • Stabbing pain in place of the pressure in the chest.
  • Stomach pain.

When to see a doctor

Pain in the chest that lasts more than a couple of minutes and does not go away with rest or medications for angina may be due to a heart attack. Call 911 or emergency medical help. Just drive yourself to the hospital if there is no other way of getting there.

If the chest discomfort is a new symptom for you, consult a health care professional to determine the cause and get proper treatment. If you have stable angina pectoris and it gets worse or changes, seek medical help immediately.

Causes

Angina is caused by reduced blood flow to the heart muscle. The blood carries oxygen, which the heart muscle needs to survive. When the heart muscle is not getting enough oxygen, which causes a condition called ischemia.

The most common cause of reduced blood flow to the heart muscle is coronary artery disease (CAD). The arteries of the heart, called coronary arteries, can be reduced by fatty deposits called plaques. This condition is called atherosclerosis.

The plaque in the blood vessels may rupture or cause a blood clot. These events can quickly block or reduce the flow through a narrowed artery. This can be so sudden and severe decrease blood flow to the heart muscle.

The heart muscle may still be able to work during times of low oxygen demand without triggering symptoms of angina. An example is when at rest. But when the demand for oxygen increases, such as when you exercise, angina can be the result.

Risk factors

The following factors may increase the risk of angina:

  • The increase of the age. Angina is more common in adults of 60 years and more.
  • Family history of heart disease. Tell your health care team if your mother, father, or siblings you have or have had heart disease or a heart attack.
  • The consumption of tobacco. Smoking, chewing tobacco, and long-term exposure to second-hand smoke can damage the lining of the arteries. The artery damage can leave deposits of cholesterol to pick up and block the flow of blood.
  • Diabetes. Diabetes increases the risk of coronary artery disease. Coronary artery disease may cause angina pectoris.
  • The high blood pressure. Over time, high blood pressure damages the arteries, speeding up the process of hardening of the arteries.
  • Elevated levels of cholesterol or triglycerides. Too bad cholesterol, called low-density lipoprotein (LDL) in the blood can cause the arteries to narrow. A high level of LDL increases the risk of angina and heart attacks. A high level of triglycerides in the blood are also healthy.
  • Other health conditions. Chronic kidney disease, peripheral arterial disease, metabolic syndrome, or a history of stroke increases the risk of angina.
  • It is not enough exercise. A sedentary lifestyle increases the risk of high cholesterol, high blood pressure, type 2 diabetes and obesity. Talk with your health care team about the type and amount of exercise that is best for you.
  • Obesity. Obesity is a risk factor for heart disease, which can cause angina. Being overweight causes the heart to work harder to supply blood to the body.
  • The emotional stress. Too much stress and anger can raise blood pressure. Rushes of hormones produced by the body during the stress can narrow the arteries and worsen angina.
  • Drugs. Some medications tighten the blood vessels, which can trigger Prinzmetal's angina. An example is that of certain medicines for migraine headaches.
  • Misuse of drugs. Cocaine and other stimulants can cause spasms of the blood vessels and cause angina.
  • The cold temperatures. Exposure to cold temperatures can trigger Prinzmetal's angina.

Complications

The pain in the chest that occurs with angina can do some activities, such as walking, uncomfortable. However, the most dangerous complication is a heart attack.

Warning signs of a heart attack include:

  • Pressure, fullness or squeezing pain in the center of the chest that lasts more than a couple of minutes.
  • The pain spreads beyond the breast to the shoulder, arm, or back, or even the teeth and jaw.
  • Fainting.
  • Threat sense of doom.
  • Increasing episodes of chest pain.
  • Nausea and vomiting.
  • Continuous pain in the upper part of the belly area.
  • Shortness of breath.
  • Sweating.

If you have any of these symptoms, seek emergency medical attention immediately.

Prevention

You can help to prevent angina following the same lifestyle changes that are used to treat angina chest:

  • Avoid or limit consumption of alcohol.
  • Do not smoke.
  • Eat a healthy diet.
  • Exercise regularly.
  • Maintain a healthy weight.
  • Manage other health conditions related to heart disease.
  • Reduce stress.
  • Getting 7 to 9 hours of sleep per day.

Also get recommended vaccines to prevent complications in the heart.

Diagnosis

To diagnose angina, a healthcare professional will examine you and ask questions about your symptoms. Generally asked about the risk factors, including whether you have a family history of heart disease.

Tests

The tests used to diagnose and confirm the angina include:

  • Electrocardiogram (ECG or EKG). This quick and painless test that measures the electrical activity of the heart. Sticky patches called electrodes are placed on the chest and sometimes the arms and legs. The wires connect the electrodes to a computer, which displays the results of the test. An EKG can show if the heart is beating too fast or too slow. The test can show if you are having or have had a heart attack.
  • X-ray of the chest. An x-ray of the chest shows the condition of the heart and the lungs. A chest x-ray may be done to determine if other conditions are causing pain in the chest, symptoms, and see if the heart is enlarged.
  • Blood tests. Some proteins will slowly leak into the blood after heart damage from a heart attack. Blood tests may be done to check these proteins, called cardiac enzymes.
  • Stress test. Sometimes, the angina is easier to diagnose when your heart is working harder. A stress test usually involves walking on a treadmill or riding a stationary bike while the heart is on. Other tests may be done at the same time as a stress test. If you are unable to do exercise, you could get drugs that affect the heart as the exercise you do.
  • The echocardiogram. This test uses sound waves to create images of the heart in motion. These images can show how blood flows through the heart. An echocardiogram may be done during a stress test.
  • Nuclear stress test. A nuclear stress test helps to measure the flow of blood to the heart muscle at rest and during effort. It is similar to a routine stress test, but during a nuclear stress test, a radioactive tracer is injected into the bloodstream. A special scanner shows how the marker moves through the arteries of the heart. The areas that have very small amounts or none of the tracers are likely to have poor blood circulation.
  • Cardiac computed tomography (CT) or magnetic resonance imaging (MRI). These tests create pictures of the heart and the chest. The CT scan of the heart explores the use of x-rays. cardiac Mri uses a magnetic field and radio waves to create images of the heart. For both tests, which are generally found in a table that slides inside a long tube of the machine. Each test can be used to diagnose heart problems. The tests can help to show the severity of damage to the heart.
  • The coronary angiography.This test uses X-ray imaging to check the inside of the blood vessels of the heart. It is part of a general group of procedures known as cardiac catheterization. A health care professional inserts a flexible tube called a catheter into a blood vessel, usually in the groin area. Is guided into the heart. Contrast dye flows through the catheter. The dye makes the arteries of the heart are shown more clearly on x-rays. The X-rays is called an angiogram.

The coronary angiography. This test uses X-ray imaging to check the inside of the blood vessels of the heart. It is part of a general group of procedures known as cardiac catheterization.

A health care professional inserts a flexible tube called a catheter into a blood vessel, usually in the groin area. Is guided into the heart. Contrast dye flows through the catheter. The dye makes the arteries of the heart are shown more clearly on x-rays. The X-rays is called an angiogram.

Treatment

Treatment options for angina include:

  • Lifestyle changes, such as eating a healthy diet and exercise.
  • Drugs.
  • Angioplasty and stent placement.
  • Open heart surgery called coronary artery bypass graft (CABG).

The objectives of the angina pectoris treatment are:

  • Reduce the number of angina episodes.
  • Do the symptoms are less severe.
  • To decrease the risk of heart attack and death.

You need treatment right away if you have unstable angina, or chest pain that is different from what we normally have.

Drugs

If lifestyle changes do not improve the health of the heart and relieve angina, you may need medication. Medicines to treat angina may include:

  • The nitrates. These medications are often used to treat angina chest. Nitrates relax and widen the blood vessels so that more blood that goes to the heart. The most common form of nitrates used to treat angina is nitroglycerin (Nitrostat). Nitroglycerin tablet is placed under the tongue. Your health care team may recommend that you take a nitrate prior to engaging in activities that tend to trigger angina, such as exercise. Some people need to take nitrates in a long-term, preventive control.
  • The aspirin. Aspirin reduces blood clotting, making it easier for the blood to go through the narrowing of the arteries of the heart. Prevention of blood clots can reduce the risk of a heart attack. Do not start taking a daily aspirin without talking to your care team first.
  • Clot-preventing drugs. Certain medications, such as clopidogrel (Plavix), prasugrel (Effient) and ticagrelor (Brilinta) make blood platelets less likely to stick together, so that the blood does not clot. One of these medicines may be recommended if you can't take aspirin.
  • Beta-blockers. Beta-blockers reduce the heart rate. The heart beats with less force, which lowers blood pressure. These drugs also relaxes the blood vessels, which improves blood flow.
  • Statins. Statins are drugs used to lower cholesterol in the blood. The high cholesterol is a risk factor for heart disease and angina pectoris. Statins block a substance that the body needs to make cholesterol. Help to prevent blockages in the blood vessels.
  • Calcium channel blockers. Calcium channel blockers, also called calcium antagonists, relax and widen blood vessels to improve the flow of blood.
  • Other blood pressure medications. Other medicines that decrease blood pressure include the angiotensin-converting enzyme (ace) inhibitors and angiotensin 2 receptor blockers (Arbs). If you have high blood pressure, diabetes, symptoms of heart failure or chronic kidney disease, your health care team may prescribe one of these types of drugs.
  • Ranolazine. This treatment can be prescribed for chronic stable angina that does not improve with other medications. Can be used alone or with other medicines for angina.

Therapies

Sometimes, a nondrug option called enhanced external counterpulsation (EECP) may be done to increase the flow of blood to the heart. With EECP, the blood pressure of type cuffs are placed around the calves, thighs, and pelvis. EECP requires multiple treatment sessions. EECP can help reduce symptoms in people with frequent, uncontrolled angina called refractory angina.

Surgery and procedures

If life-style changes, medications, and other therapies do not reduce the pain of angina pectoris, a catheter procedure or an open-heart surgery may be necessary.

Surgeries and procedures that are used to treat angina and coronary artery disease include:

  • Angioplasty with stent placement.This treatment is also called percutaneous coronary intervention. A small balloon is inserted into the narrowed artery. The balloon is inflated to widen the artery. Then, a small wire mesh of the coil, called a stent is usually inserted to keep the artery open. Angioplasty with stent placement improves the flow of blood to the heart, reducing or eliminating angina. The treatment can be a good option for those with unstable angina or if lifestyle changes and medications do not effectively treat chronic stable angina pectoris.
  • Coronary artery Bypass graft (CABG). This is a type of open-heart surgery. During CABG , a vein or artery from another part of the body is used to prevent a blockage or narrowing of the coronary artery. The surgery increases the flow of blood to the heart. It is a treatment option for both unstable angina and stable angina that has not improved with other treatments.

Angioplasty with stent placement. This treatment is also called percutaneous coronary intervention. A small balloon is inserted into the narrowed artery. The balloon is inflated to widen the artery. Then, a small wire mesh of the coil, called a stent is usually inserted to keep the artery open.

Angioplasty with stent placement improves the flow of blood to the heart, reducing or eliminating angina. The treatment can be a good option for those with unstable angina or if lifestyle changes and medications do not effectively treat chronic stable angina pectoris.

Lifestyle and home remedies

Heart disease is often the cause of angina. Make lifestyle changes to keep your heart healthy is an important part of the treatment of angina. Try these strategies:

  • Do not smoke. Quitting smoking is the most important thing you can do to improve the health of the heart. Also, avoid being around second-hand smoke. If you need to stop smoking, ask your health care team for help.
  • Get regular exercise. Regular exercise helps improve the health of the heart. As a general goal, aim for at least 30 minutes of moderate or vigorous physical activity five or more days a week. If you have had a heart attack or heart surgery, you may have limits of activity. Ask your healthcare professional what is best for you.
  • Control the weight. Too much weight strains the heart. Being overweight increases your risk of high cholesterol, high blood pressure and diabetes. Ask your healthcare team what is the best weight is for you.
  • Eat a healthy diet. Avoid or limit foods with saturated fats, trans fats, salt and sugar. Choose whole grains, fruits, vegetables, and lean protein, such as fish and beans.
  • Manage other health conditions. Ask your care team how often you need to have your blood pressure, blood sugar and cholesterol levels.
  • Control stress. Find ways to help reduce emotional stress. Do more exercise, the practice of mindfulness and connecting with others in support groups are some of the ways to relieve stress.
  • Avoid or limit consumption of alcohol. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink per day for women and up to two drinks per day for men.
  • Practice good sleep habits. Lack of sleep can increase the risk of heart disease and other chronic conditions. Adults should aim to get 7 to 9 hours of sleep daily. Go to bed and wake up at the same time every day, including weekends. If you have trouble sleeping, talk with your health care team about strategies that might help.

Preparing for your appointment

If you have sudden chest pain, call 911 or the local emergency number immediately.

If you have a strong family history of heart disease, make an appointment for a health checkup.

Appointments can be brief, and there's often a lot to discuss. So it's a good idea to take steps to prepare for your appointment. Here's some information to help you prepare and what to expect during your visit.

What you can do

  • Be aware of any pre-appointment restrictions. When you make the appointment, ask if there is something that you need to do in advance, such as restrict your diet. For example, you may be asked not to eat or drink anything for a couple of hours before a cholesterol test.
  • Write down the symptoms you are experiencing, including any that may seem unrelated to chest pain (angina). Note when you started and what you were doing when you started.
  • Write important personal information, including any family history of angina, chest pain, heart disease, stroke, high blood pressure or diabetes. Also note any major stresses or recent life changes.
  • Make a list of all the medicines, vitamins, and supplements you are taking. Include those you buy without a prescription. Also include the dose.
  • Bring someone along, if possible. Someone who goes with you can help you remember the information they give you.
  • Be prepared to discuss your diet and exercise habits. If you do not already follow a diet or exercise routine, talk with your health care team about the challenges that you might face in the introduction.
  • Write questions to ask their health care team.

For angina, some basic questions to ask include:

  • What is the most likely cause of my pain in the chest, symptoms?
  • What kind of proof do you need? How do I prepare for these tests?
  • What treatments do you recommend and why?
  • What is the most secure, the type and amount of physical activity for me?
  • I have other health conditions. How can I best manage these conditions?
  • How often should I follow up with you about my angina?
  • Are there brochures or other printed material that I can take my house?
  • What sites do you recommend to visit?

Don't hesitate to ask any questions you may have during your appointment.

What to expect from your doctor

Your health care team will probably ask a lot of questions. Be prepared to answer them you can save your time to go through any information that you want to spend more time. Your care team may ask:

  • When did you first start having symptoms?
  • How would you describe the pain in your chest?
  • Where is the pain located?
  • Does the pain spread to other parts of the body, such as the neck and arms?
  • How and when did the pain start?
  • Did something specific seem to trigger the pain in your chest?
  • Did the pain begin gradually or suddenly?
  • How long does the pain last?
  • What causes the chest pain worse?
  • What makes you feel better?
  • Do you have other symptoms with the pain, such as nausea or dizziness?
  • Do you have trouble swallowing?
  • Do you have a history of heartburn? Heartburn can mimic the sensation of angina.

What you can do in the meantime

It is never too early to make a heart-healthy lifestyle changes. Lifestyle changes can help prevent angina complications such as heart attack and stroke.

Symptoms and treatment of Angina