Overview
Angina is a type of chest pain that occurs due to reduced blood flow to the heart. It is a symptom of coronary artery disease. The pain is often described as squeezing, pressure, heaviness, tightness, or pain in the chest. Angina may be a new pain that needs medical attention or a recurring pain that goes away with treatment. There are different types of angina, including stable angina, unstable angina, variant angina (Prinzmetal angina), and refractory angina. Angina can be prevented by following a healthy lifestyle, including not smoking, eating a healthy diet, avoiding or limiting alcohol, exercising regularly, maintaining a healthy weight, managing other health conditions related to heart disease, and reducing stress. If you experience any symptoms of a heart attack, such as pressure, fullness, or a squeezing pain in the chest that lasts for more than a few minutes, pain extending beyond the chest, fainting, nausea, vomiting, sweating, or shortness of breath, seek emergency medical attention immediately.
Understanding the disease
Symptoms
The symptoms of angina can include chest pain or discomfort, pain that starts in the chest and spreads to other parts of the body, nausea or vomiting, indigestion, shortness of breath, sudden heavy sweating, racing heartbeat, feeling lightheaded or dizzy, and fatigue. Angina may present differently depending on factors such as age, sex, and underlying medical conditions.
Risk Factors
The risk factors for developing angina include increasing age, family history of heart disease, smoking or tobacco use, high blood pressure, diabetes or insulin resistance, and a lack of exercise or sedentary lifestyle. Other factors that may increase the risk of angina include a history of high cholesterol, stress, and excessive alcohol use. It is important to inform your healthcare provider about any risk factors you may have to help manage and reduce the risk of angina.
Development
The various types of angina develop due to reduced blood flow to the heart, which is the main symptom of coronary artery disease. The type of angina depends on the underlying cause and whether rest or medication relieve symptoms.
- Stable angina is the most common form and typically occurs during activity (exertion) and subsides with rest or medication.
- Unstable angina is a more severe form that can occur at rest or with minimal exertion. It is a sign of a more serious underlying condition, such as a heart attack.
- Variant angina, also known as Prinzmetal angina, usually occurs during periods of rest and is triggered by physical or emotional stress. This type is often caused by spasms in a coronary artery.
- Microvascular angina is a rare form that affects women more often than men. It is caused by spasms in the smaller coronary arteries, which can restrict blood flow to the heart muscle. The development of angina is closely related to coronary artery disease, which results from cholesterol deposits (plaques) in the heart arteries and inflammation. Maintaining a heart-healthy lifestyle can help prevent or manage angina and coronary artery disease.
Assessment and Diagnosis
Triage
If you suspect angina, you should see a healthcare provider to determine the cause and receive proper treatment. You should seek medical help immediately if you experience any of the following:
- Chest pain that lasts longer than a few minutes and doesn't go away with rest or medication.
- Worsening or change in the pattern of your angina symptoms.
- Shortness of breath, fatigue, or other signs of decreased heart function.
- Unexplained chest pain, especially if it is new or recurring. Remember to consult a healthcare professional for an accurate diagnosis and appropriate treatment.
Diagnosis
To diagnose angina, your health care provider will perform a physical exam and ask questions about your symptoms and risk factors, such as any family history of heart disease. Tests used to diagnose and confirm angina include an electrocardiogram (ECG or EKG), which measures the electrical activity of the heart, and blood tests to check cholesterol and sugar levels.
Management and Treatment
Complications
The potential complications of angina include heart failure, heart attack, stroke, aneurysm, and peripheral artery disease. Angina chest pain can make daily activities uncomfortable, and the most dangerous complication is a heart attack. Symptoms of a heart attack include persistent chest pain, pain spreading to the arms, back, or jaw, fainting, a sense of doom, nausea, and shortness of breath. To prevent angina, one should adopt a healthy lifestyle, which includes not smoking, maintaining a healthy diet, regular exercise, managing high blood pressure, cholesterol, and diabetes, and avoiding unhealthy habits like sleep apnea and tobacco use.
Prevention
angina can be prevented by making lifestyle changes that promote heart health. Key preventive measures include not smoking, eating a healthy diet, avoiding or limiting alcohol, exercising regularly, maintaining a healthy weight, managing other health conditions related to heart disease, reducing stress, and getting recommended vaccines to avoid heart complications. Quitting smoking and adopting a heart-healthy lifestyle are crucial steps in preventing angina and reducing the risk of heart disease.
Treatment
Treatment for angina involves a combination of lifestyle changes, medications, and, in some cases, procedures. The goal is to reduce the frequency and severity of symptoms and lower the risk of a heart attack and death. Lifestyle changes are an essential part of treating angina and include not smoking, eating a healthy diet, and exercising regularly. Medications may be needed if lifestyle changes do not improve heart health and relieve angina pain. Common medications used to treat angina include:
- Nitrates: These medications relax and widen blood vessels, improving blood flow to the heart. Nitroglycerin is a common form of nitrate used for angina treatment.
- Aspirin: Aspirin helps reduce blood clotting, making it easier for blood to flow through narrowed heart arteries. This can help reduce the risk of heart attacks. Consult your healthcare provider before starting daily aspirin therapy. Angioplasty with stenting can improve blood flow in the heart, reducing or eliminating angina. This procedure may be recommended for those with unstable angina or if lifestyle changes and medications don't effectively treat chronic, stable angina. Open-heart surgery (coronary artery bypass surgery) can also be an option for both unstable angina and stable angina that has not responded to other treatments. Remember to consult with a healthcare professional before starting any new treatment for angina.
Preparing for medical consultation
To prepare for an appointment for angina, follow these steps:
- Note any symptoms: