Understanding Angina Pectoris

Definition

Angina is pain or discomfort in the chest. It often has a squeezing or pressure-like feel. This discomfort can also be felt in the shoulders, arms, neck, jaws, or back. Anginal pain usually lasts for no more than 2 to 10 minutes.

Types of angina include:

• Stable angina —Has a predictable pattern. You generally know what brings it on and what relieves it. You may also know what the intensity will be.
• Unstable angina —Is more unpredictable and/or severe. Chest pain may occur while resting or sleeping. The discomfort may last longer and be more intense than that of stable angina.
  • Unstable angina may be a sign that you are about to have a heart attack. Call for emergency medical services right away.
• Variant or Prinzmetal angina —Caused by temporary spasm of coronary arteries. Occurs when you are at rest, most often in the middle of the night. It can be quite severe.

Typical Angina Pain Areas

Women are more likely to experience pain outside of these areas.

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Causes

Angina is usually a sign of coronary artery disease (CAD). It occurs when the blood vessels leading to your heart are narrowed or blocked. The blockage decreases the blood and oxygen flow to your heart. When your heart is deprived of oxygen, you will feel chest pain and other symptoms.

Coronary Artery Disease

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Risk Factors

CAD is more common in older men. Other things that may increase your risk of CAD include:

• Strong family history of heart disease
• Obesity and overweight
• Smoking
• High blood pressure
• Sedentary lifestyle
• High blood cholesterol—specifically, high low-density lipoprotein (LDL) cholesterol and low high-density lipoprotein (HDL) cholesterol
• Diabetes
• Stress
• Excessive alcohol intake

Symptoms

Symptoms may include:

• Pressure or squeezing chest pain
  • Chest pain or discomfort is the key symptom of angina
  • Some people do not experience the pain as severely
  • Elderly people, women, and people with diabetes are more likely to have subtle symptoms and pain outside of the typical areas
  • Some people have silent ischemia (lack of blood supply to the heart) and experience no symptoms of chest pain

The likelihood of a heart attack is increased when chest discomfort is severe, lasts more than 15 minutes, and is accompanied by other symptoms, such as:

• Pain in the shoulder(s) or arm(s), or into the jaw(s)
• Weakness
• Sweating
• Nausea
• Shortness of breath

Diagnosis

Tests will be done right away to see if you are having an episode of angina or a heart attack. For stable patterns of angina, other tests may be done to determine the extent of your disease. The test results will help to create a treatment plan.

Images may be taken of your heart. This can be done with:

• Echocardiogram
• Nuclear scanning
• Electron-beam CT scan (coronary calcium scan, heart scan, CT angiography)
  • American Heart Association (AHA) guidelines state that heart scans are not for everyone and are most likely to benefit patients at intermediate risk of CAD.
• Coronary angiography

Your heart activity may be tested. This can be done with:

• Electrocardiogram (ECG)
• Exercise stress test
  • A medicine is used to simulate the effects of physical exertion for those who cannot exercise.

Treatment

Treatment will help to improve blood flow to the heart. Some may be longer acting, others may be used when an attack happens. Treatment may include:

Prevention

Steps to prevent CAD include:

• Maintain a healthy weight.
• Begin a safe exercise program with the advice of your doctor.
• Stop smoking.
• Eat a healthy diet. It should be low in saturated fat. It should also be rich in whole grains, fruits, and vegetables.
• Manage high blood pressure and/or diabetes.
• Manage abnormal cholesterol levels or high triglycerides.