Introduction
Angina is chest pain or discomfort that results from a lack of blood and oxygen flow to the heart muscle. A narrowed or blocked artery due to coronary artery disease is the most common cause of angina. When blood cannot reach the heart tissue, especially during physical activity, chest discomfort may occur that can last up to several minutes. Angina may be treated with rest, medication, cardiac rehabilitation, and surgery.
Anatomy
Your heart has several large arteries and veins connected to it that branch out and become smaller as they travel throughout your body. Your arteries deliver blood from the heart and veins return blood to the heart in a process called circulation.
The aorta is the largest blood vessel in your body. The aorta carries all the blood pumped out of your heart. Through its many branches, the aorta distributes blood to all of the areas and organs in your body. Two coronary arteries branch out from the aorta supplying the heart with oxygen, blood, and nutrients to keep it healthy.
Causes
The most common cause of angina is coronary artery disease caused by atherosclerosis, hardening of the arteries. Initially, plaque formation may narrow the arteries. Over time, the plaques may rupture to form a plug or clot that can block an artery. When an artery is narrowed or blocked, blood and oxygen cannot reach the heart muscle. This results in discomfort, especially upon exertion. Other less common causes of angina include a spasm of the artery, valvular heart disease, an enlarged heart, or uncontrolled high blood pressure.
Symptoms
Angina results when the heart does not get enough blood and oxygen. This may happen after you exercise or exert yourself, such as after climbing stairs, carrying in the groceries, or during sex. Angina may occur when you are emotionally upset, angered, or stressed. Having a full stomach or being in very hot or cold temperatures may also bring about angina.
Angina causes chest discomfort that typically lasts from about one to five minutes. The discomfort usually feels like pressure, heaviness, tightness, squeezing, burning, or pain. This may occur in the chest, back, neck, jaws, arms, stomach area, and shoulders. Your shoulders, arms, or wrists may feel numb or tingle. It may be difficult to breathe. You may sweat or feel nauseous.
Contact your doctor if you experience angina. People with angina have an increased risk for a heart attack, cardiac arrest, and sudden cardiac death. An ambulance should be called immediately if a heart attack is suspected. Symptoms of a heart attack include new, worsening, or persistent pain or pressure in the center of the chest, shortness of breath, nausea, vomiting, and pain that radiates from the chest into the teeth, jaws, shoulders, or arms. A heart attack can be fatal. Immediate emergency medical care is necessary to sustain life and prevent complications.
Diagnosis
Your doctor can begin to diagnose angina after reviewing your medical history, performing an examination, and conducting some tests. There are different types of angina. You should tell your doctor about your symptoms, medical history, and any family history of heart disease. Blood tests and other assessments will be done to determine how your heart is functioning. In some cases, blood tests can predict the likelihood of the progression from angina to a heart attack.
Several tests are used to identify angina. Common tests include an electrocardiogram (ECG), exercise stress test, nuclear stress test, and coronary angiogram. An ECG records the heart’s electrical activity. An ECG may be repeated over several hours. An exercise stress test, also called a cardiac stress test or treadmill test, involves monitoring your ECG and blood pressure while you walk on a treadmill. The exercise stress test provides information about how your heart works with an increased blood flow demand. A chemical or nuclear stress test involves infusing medication in a controlled setting to raise the heart rate in order to determine how well specific areas of the heart are working. There are several different chemicals and different imaging formats that can be used based on the patient’s individual needs. A dye and X-ray are used to show an image of the heart structures with a coronary angiogram.
Treatment
There are a variety of treatments for angina, depending on the type and severity. Your doctor may prescribe nitroglycerin medication to relieve angina. Depending on your condition, your doctor may prescribe other medications to lower your blood pressure, regulate your heartbeat, relieve anxiety, or thin your blood. Cardiac rehabilitation, to strengthen your heart muscles and improve your circulation, may be ordered. Some types of angina may require hospitalization. In some cases, surgery may be recommended.
A coronary angioplasty is a surgery that opens blocked coronary arteries. A stent may be inserted to ensure that the coronary artery remains open after angioplasty. Coronary artery bypass graft (CABG) surgery involves taking a blood vessel from another part of the body to create a detour around a clogged artery to restore the blood flow to the heart. Blood vessels are commonly taken from the leg and surgically attached to the coronary artery. It may be necessary to have bypass surgery on one or more coronary arteries.
Prevention
You may decrease your risk of angina by eliminating the risk factors that you can control. It is suggested to attain and maintain a healthy weight, cholesterol level, blood sugar level, and blood pressure. Stop smoking! If you are unable to quit smoking on your own, ask your doctor about smoking cessation products and support systems that may help you. Eat a well-balanced healthy diet. Your doctor can refer you to a nutritionist that can help you plan low-sodium, low-fat, and low-sugar meals. Regular exercise can help keep your heart strong.
Am I at Risk
Risk factors may increase your likelihood of developing angina, although some people that develop the condition do not have any risk factors. You should tell your doctor about your risk factors and discuss your concerns.
Risk factors for angina:
- Coronary artery disease caused by atherosclerosis, or hardening of the arteries.
- Males greater than females
- Cigarette smoking
- High cholesterol, in particular, high LDL and low HDL cholesterol
- High blood pressure
- People with a family history of heart disease
- High blood sugar levels associated with diabetes
- Obesity
- Sedentary lifestyle
- Advancing age
- Drug use, especially cocaine
Complications
Angina may progress to a heart attack or sudden death from cardiac arrhythmias (irregular heartbeats). If you experience the symptoms of a heart attack, you should call an ambulance. While waiting for emergency care to arrive, it can help to take an aspirin, if you have some nearby.
Advancements
Some research studies have demonstrated that risk factor modification, such as a heart healthy diet, exercise, and smoking cessation, can slow the progression of artery blockages and in some cases, reduce their severity.