Angina, also called angina pectoris, is a recurring discomfort or pain in the chest that occurs when an inadequate supply of blood reaches the heart muscle. Angina is not a heart attack, though the symptoms are similar. It is a warning symptom of a more serious condition, usually coronary heart disease.
Angina currently affects more than 10 million Americans, with 350,000 new cases diagnosed each year. Although it most commonly affects males who are middle-aged or older, it can occur in both sexes and all age groups.
When to Call an Ambulance
Call 911 if you experience chest pain, even if there is no history of heart problems in your family and you believe that you are too young to have angina. Although an angina episode is not a heart attack, it does alert the doctor that a patient’s heart muscle is starved for blood and oxygen. Early treatment to improve the heart’s blood supply can avoid permanent, irreversible damage to the heart.
Angina is usually described as a pressing, burning or squeezing pain felt in the chest. Angina pain typically centers under the breastbone, but it may also spread to the throat, arms, jaws, between the shoulder blades or downward to the stomach. Other symptoms that may accompany angina include:
- Dizziness or lightheadedness.
- Difficulty breathing or shortness of breath.
Doctors divide angina into two types:
based on the symptom pattern and predictability.
When a patient experiences stable angina, chest pain adheres to a specific pattern, usually occurring after extreme emotion, overexertion, a large meal, alcohol consumption, cigarette smoking or exposure to extremely hot or cold temperatures. Symptoms usually disappear after a few minutes of rest.
With unstable angina, the symptoms are less predictable and more serious. The discomfort and pain can last 20 minutes or more, even during sleep or at rest.
Angina is not a disease but a symptom of a more serious condition, usually coronary heart disease. Coronary artery disease is an illness that produces a narrowing and blockage of the coronary arteries (blood vessels that supply blood to the heart muscle).
This is usually the result of atherosclerosis, a condition where fatty deposits (plaques) build up along the inside walls of blood vessels. In addition to coronary artery disease, angina can also occur because of heart rhythm disturbances, heart valve abnormalities, anemia and some thyroid conditions.
You can help prevent angina due to coronary artery disease by controlling your risk factors for atherosclerosis, especially high blood cholesterol, high blood pressure, smoking and diabetes.
- If you have high cholesterol, follow your doctor’s guidelines for a healthful diet low in fats and cholesterol and (if necessary) take medication to decrease you blood cholesterol level.
- If you have high blood pressure, follow your doctor’s recommendations for modifying your diet and taking your medication.
- If you smoke, quit.
- If you have diabetes, monitor your blood sugar level frequently, follow your diet, and take your insulin or oral medication as your doctor has prescribed.
- It is also wise to exercise regularly and to maintain an ideal weight. If you are a woman who is approaching menopause, ask your doctor about the need to begin estrogen replacement therapy (ERT). If angina attacks are triggered by emotional stress, stress management or relaxation techniques may be helpful.
Your doctor may suspect that you have angina based on your medical history and the pattern of your symptoms. To confirm the diagnosis, you’ll need a physical examination, with special attention given to your chest wall and heart, together with diagnostic cardiac testing.
During the physical examination, your doctor will check for signs of chest wall tenderness, usually a sign of a non-cardiac problem involving chest wall muscles, ribs or rib joints. Your doctor will also use a stethoscope to listen for any abnormal heart sounds.
The physical examination will be followed by one or more diagnostic tests to either rule out angina or determine the presence and severity of any underlying coronary disease. Following is a list of possible tests:
- An electrocardiogram. An ECG is a record of the heart’s electrical impulses. It can identify abnormalities in heart rate and rhythm, and it can help to establish whether the heart muscle is receiving enough oxygen.
- A stress test on a treadmill. A stress test monitors the effects of treadmill exercise on blood pressure and ECG, and identifies any stress-related abnormalities.
- A coronary angiogram. The coronary angiogram, a series of X-rays of the coronary arteries, is considered to be the most accurate way to measure the severity of coronary disease. During an angiogram, a thin, long, flexible tube called a catheter is threaded into an artery in the forearm or groin, and then moved through the circulatory system into one of the two major coronary arteries. Dye is then injected to show the flow inside the coronary arteries and to identify any areas of narrowing or blockage.
- Lifestyle changes. Such changes include weight loss in obese patients, therapy to quit smoking, medications to lower high cholesterol, a program of regular exercise and stress reduction techniques (meditation, biofeedback, etc.).
- Nitrates. These medications (including nitroglycerin) are vasodilators; they act to widen blood vessels. Nitrates widen the coronary arteries and increase the blood flow to the heart muscle. They also widen the body’s veins which lightens the heart’s workload by decreasing the amount of blood returning to the heart for pumping.
- Beta blockers. These medications, such as atenolol and metoprolol, decrease the heart’s workload by slowing the heart rate and reducing the force of heart muscle contractions, especially during exercise.
- Calcium channel blockers. These medications, such as nifedipine, verapamil, diltiazem and amlodipine, dilate (widen) the coronary arteries. They may also decrease the heart muscle’s demand for oxygen/blood.
- Aspirin. Because aspirin helps to prevent blood clots from forming inside narrowed coronary arteries, it can reduce the risk of myocardial infarction in people who already have coronary artery disease.
Aggressive management can lower high cholesterol levels and high blood pressure. When drugs fail to ease angina, or when the risk of a heart attack is great, coronary artery bypass surgery or balloon angioplasty may be recommended.
During coronary artery bypass surgery, a blood vessel is grafted onto the affected coronary artery to bypass the narrowed or blocked area. This blood vessel graft may be taken from an artery inside the chest, or from a long vein in the leg. In balloon angioplasty, a catheter is inserted into an artery in the groin or forearm and then passed through the circulatory system into the blocked coronary artery. Once inside the coronary artery, a small balloon at the catheter tip is briefly inflated to open the narrowed vessel.