Angina

What is angina?

The most common symptom of coronary artery disease is angina or “angina pectoris,” also known as chest pain. Angina can be described as a discomfort, heaviness, pressure, aching, burning, fullness, squeezing or painful feeling. It is caused by decreased blood flow and oxygen to your heart. If left untreated, angina may get worse, increase your risk for a heart attack, or become life-threatening.

• Stable angina. The discomfort is predictable and presents during exertion or extreme emotional distress, disappearing with rest.
• Unstable angina. This may signal an impending heart attack. Unstable angina is angina pain that is different from your regular angina pain or pain that occurs while at rest. The angina may occur more frequently, more easily at rest, feel more severe, or last longer. Although this type of angina can often be relieved with oral medications (medicine taken by mouth), it is unstable and may progress to a heart attack. Usually more intense medical treatment or a procedure is required.

What are the risk factors of angina?

Some of these risk factors can be changed or reduced and some of them can not. Lifestyle changes, medication management and knowledge are just some of the ways to help lower your risk.

What increases my risk for angina?

• Age older than 55 years
• Being a man
• Being a woman who smokes and takes birth control pills, or in menopause
• Diabetes, high blood pressure, high cholesterol, or atherosclerosis (hardening of the arteries)
• A heart problem, such as a coronary artery spasm, heart valve disease, or an enlarged heart
• A history of smoking, being around secondhand smoke, or using cocaine
• Not enough exercise, or being overweight

How is angina diagnosed?

First, your doctor will ask you a series of questions to determine what your symptoms are and what brings them on. After examining you, your doctor will order one or more of a series of tests to determine the underlying cause of the angina and the extent of coronary artery disease, if present. These tests include: exercise stress tests, electrocardiogram (EKG or ECG), nuclear imaging tests, echocardiogram, and cardiac catheterization.

• An EKG records your heart rhythm and how fast your heart beats. It is also used to look for problems or damage in different areas of the heart.
• Blood tests may show if there is damage to your heart. Your healthcare provider may also use blood tests to get information about your overall health.
• A stress test helps healthcare providers see the changes that take place in your heart while it is under stress. Healthcare providers may place stress on your heart with exercise or medicine. Ask your healthcare provider for more information about this test.
• An echocardiogram is a type of ultrasound. Sound waves are used to show the structure, movement, and blood vessels of your heart.
• Cardiac catheterization is a procedure that uses dye and an X-ray to check the blood flow in your coronary arteries. This can help your healthcare provider decide how to treat your angina. Sometimes blockages can be treated during a cardiac catheterization.

How is angina treated?

The treatment you receive depends on the severity of the underlying problem, namely the amount of damage to the heart. For most people with mild angina, a combination of medications and lifestyle changes can control the symptoms. Lifestyle changes include: eating a heart-healthy diet, lowering cholesterol, getting regular exercise, quitting smoking and controlling diabetes and high blood pressure.

• Medicines:
  • Aspirin may help prevent blood clots by thinning your blood. If you cannot take aspirin, your healthcare provider can give you a prescription blood thinning medicine instead. Aspirin and other blood thinners may increase your risk for bleeding, including stomach bleeding. You will need to be careful to prevent bruising and bleeding.
  • Other medicines may be given to open the arteries to your heart, slow your heartbeat, or decrease your blood pressure or cholesterol.
  • Do not take certain medicines without asking your healthcare provider first. These include nonsteroidal anti-inflammatory drugs (NSAIDs), herbal or vitamin supplements, or hormones (estrogen or progestin).
• Angioplasty and stenting help open the coronary arteries and allow blood to flow to the heart.
• Coronary artery bypass graft (CABG), or open heart surgery, can improve blood flow to the heart. This will help decrease your chest pain and prevent a heart attack.

When should I seek immediate care for angina?

Call 911 if:

• You have any of the following signs of a heart attack:
  • Squeezing, pressure, or pain in your chest that lasts longer than 5 minutes or returns
  • Discomfort or pain in your back, neck, jaw, stomach, or arm
  • Trouble breathing
  • Nausea or vomiting
  • Lightheadedness or a sudden cold sweat, especially with chest pain or trouble breathing
• You have chest pain that does not go away after you take medicine as directed.
• You lose feeling in your face, arms, or legs, or you suddenly feel weak.

When should I contact my healthcare provider?

• Your angina is happening more frequently, lasting longer, or causing worse pain.
• You have blood in your urine or bowel movements, or you vomit blood.
• You are dizzy or nauseated after you take your medicine.
• You have trouble breathing at rest.
• You have new or worse swelling in your feet or ankles.
• You are bleeding from your gums or nose.
• You have questions or concerns about your condition or care.