What is Angina?
Angina is chest pain or uneasiness caused by lack of oxygen due to reduced blood flow to the heart muscle. In angina, you may feel as there is a pressure or squeezing pain in your chest. Also, you may feel pain in your shoulders, arms, neck, jaw, abdomen, or back. Angina discomfort may even mimic the sensation of indigestion.
Moreover, some persons have no pain but do experience other symptoms such as shortness of breath or exhaustion. If these symptoms are caused by a deficiency of oxygen to the heart muscle, the condition is referred to as an “anginal equivalent.”
Angina, on the other hand, is not an illness. It is an indication or symptom of a more serious cardiac condition, most often coronary heart disease (CHD), also known as coronary artery disease (CAD). There are several forms of angina, including stable angina, unstable angina, microvascular angina, and angina produced by a coronary artery spasm (vasospastic or variant angina).
Angina often occurs when one or more coronary arteries become constricted or obstructed, a condition known as ischemia.
Additionally, angina might be a sign of coronary microvascular dysfunction (MVD). This is a kind of heart illness that attacks the smallest coronary arteries in the heart and is more common in women than males.
Numerous things, depending on the kind of angina you have, might provoke angina discomfort. Also, the symptoms differ depending on the kind of angina you have.
What are The Types of Angina?
Angina may be seen in different types. The kind is determined by the underlying cause and whether rest or medicine is required to alleviate symptoms.
1) Stable Angina
The most prevalent kind of angina is stable angina. It often occurs after physical activity (exercise) and subsides with rest or angina medication. For instance, the discomfort that occurs when walking uphill or in cold weather might be angina.
Stable angina pain is predictable and often resembles past chest pain events. The chest discomfort is often brief, lasting no more than five minutes.
2) Unstable Angina
Unstable angina strikes without warning and happens during rest. Alternatively, the angina discomfort is deteriorating and happens with slighter physical effort. It is usually more intense and lasts longer than stable angina, maybe up to 20 minutes. The discomfort is not relieved by rest or the standard angina treatments. If the blood flow does not recover, the heart becomes oxygen-depleted, resulting in a heart attack. Unstable angina is a serious condition that needs immediate medical attention.
3) Variant Angina (Prinzmetal Angina)
Coronary artery disease (CAD) is not the cause of the Variant angina, which is also known as Prinzmetal angina. It is produced by a spasm in the heart’s arteries, which restricts blood flow temporarily. The primary symptom of variant angina is severe chest discomfort. It happens most often in cycles, generally during rest and nighttime. Angina medicine may be used to alleviate the discomfort.
4) Refractory Angina
Despite a mix of medications and lifestyle modifications, angina attacks remain common.
5) Ludwig’s Angina
Ludwig’s Angina is a very uncommon but severe bacterial skin infection that affects the mouth, throat, and jaw. Ludwig’s angina, a kind of cellulitis, develops swiftly to infect the sensitive tissues underneath your tongue. Adults are more likely to have this dangerous disorder than youngsters. As the infection progresses, it causes the tongue to rise; which may cause breathing difficulties or obstruction if left untreated. Mostly, people who get early treatment recover fully.
Streptococcus and Staphylococcus bacterias are the most common cause of Ludwig’s angina. This often follows a mouth injury or infection, like a tooth abscess. The following reasons may also lead to Ludwig’s angina:
- A recent tooth extraction
- Poor dental hygiene
- Trauma or lacerations in the mouth
6) Microvascular Angina
Microvascular angina is more common in women. In this type, you have chest pain without coronary artery blockage. It occurs due to the reason that your smallest coronary arteries aren’t working the way they should, so your heart doesn’t get the required amount of blood. The chest pain in this type mostly lasts longer than 10 minutes.
What are The Causes of Angina?
Angina is a condition that occurs when there is insufficient blood flow to the heart muscle. Blood supplies oxygen to the heart muscle, which it needs to survive. When the heart muscle does not get adequate oxygen, a condition called ischemia occurs.
Coronary artery disease is the most prevalent cause of decreased blood flow to the heart muscle. The coronary arteries might become constricted as a result of fatty deposits termed as plaques and this condition is referred to as atherosclerosis.
If plaques break or a blood clot develops in a blood vessel, it may immediately block or restrict blood flow through a constricted artery. This might result in a rapid and significant reduction in blood flow to the heart muscle.
When oxygen demand is minimal, for example during rest, the heart muscle may be able to function with less blood flow without producing angina symptoms. On the other hand, when the requirement for oxygen increases such as during exercise, angina may occur.
Less common causes of angina also include:
- Hypertrophic cardiomyopathy (an enlarged or thickened heart)
- Pulmonary embolism (a blockage in a major artery of your lungs)
- Pericarditis (swelling of the sac around your heart)
- Aortic dissection (tearing in the wall of your aorta)
- Aortic stenosis (narrowing of a valve in the main part of your heart)
What are The Symptoms of Angina?
Chest pain and discomfort are common symptoms of angina. The chest pain and discomfort may be described as follows:
- Pressure
- Squeezing
- Burning
- Fullness
- Pain may also be experienced in the arms, jaw, neck, shoulder, or back.
Additional symptoms of angina also include:
- Fatigue
- Dizziness
- Shortness of breath
- Nausea
- Sweating
- Indigestion
- Heartburn
Angina may vary in intensity, duration, and kind. Symptoms that are new or unusual may indicate a more hazardous type of angina (unstable angina) or a heart attack.
Any new or increasing angina symptoms should be checked by a health care practitioner quickly to determine whether you’re suffering from stable or unstable angina.
Angina in Women
Angina symptoms in women may vary from typical symptoms of angina. This difference in symptoms may also cause a delay in getting treatment. For instance, although chest pain is a typical symptom among women having angina, but it is not always the sole or most prominent symptom in women. Women may also experience the following symptoms:
- Discomfort in the neck, teeth, jaw, or back
- Shortness of breath
- Stabbing pain is present instead of chest pressure
- Nausea and Vomiting
- Pain in the stomach (abdominal pain)
The American Heart Association (AHA) urges females to get help for symptoms of heart disease. The association also highlight that cardiovascular disease is the main reason of death among females in the U.S.A. and it occurs in nearly half of Black American females.
Risk factors For Angina
The following factors may raise your chance of developing angina:
Age
Angina is more prevalent in persons over the age of 60.
Family History of Heart Disease
You should inform your physician if any of your parents or siblings have or had cardiovascular disease or a heart attack.
Diabetes
Diabetes raises the risk of coronary artery disease, which results in angina as well as heart attacks. This is because diabetes accelerates atherosclerosis and raises cholesterol levels.
Tobacco Consumption
Smoking, chewing tobacco, and prolonged exposure to secondhand smoke may cause damage to the artery lining, causing cholesterol deposits to accumulate and obstruct blood flow.
High Blood Pressure
The prolonged rise in your blood pressure can damage your arteries by accelerating the hardening of the arteries.
Elevated cholesterol or triglyceride levels
Elevated low-density lipoprotein (LDL) levels in the blood may cause arteries to constrict. A high LDL cholesterol level raises the risk of developing angina and heart attacks. An elevated triglyceride level in the bloodstream is also harmful.
Stress on the Emotional Level
Excessive stress and anger may cause blood pressure to rise. Increased levels of hormones released during times of stress might constrict the arteries and aggravate angina.
Other Health Problems
Angina is more likely to occur if you have peripheral artery disease, chronic renal disease, a previous history of stroke or metabolic syndrome.
Obesity
Obesity increases the chance of developing heart disease, which may result in angina. Obesity strains the heart’s ability to provide blood to the body.
Misuse of Drugs
Cocaine and other stimulants have the potential to induce blood vessel spasms and angina.
Cold Temperatures
Cold temperatures may trigger Prinzmetal’s angina.
Medications
Certain medications (like migraine medications) that constrict blood arteries may precipitate Prinzmetal’s angina.
Inadequate Exercise
A sedentary or inactive lifestyle is associated with elevated cholesterol levels, type 2 diabetes, hypertension, and obesity. You should consult your physician to determine the kind and quantity of exercise that is most appropriate for you.
Diagnosis of Angina
Various tests may be necessary to diagnose angina.
Consultation with a physician
If you see your doctor after a case of chest discomfort, they may inquire about the following:
- The symptoms you had
- What you were doing at the time when the symptoms began
- Your lifestyle, your diet and then if you smoke or drink
- Your family’s medical background – Cardiovascular disease may run in families.
Additionally, they may do certain tests to determine the risk of a cardiac condition, such as the following:
- Blood pressure reading
- Calculating your BMI (body mass index) — requires you to weigh and measure your height.
- Determining your waist circumference
- Blood tests to determine your cholesterol level
If they suspect you have angina or another kind of heart disease, they may recommend you to the hospital for more testing.
In the hospital, you may undergo tests to determine if you have angina and to determine your risk of developing more severe conditions such as heart attacks or stroke.
You might have:
Electrocardiogram (ECG or EKG)
This is a test used to measure the electrical activity and rhythm of the heart. Sticky patches (called electrodes) are placed on the chest and the arms & legs. These electrodes are connected to a computer via wires, which display the test results. An electrocardiogram (ECG) can show whether the heart is beating too slow, too fast, or not at all. Your physician can also look for patterns in the heart rhythm to determine if blood flow through your heart has been slowed or interrupted.
Stress Test
Sometimes it is easier to identify angina (or ischemic chest pain) when your heart is working harder. In a stress test (or an exercise ECG) an electrocardiogram is performed while riding a stationary bike or walking on a treadmill. Other tests may also be performed at the same time as a stress test. If you are not able to exercise, then you may be given drugs that mimic the effect of exercise on the heart.
Chest X-ray
A chest X-ray shows the condition of your heart and lungs. A chest X-ray also rules out other things that might be causing chest pain, like lung conditions, and to see whether the heart is enlarged.
Echocardiogram
An echocardiogram or “echo” is a scan that uses sound waves to create images of the heart in motion. An echocardiogram may help in diagnosing and monitoring certain heart conditions by analyzing how blood flows through the heart and surrounding blood vessels, checking their structure, and evaluating the pumping chambers of the heart.
Cardiac Computerized Tomography (CT)
A cardiac computerized tomography (CT) is an imaging test and it can show if your heart is enlarged or if any of its arteries are narrowed. It is a noninvasive procedure and it uses a powerful X-ray machine to produce images of your heart and its blood vessels. This test is done to diagnose a variety of heart conditions.
Cardiac magnetic resonance imaging (MRI)
Cardiac magnetic resonance imaging (MRI) is a test that uses magnetic fields and radio waves to create detailed images of the heart’s structure and blood vessels.
Blood Tests
Certain heart enzymes enter your bloodstream when the heart muscle is damaged, as in a heart attack. Your doctor can prescribe you a cardiac enzyme blood test that can help detect these substances. The doctor may also recommend some general tests like a metabolic panel or complete blood count (CBC).
Coronary Angiography
It is a scan performed after a dye is injected into your heart’s blood vessels. The dye displays the image of your blood vessels on an X-ray. Your doctor may perform this procedure during cardiac catheterization.
Prevention of Angina
The following strategies can help you to prevent angina:
- Avoiding or quitting smoking
- Avoiding or limiting your alcohol consumption
- Consuming a nutritious and heart-healthy diet
- Practicing ways to manage stress
- Maintaining a healthy weight
- Getting regular exercise
- Managing other health conditions related to heart disease
- Receiving recommended vaccines to prevent heart complications.
What is The Treatment Of Angina?
The main aim of angina treatment is to lessen the frequency and severity of the symptoms and to reduce the risk of heart attack and death.
Treatment options for angina are:
- Lifestyle changes
- Medications
- Angioplasty and stenting
- Open-heart surgery (coronary bypass surgery)
The majority of patients who suffer from angina need several medications. If medications are ineffective, surgery may be needed.
Also, it is crucial to adopt healthy lifestyle modifications.
Medicines for The Treatment of Angina Attacks
If you are diagnosed with stable angina (the most frequent form), you will be prescribed a medicine when you experience an angina attack.
This medicine is referred to as glyceryl trinitrate, or GTN. It is available in the form of a mouth spray or pills that dissolve beneath the tongue.
If you are experiencing an angina attack:
- Put down what you’re doing and take a break.
- Utilize your GTN medication.
- If the first dosage does not work, repeat it after 5 minutes.
If symptoms persist 5 minutes after taking the second dosage, then you should immediately take medical help.
Moreover, you may utilize GTN to prevent an attack before engaging in physical activity such as exercise. Immediately after use, you may have a flushing, headache, or dizziness.
GTN pills typically expire around 8 weeks after being opened, at which time they must be replaced. Because GTN spray lasts far longer, it may be more convenient.
Medicines to Avoid Future Attacks
To help prevent future attacks, you may need to take at least one other medicine daily for the whole of your life. Certain individuals may need the use of two or more medicines.
The following are the primary medications used to avoid angina attacks:
Beta blockers – cause the heart to beat more slowly and with less power.
Calcium channel blockers – cause the arteries to relax, boosting blood flow to the heart muscle
If you are unable to take one of these medicines, you may be prescribed ranolazine, nicorandil, or ivabradine.
Medicines to Avoid Heart Attacks and Stroke
As I have explained above angina is a warning indication that you are at an increased risk of getting serious health issues such as heart attacks or strokes.
So, you need to take additional medicines to lessen this risk.
These medicines include the following:
Low-dose aspirin – to avoid blood clots
ACE inhibitors – to lower your blood pressure
Statins – to lower your blood cholesterol levels
Surgery
Surgery may be required if these medicines are ineffective in controlling your angina.
There are two major types of surgery for angina:
Open-Heart Surgery or Coronary Artery Bypass Graft (CABG)
During coronary artery bypass surgery, a portion of a blood vessel from another region of the body is utilized to redirect blood around a blocked or narrowed heart artery. CABG increases blood flow to the heart and is a treatment option for both unstable angina and stable angina that has not responded to medicines.
Coronary Angioplasty with Stent Insertion
During an angioplasty, also called a percutaneous coronary intervention (PCI), a small tube known as a stent is used to widen the narrowed section of the coronary artery.
Both of these surgeries are very effective and which one is best for you is dependent on your circumstances. If surgery is required in your case, you can discuss your alternatives with your doctor or surgeon.
You will also need to take some medicines after surgery.
Unstable Angina
If you are suffering from unstable angina (in which symptoms emerge unexpectedly), you will require medicines to prevent blood clots and lessen your risk of getting a heart attack or stroke.
You might be given
Clopidogrel
Low-dose aspirin
A blood-thinning medicine’s injection shortly after diagnosis
If are at a high risk of having another angina attack, or a heart attack or a stroke then surgery (either CABG or PCI) may be required.
Lifestyle Changes and Home Remedies for Angina
Healthy lifestyle changes to keep your heart healthy are an important part of angina treatment. Some of the following may help ease angina:
Stop smoking and avoid exposure to secondhand smoke
Quitting smoking can help control angina. If you need help to quit smoking, consult your doctor about smoking cessation treatment.
Avoid or Limit Alcohol
If you choose to drink alcohol, then have it in moderate amount. The optimal alcohol amount should be up to two drinks a day for healthy men and up to one drink a day for healthy women.
Exercise Regularly
Although exercise can bring on angina, but a supervised exercise program can safely strengthen, your heart and eventually reduce angina. So, you should start slowly, and gradually build up your level of exercise. Your doctor can tell you what you cannot and can do. As a general goal, you should daily aim to do at least 30 minutes of moderate physical activity.
Manage Your Weight
You must consult your health care provider about safer weight-loss options, if you’re overweight or obese.
Manage Other Health Conditions
Diabetes, high blood pressure, and high blood levels of cholesterol can lead to angina. Thus lowering high blood pressure, high blood sugar, and high blood cholesterol can help control angina.
Heart-Healthy Diet
Eating a heart-healthy diet that is low in salt, and saturated & trans fats; and is rich in whole grains, fruits, and vegetables can help fight the cholesterol-filled plaque that is responsible for angina.
Reduce Stress and Anger
If stress and anger regularly bring on your angina, then meditation or a stress-reduction program can help you control angina. Getting more exercise and connecting with others in support groups are some extra ways to lessen your emotional stress.
Final Word
Angina involves sensations of pain, squeezing, or pressure in the chest. It increases your risk of getting a heart attack. You must consider angina as a warning sign and make healthy choices.
Take care of yourself if you’re suffering from heart disease that triggers angina, and follow your doctor’s advice on how to deal with that condition.
Immediately consult your physician if you’re experiencing sudden, unexplained, or worsening chest pain. Effective medical treatments and healthy lifestyle changes can manage angina or prevent it from returning.
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References:
Angina
https://www.mayoclinic.org/diseases-conditions/angina/symptoms-causes/syc-20369373
Angina
https://www.mayoclinic.org/diseases-conditions/angina/diagnosis-treatment/drc-20369378
Angina – Treatment
https://www.nhs.uk/conditions/angina/treatment/
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Disclaimer: This article is intended for informational purposes only. Any information associated with this article should not be considered as a substitute for prescriptions suggested by local healthcare professionals.
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