Angina pectoris is discomfort you feel when there is not enough blood getting to your heart muscle to meet its needs. The discomfort can occur in the chest, arms, shoulder, jaw, throat, or between the shoulder blades. It most commonly occurs in the chest. Angina can make your chest feel tight, heavy or squeezed. It can be painful. Angina is a common symptom of coronary artery disease (CAD). It occurs when plaque builds up inside the coronary arteries. This narrows the artery and blocks blood flow.
There are two types of angina:
Stable angina is a recurring pain or discomfort. It is often brought on by physical activity. During physical activity your heart rate and blood pressure increase. This causes the heart to need more oxygen and nutrients. Angina pain is a symptom that the heart is not getting enough oxygen. The pain stops when you rest or take a medication called nitroglycerin.
Unstable angina occurs when the pattern of pain or discomfort begins to occur more frequently and can become more severe. It takes less exercise to cause symptoms, and symptoms may not go away when you rest. His form of angina can even occur when resting. People with unstable angina that is not treated are at high risk of a heart attack or death. If unstable angina is recognized and treated, it greatly reduces these risks.
What Are The Symptoms of Angina?
- Pain or discomfort in the chest, throat, arms, jaw or between the shoulder blades. Some people have tightness or heaviness in these areas with no pain.
- A feeling of indigestion or nausea
- Difficulty breathing
Why Does Angina Occur?
Angina may be caused by any condition that affects the blood flow to your heart, such as:
- Coronary artery disease – The walls of the arteries that carry blood to the heart develop a plaque buildup. This restricts the flow of blood and less oxygen reaches the heart. This is by far the most common cause of angina.
- Coronary artery spasm – A coronary artery narrows causing blood to slow or stop flowing through the artery. When the spasm stops, the artery and blood flow return to normal.
- Abnormal heart valves
- Abnormal heart rhythms
- Anemia – The level of red blood cells or hemoglobin ( the oxygen-carrying chemical in the blood) are too low.
- Polycythemia – The blood has too many red blood cells, which causes the blood to get thick.
- A thyroid problem
How Is Angina Diagnosed?
Your doctor will ask about your symptoms, take a medical history and do a physical exam. Your doctor may recommend one or more tests. Tests might include an ECG, exercise stress test, stress echo, nuclear stress test or cardiac catheterization.
How Is Angina Treated?
Lifestyle – When angina is caused by coronary artery disease, treatment often involves changes in your lifestyle. You may need to:
- Quit smoking
- Lose weight
- Get more exercise
- Lower your blood pressure, cholesterol and blood sugar
Medicine – Nitroglycerine is the most common medicine for treating angina It reduces the workload on the heart by enlarging the coronary blood vessels. This increases blood flow to the heart and lowers blood pressure slightly. Nitroglycerine comes in the form of pills (taken by letting the tablet dissolve under your tongue) and spray. It is also available in long acting forms by pill, paste and patches.
If your doctor has prescribed nitroglycerine, you should understand how to take the medication:
- Nitroglycerine tablets should be placed under the tongue and allowed to dissolve. The tablet will not work if you chew or swallow it. If your doctor has prescribed a cream, the cream should be placed on the skin and covered. Do not rub the cream into the skin.
- Nitroglycerine tablets are sensitive to heat, light, and moisture. Keep the tablets tightly sealed in their original bottle and store in a dark place. Old nitroglycerine tablets lose their strength so ask your doctor about refilling your prescription every 6 months.
- Keep your nitroglycerine tablets with you at all times. Nitroglycerine is not habit forming. Don’t be afraid to take it if you are having symptoms. Some people take a nitroglycerine tablet before an activity that they know causes angina. Ask your doctor if this is something you should do.
- Some people experience a mild headache after taking nitroglycerine. This is a common side effect and will go away when the nitroglycerine wears off.
Surgery – Angina caused by blocked arteries can be treated with two types of procedures.
The first procedure is called balloon angioplasty. Under local anesthesia, a tiny tube called a catheter is placed in an artery in the leg or arm. It is guided up to the coronary artery where a small balloon on the tip of the tube is inflated. This pushes the blockage against the sides of the artery wall and then the balloon is deflated and the tube is removed. This expands the artery enough to let the blood flow normally. Most people have a stent (tiny mesh tube) inserted as part of this procedure to help keep the artery open. With a stent, the chance of having the artery blocked again is reduced. This procedure usually requires a short stay in the hospital.
The second procedure for blocked arteries is coronary artery bypass surgery. During this surgery a vein from the leg or an artery from the chest is used to bypass the blocked artery. This creates a new route for the blood to flow. This procedure usually requires a stay in the hospital of approximately one week, followed by several weeks of recovery.
How Can I Take Care of Myself and Prevent Angina?
Follow the treatment prescribed by your doctor. In addition, follow these guidelines:
- Control your physical activity: Learn what types of activity cause you to have angina and avoid these activities. Avoid sudden hard physical activity. Learn to pace yourself physically.
- Moderate exercise is beneficial to many people living with angina. Consult your doctor about beginning an exercise program.
- Avoid situations that are stressful. Learn the types of situations that upset you. Many people can learn to control their emotions better once they are aware of situations that trigger emotional upset. In particular, you should try to avoid situations that cause you to feel pressured, such as deadlines and an overcrowded schedule. Excitement and anger can also trigger angina.
- Eat a healthy diet. If you are overweight, begin a weight-loss program under the supervision of your doctor or a dietitian. Eat a healthy, well-balanced diet and avoid foods high in cholesterol and fat (especially saturated fat). Heavy meals and/or eating too fast can put a strain on your heart. Try to avoid eating large meals and rich foods that make you feel stuffed.
- Don’t smoke: Cigarette smoking often makes angina worse and it increases your risk for heart attack and other circulatory problems.
- Have your blood pressure checked regularly. High blood pressure increases the heart’s work and can aggravate angina.
When Should I Call My Doctor?
See your doctor if the angina becomes worse or occurs more often. Sometimes it’s hard to tell a severe attack of angina from a true heart attack. Call your doctor or 911 or go to a hospital emergency room right away if:
- You have chest discomfort with light-headedness
- You are sweating a lot during an attack of angina
- You have chest discomfort (pressure, fullness, squeezing or pain) that lasts more than 10 minutes or goes away and comes back.
You still have pain 15 minutes after taking one nitroglycerine tablet every five minutes.