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Angina

Definition


Disease: Angina Angina
Category: Cardiovascular diseases
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Disease Definition:

Angina, also called angina pectoris, is a symptom of coronary artery disease. It is usually described as squeezing, pressure, heaviness, tightness or pain in the chest, as if someone is standing on it. Angina is caused by reduced blood flow to the heart muscle. When the heart muscle (myocardium) doesn’t get enough blood rich with oxygen, a person may have chest pain.

Angina could be stable or unstable:

 

  • Stable angina, also called chronic stable angina.
  • Unstable angina is usually a sign of a coming heart attack.
  • Variant angina, also called Prinzmetal’s angina, is a rarer type that is caused by a coronary artery spasm.



Angina is a relatively common disease, but can be quite hard to distinguish from other types of chest pain, such as the pain or discomfort of indigestion. Prompt medical attention should be sought in case a person experiences unexplained chest pain.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

The major signs and symptoms of angina are chest pain and chest discomfort, but there are other symptoms that may accompany angina, such as nausea, shortness of breath, anxiety, fatigue, sweating or dizziness.

One of the characteristics of angina is the chest pain and discomfort that is described as pressure, fullness, squeezing or pain in the center of the chest. It is also described as a feeling, like a vise is squeezing the chest, or like a heavy weight is placed on the chest. This pressure can extend to the jaw, neck, shoulder, back or arm, especially the left one.

The duration, type and severity of angina can vary and it is very important to recognize if the person is experiencing new or changing chest pain, because these may signal a more dangerous form of angina, such as unstable angina or a heart attack.

Stable angina develops when the heart works harder, such as when climbing stairs or exercising and lasts a short period of time; five minutes or shorter. Stable angina can usually be predicted and the pain is similar to previously experienced types of chest pain. The pain could feel like indigestion and spread to the arms, back or other areas, though it disappears when resting or using angina medication. This type of angina could be triggered by emotional or mental stress.

Unstable angina is a change in the usual pattern of angina; it is unexpected and can occur even when resting. This type of angina could be a signal of a coming heart attack, it lasts longer and could take as long as thirty minutes, and it does not disappear if one rests or uses angina medication.

The variant angina is often severe and happens when resting, but it may be relieved by angina medication.

A woman’s angina has different symptoms from the classic angina symptoms, for instance instead of the typical vise-like pressure, women have chest pain that feels like a stabbing, pulsating or sharp form of chest pain, they are also more likely to experience nausea or abdominal pain. These differences may lead to delays in seeking treatment.
The most common form of angina is the stable angina. If this is a new symptom, a person should consult the doctor to establish the diagnosis and proper treatment. In case the angina changes or gets worse, a person should seek medical attention immediately because they might be having a heart attack.

Causes:

When the blood flow to the heart muscle is reduced, angina occurs. Blood carries oxygen that the heart needs to survive, when it doesn’t get enough oxygen, it causes a condition called ischemia.
Coronary artery disease (CAD) is the most common cause of reduced blood flow to the heart muscle. In this case, the coronary arteries become narrowed by fatty deposits called plaques, which is a condition known as atherosclerosis.

Angina occurs when the heart is not getting enough blood rich with oxygen, so this reduced blood flow is a supply problem. When the heart arteries are narrowed due to fatty buildup, a person doesn't always experience angina because at times of low demand, for example when resting, the heart muscle can get by on the reduced amount of blood flow without triggering angina symptoms. But when the demand for oxygen is increased, angina will be the result.

Stable angina is usually triggered by physical exertion, for instance walking, exercising or climbing stairs. In this case, the heart demands more blood, but because the arteries are narrowed, it will be more difficult for the muscle to get enough blood. Other reasons that cause angina are emotional stress, smoking, heavy meals and cold temperatures.

If plaques or fatty deposits rupture in the blood vessel, or a blood clot forms, it can further reduce or even completely block the flow through already narrowed artery, which suddenly and severely decreases blood flow to the heart muscle. Unstable angina usually worsens and is not relieved by rest or medication, but if the blood flow doesn’t improve, the heart muscle that is deprived of oxygen dies and a heart attack occurs. Severe anemia could also cause unstable angina, especially if the person already has narrowed coronary arteries. This type of angina is quite dangerous and requires immediate emergency treatment.

Variant angina is usually caused by a spasm in a coronary artery, in which case the artery briefly narrows and reduces blood flow to the heart. This type is relatively rare and occurs in about 2% of angina cases.

Complications

Complications:

The most dangerous complication to be concerned about with angina is a heart attack. Additionally, doing some normal, daily activities could be quite uncomfortable because of the chest pain, such as walking.

In case the chest pain changes, becomes more severe or lasts more than a few minutes and doesn’t go away when the person takes their medications or rests, they should call their local emergency number right away, because they might be having a heart attack.
Also, the person shouldn’t drive themselves to the hospital except there is no other option.

Treatments:

Treatment for angina includes angioplasty and stenting, medications, lifestyle changes or coronary bypass surgery. Lowering the risk of a heart attack and death and reducing the frequency and severity of the symptoms are some of the goals of angina treatment.
Lifestyle changes may be all that a person needs to do if their angina is mild. However, medical treatment in a hospital should be immediately sought if someone experiences angina pain that’s different from what they usually have, such as occurring when they're resting, or if they experience unstable angina.

A person should pace him/herself and take rest breaks, because angina is often brought on by exertion. These are some of the lifestyle changes that could be of some help:

 

  • Eating a healthy diet with limited amounts of saturated fat, many fruits and vegetables and lots of whole grains
  • Avoiding large meals
  • Quitting smoking and avoiding being exposed to secondhand smoke
  • Avoiding stress. A person should find ways to relax. They could also consult their doctor about stress-reduction techniques
  • Losing weight. In case a person is overweight, they could consult a doctor about weight-loss options
  • Starting a safe exercise plan


Some of the medications that are used for treating angina include:

Acetylsalicylic acid (Aspirin):
Aspirin makes it easier for blood to flow through narrowed heart arteries, because it reduces the ability of the blood to clot, also reduces the risk of a heart attack.

Statins:
These drugs lower the blood cholesterol by blocking a substance the body needs to make cholesterol. They may also help prevent further blockage in the blood vessels by reabsorbing the cholesterol that has accumulated in plaques in the artery walls.

Nitrates:
Nitrates make the blood vessels relax and widen, allowing more blood to flow to the heart muscle. Nitrates are used often to treat angina, and its most common form is with nitroglycerin tablets put under the tongue. These drugs could be used on a long-term preventive basis, when having angina-related chest discomfort, or before doing something that usually triggers angina, such as physical exertion.

Calcium channel blockers:
Also called calcium antagonists, these drugs increase the blood flow in the heart, reducing or even preventing angina by affecting the muscle cells in the arterial walls that relax and widen the blood vessels.

Beta blockers:
These drugs block the affects of the hormone epinephrine (adrenaline), as a result the heart beats more slowly and with less force, thereby reducing blood pressure. Beta blockers also reduce or prevent angina by relaxing and opening up the blood vessels to improve the blood flow.

Angiotensin-converting enzyme inhibitors (ACE):
ACE inhibitors help relax blood vessels by preventing an enzyme in the body from producing angiotensin II, which is a substance in the body that affects the cardiovascular system in numerous ways, one of which is narrowing the blood vessels that can cause high blood pressure and force the heart to work harder.

Ranolazine:
This medication can be used either alone or with other angina medications, such as calcium channel blockers, nitroglycerin or beta blockers. Ranolazine is a relatively new drug, but unlike other angina medications, it can be used when a person is taking oral erectile dysfunction medications.

Stable angina is usually treated by lifestyle changes and medications, but to reopen the narrowed heart arteries, other invasive techniques are used, such as angioplasty and stenting. Recent research has suggested that before having angioplasty and stenting it’s best to try lifestyle changes and medications.

A certain medical study evaluated treatments for chronic, stable angina and found that over the long term, angioplasty and stenting are no better than lifestyle changes and medication.

In case lifestyle changes and medications don’t treat chronic, stable angina effectively, or if a person has unstable angina, then angioplasty and stenting could be a good treatment option.

Some of the invasive options include:

Coronary artery bypass surgery:
This is a treatment option for unstable angina. It increases blood flow to the heart, reducing or eliminating angina. During a coronary artery bypass surgery, the surgeon uses a vein or artery from somewhere else in the patient's body to bypass a blocked or narrowed heart artery.

Angioplasty and stenting:
Also called a percutaneous coronary intervention (PCI), angioplasty and stenting, or heart bypass surgery is often used to treat unstable angina. During the surgery the surgeon inserts a tiny balloon into the narrowed artery. The balloon is inflated to widen the artery, and a small wire mesh coil (stent) is inserted to keep the artery open, which improves blood flow in the heart, reducing or eliminating angina.

Prognosis:

Not available

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