Angina Pectoris

Angina pectoris is chest pain or
discomfort that occurs when a part of your heart doesn’t get enough blood and oxygen. It
is most often just called angina. Angina can be a symptom of coronary artery disease
(CAD). But it can have other causes.


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Angina pectoris occurs when your
heart muscle (myocardium) does not get enough blood and oxygen. Not enough blood supply
is called ischemia.

Angina can be a symptom of coronary artery disease (CAD). This is
when arteries that carry blood to your heart become narrowed and blocked. This can
happen because of:

  • Hardening of arteries (atherosclerosis)
  • A blood clot
  • Plaque in an artery that can rupture (unstable plaque)
  • Poor blood flow through a narrowed heart valve
  • Lessened pumping of the heart muscle
  • Coronary artery spasm

There are 2 other forms of angina pectoris. They are:

  • Microvascular angina. This
    used to be called Syndrome X. It causes chest pain with no coronary artery blockage.
    The pain is caused by from poor function of tiny blood vessels that lead to the
    heart, arms, and legs. It is more common in women.
  • Variant angina pectoris. This
    is also called Prinzmetal’s angina. It is rare. It occurs almost only at rest, not
    after exercise or stress. It usually occurs between midnight and 8 a.m. It can be
    very painful. It is related to spasm of the artery. It is also more common in
    women.

Anything that causes your heart
muscle to need more blood or oxygen can result in angina especially if you already have
a blockage or narrowing. Situations that may trigger angina include:

  • Physical activity
  • Emotional stress
  • Extreme cold or heat
  • Heavy meals
  • Drinking too much alcohol
  • Cigarette smoking

These are the most common symptoms
of angina:

  • A pressing, squeezing, or crushing
    pain, usually in the chest under your breastbone
  • Pain that may also occur in your upper
    back, both arms, neck, or ear lobes 
  • Chest pain that spreads to your arms,
    shoulders, jaw, neck, or back
  • Shortness of breath
  • Weakness
  • Tiredness (fatigue)
  • Feeling faint

Angina chest pain is usually
relieved within a few minutes by resting or by taking prescribed cardiac medicine, such
as nitroglycerin.

Your healthcare provider will ask
about your medical history. He or she will give you a physical exam. A healthcare
provider can often diagnose angina from symptoms and how and when they occur. You may
also have tests such as:

  • Electrocardiogram (ECG). This test records the electrical activity of
    the heart. It shows abnormal rhythms (arrhythmias). And it detects heart muscle
    damage.
  • Stress
    test.
     This is done while you exercise on a treadmill or pedal a
    stationary bike. The test checks your heart’s ability to function when under stress
    such as exercise. Breathing and blood pressure rates are also watched. A stress test
    may be used to find coronary artery disease. Or it may be done to find safe levels of
    exercise after a heart attack or heart surgery. A type of stress test uses medicine
    to stimulate the heart as if you were exercising. An exercise treadmill test only
    uses an ECG to evaluate for ischemia. A stress echocardiogram uses an ECG and
    ultrasound pictures of the heart. A nuclear perfusion stress test uses an ECG and
    radioactive tracer detected by a nuclear camera.
  • Cardiac
    catheterization.
    A wire is passed into the coronary arteries. Then a
    contrast dye is injected into your artery. X-ray images are taken to see the
    narrowing, blockages, and other problems of certain arteries.
  • Cardiac
    MRI.
    This test can look at the amount of blood flow to the heart
    muscle. It may not be available at all medical centers.
  • Coronary CT
    scan.
    This test looks at the amount of calcium and plaque inside of
    the blood vessels of the heart. It can also show blood flow through the coronary
    arteries.

Treatment will depend on your symptoms, age, and general health. It
will also depend on how severe the condition is.

Your healthcare provider may
prescribe medicines if you have angina. The most common is nitroglycerin. This helps to
relieve pain by widening your blood vessels. This lets more blood flow to your heart
muscle. It decreases the workload of your heart. You may take a long-acting form of
nitroglycerin daily to prevent angina. Or, you may take it as a nose spray or under the
tongue when angina occurs.

Don’t take erectile dysfunction (ED) medicines if you take
nitroglycerin. These include sildenafil, vardenafil, and tadalafil. This can cause a
dangerous drop in blood pressure. Tell your healthcare provider if you are taking ED
medicines. 

Other medicines can be used to treat angina. These include
beta-blockers and calcium channel blockers. Beta-blockers block a hormone that increases
the heart rate and blood pressure. This helps relax the blood vessels to improve blood
flow. Calcium channel blockers help open the coronary arteries.

Angina means that some part of your
heart is not getting enough blood. If you have angina, you have an increased risk for a
heart attack.

Keeping up a healthy lifestyle can
help to delay or prevent angina pectoris. A healthy lifestyle includes:

  • A healthy diet
  • Physical activity
  • Stress management
  • Not smoking
  • Keeping a healthy weight
  • Taking medicines as prescribed
  • Treating high blood pressure, high
    cholesterol, diabetes, and excess weight

If you have angina, note the
patterns of your symptoms. Pay attention to what causes your chest pain. Note what it
feels like, how long the pain lasts, and if medicine relieves your pain. Call 911 if your angina symptoms change
suddenly. This is called unstable angina.

It’s important to work with your
healthcare provider to treat coronary artery disease, which causes angina. You need to
control your risk factors. These include high blood pressure, cigarette smoking, high
blood cholesterol levels, lack of exercise, excess weight, and a diet high in saturated
fat. Take your medicines exactly as directed. This is an important part of living with
angina. If you take nitroglycerin, make sure to have it with you at all times. Take it
as instructed whenever you have angina.

Call 911 if
you have any of the following:

  • Angina symptoms that change
    suddenly
  • Symptoms that happen when you are
    resting
  • Symptoms that continue after using
    nitroglycerin
  • Symptoms that last longer than
    usual
  • Symptoms that start to occur
    unpredictably

You may be having a heart attack. Call 911. Do not drive yourself.

Call your healthcare provider right away if:

  • Your angina symptoms get worse
  • You have new symptoms
  • You have side effects from your
    medicines
  • Angina is chest pain or discomfort
    that occurs when some part of your heart does not get enough blood and oxygen.
  • Angina is a symptom of coronary artery
    disease. This occurs when arteries that carry blood to your heart become narrowed and
    blocked.
  • Angina can feel like a pressing,
    squeezing, or crushing pain in the chest under your breastbone. You may have pain in
    your upper back, both arms, neck, or ear lobes. You may also have shortness of
    breath, weakness, or fatigue. 
  • Nitroglycerin is the most common
    medicine to treat angina
  • Managing angina includes treating high
    blood pressure and high blood cholesterol levels. It also includes healthy eating,
    weight loss, exercise, and not smoking.

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.