Angina

Angina

Definition:

Angina is a type of chest pain caused by reduced blood flow to the heart muscle. Angina (an-JI-nuh or AN-juh-nuh) is a symptom of coronary artery disease. Angina is typically described as squeezing, pressure, heaviness, tightness or pain in your chest. Many people with angina say it feels like someone is standing on their chest.

Angina, also called angina pectoris, can be a recurring problem or a sudden, acute health concern.
Angina is relatively common, but can be hard to distinguish from other types of chest pain, such as the pain or discomfort of indigestion. If you have unexplained chest pain, seek medical attention right away.

Symptoms:

Angina symptoms include:

• Chest pain or discomfort
• Pain in your arms, neck, jaw, shoulder or back accompanying chest pain
• Nausea
• Fatigue
• Shortness of breath
• Anxiety
• Sweating
• Dizziness

The chest pain and discomfort common with angina may be described as pressure, squeezing, fullness or pain in the center of your chest. Some people with angina symptoms describe angina as feeling like a vise is squeezing their chest, or feeling like a heavy weight has been placed on their chest.
The severity, duration and type of angina can vary. It's important to recognize if you have new or changing chest pain. New or different symptoms may signal a more dangerous form of angina (unstable angina) or a heart attack.

Stable angina is the most common form of angina and typically occurs with exertion and goes away with rest. If chest pain is a new symptom for you, it's important to see your doctor to find out what's causing your chest pain and to get proper treatment. If your stable angina gets worse or changes, seek medical attention immediately.
Characteristics of stable angina

• Develops when your heart works harder, such as when you exercise or climb stairs
• Can usually be predicted and the pain is usually similar to previous types of chest pain you've had
• Lasts a short time, perhaps five minutes or less
• Disappears sooner if you rest or use your angina medication
• Could feel like indigestion
• Might spread to your arms, back or other areas
• Can be triggered by mental or emotional stress

Characteristics of unstable angina (a medical emergency)

• Occurs even at rest
• Is a change in your usual pattern of angina
• Is unexpected
• Is usually more severe and lasts longer than stable angina, maybe as long as 30 minutes
• May not disappear with rest or use of angina medication
• Might signal a heart attack

Characteristics of variant angina (Prinzmetal's angina)

• Usually happens when you're resting
• Is often severe
• May be relieved by angina medication

Prinzmetal's angina is rare — only about 2 percent of angina cases are Prinzmetal's angina. This type of angina is caused by a spasm in your heart's arteries that temporarily reduces blood flow.

Angina in women
A woman's angina symptoms can be different from the classic angina symptoms. For example, a woman may have chest pain that feels like a stabbing, pulsating or sharp form of chest pain rather than the more typical vise-like pressure. Women are also more likely to experience symptoms, such as nausea, shortness of breath or abdominal pain. These differences may lead to delays in seeking treatment.

When to see a doctor
If your chest pain lasts longer than a few minutes and doesn't go away when you rest or take your angina medications, it may be a sign you're having a heart attack. Call 911 or emergency medical help. Arrange for transportation. Only drive yourself to the hospital as a last resort.

Causes:

Angina is caused by reduced blood flow to your heart muscle. Your blood carries oxygen, which your heart muscle needs to survive. When your heart muscle isn't getting enough oxygen, it causes a condition called ischemia.
The most common cause of reduced blood flow to your heart muscle is coronary artery disease (CAD). Your heart (coronary) arteries can become narrowed by fatty deposits called plaques. This is called atherosclerosis.

This reduced blood flow is a supply problem — your heart is not getting enough oxygen-rich blood. You may wonder why you don't always have angina if your heart arteries are narrowed due to fatty buildup. This is because during times of low oxygen demand — when you're resting, for example — your heart muscle may be able to get by on the reduced amount of blood flow ithout triggering angina symptoms. But when you increase the demand for oxygen, such as when you exercise, this can cause angina.

• Stable angina. Stable angina is usually triggered by physical exertion. When you climb stairs, exercise or walk, your heart demands more blood, but it's harder for the muscle to get enough blood when your arteries are narrowed. Besides physical activity, factors such as emotional stress, cold temperatures, heavy meals and smoking also can narrow arteries and trigger angina.

• Unstable angina. If fatty deposits (plaques) in a blood vessel rupture or a blood clot forms, it can quickly block or reduce flow through a narrowed artery, suddenly and severely decreasing blood flow to your heart muscle. Unstable angina can also be caused by conditions such as severe anemia, especially if you already have narrowed coronary arteries.
  Unstable angina worsens and is not relieved by rest or your usual medications. If the blood flow doesn't improve, heart muscle deprived of oxygen dies — a heart attack. Unstable angina is dangerous and requires emergency treatment.
   
  
• Variant angina. Variant angina, also called Prinzmetal's angina, is caused by a spasm in a coronary artery in which the artery temporarily  narrows. This narrowing reduces blood flow to your heart, causing chest pain. Variant angina accounts for about 2 percent of angina cases.

Complications:

The chest pain that can occur with angina can make doing some normal activities, such as walking, uncomfortable. However, the most dangerous complication to be concerned about with angina is a heart attack.
Common symptoms of a heart attack include:

• Pressure, fullness or a squeezing pain in the center of your chest that lasts for more than a few minutes
• Pain extending beyond your chest to your shoulder, arm, back, or even to your teeth and jaw
• Increasing episodes of chest pain
• Prolonged pain in the upper abdomen
• Shortness of breath
• Sweating
• Impending sense of doom
• Fainting
• Nausea and vomiting

If you have any of these symptoms, seek emergency medical attention immediately.

Treatments and drugs:


There are many options for angina treatment, including lifestyle changes, medications, angioplasty and stenting, or coronary bypass surgery. The goals of treatment are to reduce the frequency and severity of your symptoms and to lower your risk of heart attack and death.
However, if you have unstable angina or angina pain that's different from what you usually have, such as occurring when you're at rest, you need immediate treatment in a hospital.
Lifestyle changes
If your angina is mild, lifestyle changes may be all you need to do. Even if your angina is severe, making lifestyle changes can still help. Changes include:

• If you smoke, stop smoking. Avoid exposure to secondhand smoke.
• If you're overweight, talk to your doctor about weight-loss options.
• If you have diabetes make sure that it is well controlled and that you are following an optimal diet and exercise plan.
• Because angina is often brought on by exertion, it's helpful to pace yourself and take rest breaks.
• Avoid large meals.
• Avoiding stress is easier said than done, but try to find ways to relax. Talk with your doctor about stress-reduction techniques.
• Eat a healthy diet with limited amounts of saturated fat, lots of whole grains, and many fruits and vegetables.
• Talk to your doctor about starting a safe exercise plan.

Medications
If lifestyle changes alone don't help your angina, you may need to take medications. These may include:

• Aspirin. Aspirin reduces the ability of your blood to clot, making it easier for blood to flow through narrowed heart arteries. Preventing blood clots can also reduce your risk of a heart attack. But don't start taking a daily aspirin without talking to your doctor first.

• Nitrates. Nitrates are often used to treat angina. Nitrates relax and widen your blood vessels, which allows more blood to flow to your heart muscle. You might take a nitrate when you have angina-related chest discomfort, before doing something that normally triggers angina (such as physical exertion), or on a long-term preventive basis. The most common form of nitrate used to treat angina is with nitroglycerin tablets put under your tongue.

• Beta blockers. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. As a result, the heart beats more slowly and with less force, thereby reducing blood pressure. Beta blockers also help blood vessels relax and open up to improve blood flow, thus reducing or preventing angina.

• Statins. Statins are drugs used to lower blood cholesterol. They work by blocking a substance your body needs to make cholesterol. They may also help your body reabsorb cholesterol that has accumulated in plaques in your artery walls, helping prevent further blockage in your blood vessels. Statins also have many other beneficial effects on your heart arteries.

• Calcium channel blockers. Calcium channel blockers, also called calcium antagonists, relax and widen blood vessels by affecting the muscle cells in the arterial walls. This increases blood flow in your heart, reducing or preventing angina.

• Angiotensin-converting enzyme (ACE) inhibitors. These drugs help relax blood vessels. ACE inhibitors prevent an enzyme in your body from producing angiotensin II, a substance in your body that affects your cardiovascular system in numerous ways, including narrowing your blood vessels. This narrowing can cause high blood pressure and force your heart to work harder.

• Ranolazine (Ranexa). Ranexa can be used alone or with other angina medications, such as calcium channel blockers, beta blockers or nitroglycerin. Unlike some other angina medications, Ranexa can be used if you're taking oral erectile dysfunction medications.

Medical procedures and surgery
Lifestyle changes and medications are frequently used to treat stable angina. But medical procedures such as angioplasty, stenting and coronary artery bypass surgery are also used to treat angina.

• Angioplasty and stenting. During an angioplasty — also called a percutaneous coronary intervention (PCI) — a tiny balloon is inserted into your narrowed artery. The balloon is inflated to widen the artery, and then a small wire mesh coil (stent) is usually inserted to keep the artery open. This procedure improves blood flow in your heart, reducing or eliminating angina. Angioplasty and stenting is a good treatment option if you have unstable angina or if lifestyle changes and medications don't effectively treat your chronic, stable angina.

• Coronary artery bypass surgery. During coronary artery bypass surgery, a vein or artery from somewhere else in your body is used to bypass a blocked or narrowed heart artery. Bypass surgery increases blood flow to your heart and reduces or eliminates angina. It's a treatment option for both unstable angina as well as stable angina that has not responded to other treatments.