Disease: Angina

Overview

Angina is a type of chest pain caused by reduced blood flow to the heart. Angina (an-JIE-nuh or AN-juh-nuh) is a symptom of coronary artery disease.

Angina, which may also be called angina pectoris, is often described as squeezing, pressure, heaviness, tightness or pain in 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. Angina may be a new pain that needs evaluation by a doctor, or recurring pain that goes away with treatment.

Although angina is relatively common, it can still 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.

Source: http://www.mayoclinic.com

Symptoms

Angina symptoms include:

  • Chest pain or discomfort, possibly described as pressure, squeezing, burning or fullness
  • Pain in your arms, neck, jaw, shoulder or back accompanying chest pain
  • Nausea
  • Fatigue
  • Shortness of breath
  • Sweating
  • Dizziness

These symptoms need to be evaluated immediately by a doctor who can determine whether you have stable angina, or unstable angina that may indicate a possible heart attack.

Stable angina is the most common form of angina. It usually happens when you exert yourself and goes away with rest. For example, pain that comes on when you're walking uphill or in the cold weather is often angina.

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

The severity, duration and type of angina can vary. New or different symptoms may signal a more dangerous form of angina (unstable angina) or a heart attack.

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 30 minutes or longer
  • May not disappear with rest or use of angina medication
  • Might signal a heart attack

There's another type of angina, called variant angina or Prinzmetal's angina. This type of angina is rarer. It's caused by a spasm in your heart's arteries that temporarily reduces blood flow.

Characteristics of variant angina (Prinzmetal's angina)

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

Angina in women

A woman's angina symptoms can be different from the classic angina symptoms. These differences may lead to delays in seeking treatment. For example, chest pain is a common symptom in women with angina, but it may not be the only symptom or the most prevalent symptom for women. Women may also experience symptoms such as:

  • Nausea
  • Shortness of breath
  • Abdominal pain
  • Discomfort in the neck, jaw or back
  • Stabbing pain instead of chest pressure

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.

If chest discomfort 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 stable angina gets worse or changes, seek medical attention immediately.

Source: http://www.mayoclinic.com

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 without 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, other 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 blood clots that block or partially block your heart's blood vessels.

    Unstable angina worsens and isn't relieved by rest or your usual medications. If the blood flow doesn't improve, your heart is deprived of oxygen and a heart attack occurs. Unstable angina is dangerous and requires emergency treatment.

  • Prinzmetal's angina. This type of 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. Emotional stress, smoking and use of the illegal drug cocaine may trigger this type of angina.

Source: http://www.mayoclinic.com

Diagnosis

To diagnose angina, your doctor will start by doing a physical exam and asking about your symptoms. You'll also be asked about any risk factors, including whether you have a family history of heart disease.

There are several tests your doctor may order to help confirm whether you have angina:

  • Electrocardiogram (ECG or EKG). Each beat of your heart is triggered by an electrical impulse generated from special cells in your heart. An electrocardiogram records these electrical signals as they travel through your heart. Your doctor can look for patterns among these heartbeats to see if the blood flow through your heart has been slowed or interrupted or if you're having a heart attack.
  • Stress test. Sometimes angina is easier to diagnose when your heart is working harder. During a stress test, you exercise by walking on a treadmill or pedaling a stationary bicycle.

    While exercising, your blood pressure is monitored and your ECG readings are watched. Other tests also may be conducted while you're undergoing stress testing. If you're unable to exercise, you may be given drugs that cause your heart to work harder to simulate exercising.

  • Echocardiogram. An echocardiogram uses sound waves to produce images of the heart. Your doctor can use these images to identify angina-related problems, including whether there are areas of your heart muscle that have been damaged by poor blood flow. An echocardiogram is sometimes given during a stress test, and this can show if there are areas of your heart that are not getting enough blood.
  • Nuclear stress test. A nuclear stress test helps measure blood flow to your heart muscle at rest and during stress. It is similar to a routine stress test, but during a nuclear stress test, a radioactive substance is injected into your bloodstream.

    This substance mixes with your blood and travels to your heart. A special scanner — which detects the radioactive material in your heart — creates images of your heart muscle. Inadequate blood flow to any part of your heart will show up on the images because not as much of the radioactive substance is getting there.

  • Chest X-ray. This test takes images of your heart and lungs. This is to look for other conditions that might explain your symptoms and to see if you have an enlarged heart.
  • Blood tests. Certain heart enzymes slowly leak out into your blood if your heart has been damaged by a heart attack. Samples of your blood can be tested for the presence of these enzymes.
  • Coronary angiography. Coronary angiography uses X-ray imaging to examine the inside of your heart's blood vessels. It's part of a general group of procedures known as cardiac catheterization.

    During coronary angiography, a type of dye that's visible by X-ray machine is injected into the blood vessels of your heart. The X-ray machine rapidly takes a series of images (angiograms), offering a detailed look at the inside of your blood vessels.

  • Cardiac computerized tomography (CT) scan. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest, which can show if any of your heart's arteries are narrowed or if your heart is enlarged.
  • Cardiac MRI. In a cardiac MRI, you lie on a table inside a long tube-like machine that produces detailed images of your heart's structure and its blood vessels.

Source: http://www.mayoclinic.com

Complications

The chest pain that occurs with angina can make doing some normal activities, such as walking, uncomfortable. However, the most dangerous complication is a heart attack.

Common signs and 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.

Source: http://www.mayoclinic.com

Prevention

You can help prevent angina by making the same lifestyle changes that might improve your symptoms if you already have angina. These include:

  • Quitting smoking
  • Monitoring and controlling other health conditions, such as high blood pressure, high cholesterol and diabetes
  • Eating a healthy diet and maintaining a healthy weight
  • Increasing your physical activity after you get your doctor's OK. Aim for 150 minutes of moderate activity each week. Plus, it's recommended that you get 10 minutes of strength training twice a week and to stretch three times a week for 5 to 10 minutes each time.
  • Reducing your stress level
  • Limit alcohol consumption to two drinks or fewer a day for men, and one drink a day or less for women.
  • Get an annual flu shot to avoid heart complications from the virus

Source: http://www.mayoclinic.com

Lifestyle and home remedies

Because heart disease is often the cause of angina, you can reduce or prevent angina by working on reducing your heart disease risk factors. Making lifestyle changes is the most important step you can take.

  • If you smoke, stop smoking. Avoid exposure to secondhand smoke.
  • If you're overweight, talk to your doctor about weight-loss options.
  • 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.
  • Because angina is often brought on by exertion, it's helpful to pace yourself and take rest breaks.
  • Treat diseases or conditions that can increase your risk of angina, such as diabetes, high blood pressure and high blood cholesterol.
  • Avoid large meals that make you feel overly full.
  • Avoiding stress is easier said than done, but try to find ways to relax. Talk with your doctor about stress-reduction techniques.
  • Limit alcohol consumption to two drinks or fewer a day for men, and one drink a day or less for women.

Source: http://www.mayoclinic.com

Risk factors

The following risk factors increase your risk of coronary artery disease and angina:

  • Tobacco use. Chewing tobacco, smoking and long-term exposure to secondhand smoke damage the interior walls of arteries — including arteries to your heart — allowing deposits of cholesterol to collect and block blood flow.
  • Diabetes. Diabetes is the inability of your body to produce enough or respond to insulin properly. Insulin, a hormone secreted by your pancreas, allows your body to use glucose, which is a form of sugar from foods. Diabetes increases the risk of coronary artery disease, which leads to angina and heart attacks by speeding up atherosclerosis and increasing your cholesterol levels.
  • High blood pressure. Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. Over time, high blood pressure damages arteries by accelerating hardening of the arteries.
  • High blood cholesterol or triglyceride levels. Cholesterol is a major part of the deposits that can narrow arteries throughout your body, including those that supply your heart. A high level of the wrong kind of cholesterol, known as low-density lipoprotein (LDL) cholesterol (the "bad" cholesterol), increases your risk of angina and heart attacks. A high level of triglycerides, a type of blood fat related to your diet, also is undesirable.
  • Family history of heart disease. If a family member has coronary artery disease or has had a heart attack, you're at a greater risk of developing angina.
  • Older age. Men older than 45 and women older than 55 have a greater risk than do younger adults.
  • Lack of exercise. An inactive lifestyle contributes to high cholesterol, high blood pressure, type 2 diabetes and obesity. However, it is important to talk with your doctor before starting an exercise program.
  • Obesity. Obesity raises the risk of angina and heart disease because it's associated with high blood cholesterol levels, high blood pressure and diabetes. Also, your heart has to work harder to supply blood to the excess tissue.
  • Stress. Stress can increase your risk of angina and heart attacks. Too much stress, as well as anger, also can raise your blood pressure. Surges of hormones produced during stress can narrow your arteries and worsen angina.

Source: http://www.mayoclinic.com

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