What is angina pectoris?
Angina pectoris (angina) is the medical term for pain or discomfort experienced in the chest area.
Usually a symptom of an underlying health problem, it occurs due to myocardial ischemia, where the body’s coronary arteries are obstructed or spasm, restricting blood flow and oxygen to the heart.
The term originates from the Latin words angere and pectus, which mean strangle and chest in English. The condition can thus be translated as a strangling sensation in the chest.
Are there different types of angina?
Yes. There are four main types…
Stable angina (effort or chronic angina) occurs when the heart muscle needs to work harder due to physical exertion (such as when you walk or run) or emotional stress. The symptoms are usually predictable, episodes of pain or discomfort tend to be alike, and rest or medication can normally relieve the symptoms. Heavy meals, smoking, and exposure to heat or cold can also trigger symptoms.
Unstable or crescendo angina (a type of acute coronary syndrome) is less common, more serious, and requires emergency medical treatment. It is characterized by unpredictable pain or discomfort that occurs with or without physical exertion. Symptoms may change, intensify, and become more frequent at random, without provocation. This type of angina may signal that a heart attack is near.
Variant angina, or prinzmetal’s angina, is rare. It is caused by spasms in one or more of the coronary arteries (the exact mechanism is not understood), which results in the abnormal narrowing of these vessels. This disrupts normal blood flow to the heart and causes chest pain. The pain can be intense. Prinzmetal’s angina tends to occur at rest and in cycles, without any coronary artery disease.
Microvascular angina (cardiac syndrome X) occurs when there is decreased blood flow to the heart due to spasms within damaged/abnormal/narrowed walls of the tiny blood vessels branching off from the coronary arteries. The coronary arteries are usually normal. Microvascular disease is said to be the cause of this type of angina, which may be more severe and typically lasts longer than 10 minutes.
What are the symptoms of angina?
Pain is a common angina symptom. It may accompany shortness of breath, sweating, nausea, fatigue, and other autonomic nervous system symptoms, but not everyone experiences pain.
Many patients experience what is described as an uncomfortable pressure, squeezing, fullness, heaviness, tightness, burning, or choking feeling. Some say it feels like indigestion. The sensation generally occurs in the center of the chest, but it may also be felt in the back, shoulders, neck, jaw, or epigastrium (upper central abdomen). It can be mild or severe with either type of angina.
It’s worth noting that the severity of a patient’s angina symptoms does not increase their risk of having a heart attack to a significant degree. There can be intense pain with hardly any risk of a myocardial infarction occurring, or a heart attack can occur with little to no pain at all.
What causes angina pectoris?
Coronary artery disease (CAD) is normally the cause – a process wherein the walls of the arteries of the heart harden/thicken and become narrow (atherosclerosis) due to an accumulation of fatty plaque deposits. These deposits constrict blood flow to the heart and deprive it of oxygen.
CAD has many different causes, including high blood cholesterol, dyslipidemia, and kidney disease, obesity, smoking, excessive alcohol consumption, lack of exercise, hypertension, diabetes, stress, and depression. Other risk factors include age (men over 45 and women over 55), gender (males are more likely to have this problem), and a family history of early cardiovascular disease.
Certain medications can sometimes cause angina, such as vasodilators, vasoconstrictors, and thyroid hormones. Additionally, a number of medical conditions can cause angina pectoris, including polycythemia, hyperthyroidism, and hypoxemia, hypovolemia, hypervolemia, hypothermia, hypertrophic cardiomyopathy, tachycardia, bradycardia, anemia, and heart valve disease.
How is angina diagnosed?
Diagnosis starts with a physical exam by a medical professional, who will inquire about the patient’s specific symptoms and history and check blood pressure and pulse rate.
To confirm the presence of and type of angina, the doctor may then order an electrocardiogram (ECG or EKG), a stress test (on a treadmill), and an echocardiogram. The patient may also have to undergo a nuclear stress test (where a radioactive substance is injected), blood tests (to check fat, cholesterol, sugar, and protein levels), a chest X-ray, and/or a computerized tomography (CT) scan.
Sometimes, procedures like a coronary catheterization may be performed, to determine whether the patient should be treated with medication, angioplasty, coronary bypass surgery, or other methods.
How is angina pectoris treated?
Typically, angina treatments aim to decrease the severity and frequency of the patient’s symptoms, as well as prevent progression of the disease and reduce the risk of a heart attack and death. This is normally achieved by lowering blood pressure and cholesterol, slowing the heart rate, relaxing blood vessels, preventing blood clots, and reducing strain on the heart.
If the patient’s symptoms are mild, lifestyle changes (eating healthier, avoiding stress, giving up smoking, etc.) and medication may be enough to treat the angina. Otherwise, surgery (angioplasty and coronary artery bypass grafting) and cardiac rehabilitation may be necessary.
Medications commonly used to treat angina include nitroglycerin (nitrates), ranolazine (ranexa), beta blockers, calcium channel blockers, ACE inhibitors, statins (to lower blood cholesterol), aspirin (reduces blood clotting), and estrogen replacement therapy (in women with microvascular angina).
Rehabilitation involves ongoing exercise training, education, and counselling. Enhanced external counterpulsation (EECP) therapy is another possible treatment option.
What is the prognosis for angina patients?
It depends on the type of angina and what is causing it. It also depends on the patient’s particular risk factors and whether or not he or she is undergoing treatment for the problem.
Lifestyle plays a major role in angina management, and angina pectoris that occurs due to atherosclerotic heart disease can normally be controlled with medication, regular exercise, and lifelong attention to diet. Avoiding triggers of the symptoms is also usually part of the treatment plan.
People with variant and syndrome X angina generally have a good prognosis with little risk of long-term heart damage, but angina patients should take steps to treat the condition (its underlying cause) and prevent progression. Not doing so can result in a heart attack, poor life quality, and death.