Angina

Angina (pronounced an-JIE-nuh or AN-juh-nuh) is chest pain or discomfort caused by reduced blood flow to the heart muscle. Angina is typically a sign of an underlying heart problem, usually coronary artery disease. Angina can be a recurring problem or a sudden, acute health problem.

Stable Angina is the most common type of angina and can be triggered by physical activity or stress. With exertion the heart muscle requires more oxygen and blood. When an artery feeding blood to the heart is critically narrowed, insufficient blood reaches the heart muscle.

Stable angina typically subsides with rest.

Unstable Angina occurs when fat-containing deposits (plaques) in the wall of a coronary blood vessel rupture and form a blood clot, which suddenly reduces the blood flow through the artery to the heart muscle. Unstable angina is dangerous and may be one warning sign of an impending heart attack.

Variant Angina (Prinzmetal’s Angina) is caused by spasm of a coronary artery, causing the artery to temporarily narrow, reducing blood flow to the heart and causing chest pain. Variant angina can happen even at rest.

Coronary artery disease: a fatty substance called plaque builds up in the arteries, blocking blood flow to the heart muscle. This forces the heart to work with less oxygen, causing pain.

Pulmonary embolism: a blockage in a major artery of the lungs

Hypertrophic cardiomyopathy: an enlarged or thickened heart

Aortic stenosis: narrowing of the main valve connecting the heart to the rest of the body<

Pericarditis: inflammation of the sac around the heart

Aortic dissection: tearing in the wall of the aorta, the largest artery in the body

Symptoms may vary depending on the type of angina, but symptoms associated with angina may include:

• Chest pain/discomfort
• Pain in arms, neck, jaw, shoulder or back (accompanying chest paint)
• Nausea and vomiting
• Fatigue
• Shortness of breath
• Sweating
• Dizziness
• Feelings of weight being placed on the chest

• High blood pressure
• High cholesterol levels
• Diabetes
• Older age
• Family history of heart disease
• Tobacco use
• Obesity
• Unhealthy diet

All chest pain should be checked out by a doctor to determine if the symptoms are caused by angina. If it is Unstable Angina, emergency medical treatment may be needed to prevent a heart attack.

The doctor will most likely perform a physical exam and ask about your symptoms and risk factors, including your family history of heart disease.

The doctor may order several tests to help confirm whether you have angina:

• Electrocardiogram (ECG or EKG)
• Exercise/Nuclear stress test
• Echocardiogram/Chest X-ray
• Blood tests
• Coronary angiography
• Cardiac computerized tomography (CT) scan

Treatment options will depend on what, if any, damage there is to your heart.

Your physician may determine that medication and lifestyle changes are enough to help blood flow and control the symptoms.

Lifestyle changes like quitting smoking, keeping up with a healthy diet, and exercising, may help reduce angina.

A heart-healthy diet can help regulate blood pressure and cholesterol levels, decreasing the risk of heart disease. Many dieticians and physicians recommend a diet of fruits and vegetables, whole grains, lean meats and fish, with limited intakes of salt, fat, and sugar.

Medication may be prescribed to widen blood vessels increasing blood flow to the heart to slow the heart down so it does not have to work as hard, and to prevent blood clots. Prescribed medications may include nitroglycerin, as well as beta blockers, calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors, oral antiplatelet medicines or anticoagulants.

If lifestyle changes and medicines do not control angina, your physician may recommend a medical procedure to visualize and/or open your coronary arteries:

Angioplasty/stenting: The doctor threads a small balloon to the location of the blockage in the heart artery and then the balloon is inflated inside the narrowed artery to widen it and restore blood flow. A small tube called a stent may be left inside the artery to help keep it open. The stent made of a metal alloy is permanent. Some stents contain medication that helps the artery from getting blocked again. This procedure usually takes less than two hours and may require an overnight hospital stay.

Coronary artery bypass grafting (CABG) or bypass surgery: The surgeon takes healthy arteries or veins from another part of your body and uses them to go around the blocked or narrowed blood vessels. Generally, a week-long hospital stay may be required after the surgery. You may be placed in the intensive care unit (ICU) for one to two days after surgery.

Cardiac Rehabilitation may also be recommended for angina or after one of the above medical procedures. Cardiac rehab is a medically supervised program that can help improve your heart health. The cardiac rehab team may include doctors, nurses, exercise specialists, physical and occupational therapists, dietitians or nutritionists or other mental health specialists. Cardiac rehab focuses on two parts: exercise training and education/counseling/training.