All about angina

Zoomer | July 19th, 2007

Angina (sometimes called angina pectoris) is a squeezing, suffocating, or burning feeling in the chest. It occurs when your heart is not getting as much blood and oxygen as it needs, usually because one or more of the coronary arteries is blocked. It is not a heart attack, but rather a warning signal. People with angina may be at increased risk of a heart attack, cardiac arrest, or sudden cardiac death.

If you have chest pain, see a doctor right away – don’t assume that it is angina. But if you have been diagnosed with angina, here’s what to know.

Symptoms
Specific symptoms of angina include:

• Pain that starts in the centre of your chest and spreads to your left arm, neck, back, throat or jaw
• Tightness, pressure, squeezing and/or aching feeling in your chest or arm(s)
• Persistent moderate to severe indigestion
• Sharp, burning or cramping pain
• Discomfort in your neck or upper back, particularly between the shoulder blades
• Numbness or a loss of feeling in your arms, shoulders or wrists.

If you experience one or more of these symptoms for the first time, see your doctor right away. If your particular pattern of angina changes, you should also go in right away.

A warning signal
Pain is often our body’s signal that something is wrong. In the case of angina, it is the heart sending the signal that your body is working too hard for your heart to handle and that you need to slow down; stop what you are doing, and rest. It commonly occurs during physical activity, exercise, stress, during extreme cold or heat, after heavy meals, and while drinking alcohol or smoking – essentially whenever the heart is working a littler harder.

Angina is most often caused by coronary artery disease (CAD) which itself is due to atherosclerosis, or a building up of fatty deposits inside the arteries that block the flow of blood.

In some cases angina can be caused by uncontrolled high blood pressure, or other heart conditions such as an enlarged heart, or narrowing of one of the valves in the heart.

It can also be caused by coronary artery spasm, which occurs when one of the blood vessels supplying the heart muscle contracts, causing blood flowing to the part of the heart supplied by the artery to decrease or even stop. This last can result in a heart attack.

Types of angina
There are several types of angina:

• Stable angina usually follows a predictable pattern and occurs when you are exercising or under emotional stress. The pain is usually relieved with rest or medication. Patients with stable angina should try to track how long it lasts and what helps ease the pain, in order to detect unstable angina if it should occur.

• Unstable angina causes chest pain that is unexpected and usually happens when you are at rest. If you have chest pain that is new, worsening or constant, you have a greater risk of having a heart attack, an irregular heartbeat (arrhythmia), or sudden death. You should see your doctor or proceed to an ER right away.

• Variant angina nearly always happens while you are at rest. It doesn’t follow physical exertion or emotional stress. Attacks may be very painful and usually happen between midnight and 8 a.m.

• Atypical angina is a vague chest discomfort, shortness of breath, fatigue, nausea, back or neck pain or burning indigestion, instead of the more usual pain. Women are more likely to experience this type of angina.

Diagnosis
Angina is diagnosed through both a medical history and a series of tests to examine the cardiovascular system. This can include angiography (examination of the arteries using dye and x-rays), an electrocardiogram (ECG/ EKG; measurement of the electrical activity in the heart), an echocardiogram (ultrasound of the heart), stress test (monitoring of the heart during exercise), and other tests.

Treatment
Lifestyle changes are key. Physical activity (with your doctor’s approval) is important, as is control of risk factors: high blood pressure, diabetes, and high cholesterol. A healthy diet, no smoking, and limiting alcohol use and reducing stress also will help to play a role.

Medication is also used to treat angina. Many of us are familiar with nitroglycerin as a treatment during an attack, but other medications may be prescribed: anti-platelets, beta blockers, and calcium channel blockers.

Angina can also be treated surgically by widening or bypassing the narrowed artery to increase the blood flow to your heart.

Angina is not a death sentence, but it is a warning that it is time to take your heart’s health very seriously.