Facts of angina – everything you need to know

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If you have constant chest pain may be it is a sign of angina which later on can lead to other complicated diseases. Now is the right time to know more about angina.

What is angina?

anginaAngina is a type of chest pain which occurs due to less blood reaching your heart muscles. It is an important symptom of coronary artery disease (CAD) which is a widespread health problem globally. CAD is characterised by narrowing of the coronary vessels due to thickening of the blood vessel walls.

Causes of angina

Angina is typically caused when the heart is under pressure, for e.g. after exercise or emotional or mental stress. At these times, more blood flows to the heart muscles and the thickened blood vessels groan under the strain leading to angina.

Types of angina

Angina is basically of two types

  1. Stable or classical angina
  2. Unstable or variant angina

Stable angina: This occurs in many persons with CAD or other heart muscles usually after exertion. It is described as a crushing pain or pressure on the chest like someone is standing on your chest or squeezing your chest tight. It is generally relieved when the person rests. It may be associated with pain in the back, arms or jaw.
Unstable angina: This is also called Prinzmetal’s angina and occurs in about 2% of all angina cases. It is due to spasm of the coronary blood vessels and this narrows the blood vessels temporarily. The difference is that the angina in this case occurs at rest.

Symptoms and signs of angina

The chest pain of angina occurs behind the breastbone and is severe in intensity. Other symptoms that may occur are

  • Nausea
  • Indigestion or heartburn
  • Pain radiating to teeth, jaw, arms or back
  • Sweating
  • Difficulty inbreathing

Diagnosis of angina

A person who has had angina will usually recognise the chest pain. If the chest pain is different or more severe than usual, it is best to seek medical attention immediately. The chest pain of angina must be differentiated from pain or discomfort due to indigestion.

Investigations for angina

A person diagnosed with angina should be thoroughly evaluated by a cardiologist. Some of the investigations done are-

ECG: This will show if the electrical impulses of the heart are interrupted which may occur during a heart attack. When compared to an older ECG, it may show changes which signal heart problem.

Stress test: The person is asked to exercise on a treadmill or a stationary bike while his ECG and heart rate are being monitored. If the person has a heart problem or has poor stamina he may not be able to complete the stress test.

X ray chest: This is important to look for an enlarged heart and to check for any lung problems.

Blood tests: Certain enzymes if elevated signal an upcoming heart attack.

Cardiac CT scan: This is helpful to check the heart status and to check for narrowing or blocks in the coronary arteries. It also identifies any problems in the lungs or chest wall.

Coronary angiography: This is an imaging test in which a certain dye is injected through the arm into the coronary blood vessels. The images are taken and the dye delineates the coronary blood vessels and this test is invaluable to pick up problems in the same which are causing the angina.

Treatment of angina

The goal of treatment in angina is to prevent a serious complication like a heart attack. Angina can be reduced by lifestyle changes, drug therapy or surgical intervention.

Lifestyle changes

  1. Quit smoking: Do not smoke or be exposed to second hand smoke for long periods of time as this narrows the coronary arteries.
  2. Eat right: Follow a healthy diet plan with less saturated fats and plenty of fruits, vegetables and whole grains. Take a nutritionist’s advice to know how many calories you can consume daily.
  3. Limit alcohol: Drink only in moderation as too much alcohol can adversely impact your heart health.
  4. Check your weight: If you are overweight or obese, chart an exercise plan to get rid off the excess weight. Join a gym or enlist a personal trainer to help you in your efforts.
  5. If you suffer from indigestion, avoid large meals and fried, fatty or spicy foods. Indigestion can mimic angina so avoid late meals too close to bedtime.
  6. If you have hypertension, diabetes or other health problems, go to your doctor regularly and keep them in check.
  7. Deal with stress positively: Spend some time in meditation or silence to find inner peace and reduce stress. Alternatively try music, pilates or tai chi in the search to destress.

Drug therapy

When an angina attack happens, sublingual nitroglycerin is recommended. This drug widens the blood vessels thus reducing the pain. It should be kept under the tongue when an attack occurs. Consult your doctor before using it as a headache is aside-effect. Nitrates are the first line drugs used in treating angina.

Aspirin in a low dose can be taken daily or as recommended by the physician.It acts by thinning the blood and preventing blood clots making it easier for the blood to move in the coronary blood vessels.

Statins: These drugs lower cholesterol in the blood and prevent plaques from forming in the blood vessels.

Other drugs that are commonly used are beta blockers, ACE inhibitors and calcium channel blockers.

Surgical procedures

  1. Angioplasty- This is done when you have chronic stable angina not relieved by medication and lifestyle changes or in cases of unstable angina. In angioplasty a balloon is used to widen the artery and then a stent is inserted tokeep the artery open.
  2. Coronary artery bypass surgery is done when there is a major block in one or more coronary blood vessels. A blood vessel is used from your thigh and the blocked part of the coronary vessel is removed. This is a major surgery and done when other treatment options are unsuccessful.

Prevention of angina

Angina can be prevented by following the lifestyle changes enumerated above.

Photographs by sxc.hu

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