Angina refers to chest pain that occurs due to inadequate blood supply to the heart muscle. Patients describe it as squeezing, pressure, tightness, or burning sensation in the chest area. The pain often originates in the area behind the breastbone. It can radiate to the back, shoulders, jaw, throat, and neck.
Angina is not a disorder or disease in itself. It is a common symptom of an underlying heart problem. It often occurs when blood circulation to the heart is interrupted. Common causes are blocked and narrowed arteries.
Depending on the type of angina a patient has, they may feel chest pain during physical activity or while resting. The pain can last between 5 and up to 20 minutes. The pain usually radiates to the upper part of the body. It can be felt on the shoulders, jaw, and arms. Other symptoms may include fatigue and shortness of breath. The pain can sometimes become so intense that it can disrupt sleep or cause the patient to feel very weak.
Below are the four types of angina and what causes them to occur:
Stable angina - This type often occurs in times of emotional stress. It can also occur when a person is exposed to extreme cold or hot temperatures. Other causes are smoking and heavy meals. These cause chest pain because they force the heart muscle to work harder in order to pump enough blood to the rest of the body. Pain caused by stable angina is often manageable. It can be relieved with medications and by resting.
Unstable angina - This type often occurs unexpectedly. It can be felt while the patient is resting. It occurs when the arteries that supply blood to the heart are blocked. This is treated as a medical emergency because it can lead to a heart attack.
Pain caused by unstable angina often does not respond to conservative treatment. Patients may need to undergo certain procedures to make the blood vessels wider. This is done to improve blood flow to the heart.
Variant angina - This type also occurs suddenly. It causes extreme chest pain. Its main cause is coronary artery spasm (CAS). When compared to other types of angina, this one is very rare. It is a chronic condition that requires long-term management. The prognosis is often good.
Microvascular angina - This type occurs due to spasm of the heart’s smallest blood vessels. This limits the amount of blood that flows through the heart.
Certain conditions can increase the risk of heart disease, which leads to angina. These include high cholesterol levels, diabetes, and obesity. The list also includes metabolic syndrome, a family history of heart disease, and advancing age. People who are 45 years and older have a higher-than-average risk of developing heart problems.
Patients with symptoms mentioned above may consult a general doctor first. If initial tests suggest angina, they will be referred to a heart specialist. Common tests used to determine the cause of chest pains are the following:
Blood tests - Blood tests can detect if the patient has had a heart attack or is at risk of heart disease. It can also detect blood-clotting problems. Blood clots can block arteries.
ECG - This test is used to detect heart problems. These include abnormal heartbeats, heart attacks, and heart failure. ECG can be combined with a stress test. This involves placing electrodes on the patient’s chest as well as blood pressure cuff around the arm. The patient is then asked to walk on a treadmill while a technician monitors his or her heart activity.
Chest x-ray - This test is used to obtain pictures of the organs in the chest area. It can show abnormal changes in the size and structure of the lungs, heart, and blood vessels.
Cardiac catheterisation - This test is used if the results of initial tests suggest heart disease or problems with the heart muscle and arteries. It involves threading a catheter from a large blood vessel until it reaches the heart. It also uses a contrast dye that is injected through the catheter. The dye shows on x-ray images and can confirm if the arteries are blocked or narrowed.
Cardiac CT scan - A CT scan is more sensitive than a chest x-ray. It can show blockages in the heart arteries as well as take images of the beating heart. It can also confirm the presence of scar tissues in heart attack patients.
By combining the results of all the tests mentioned above, a heart specialist can make a definitive diagnosis. He or she can confirm what causes chest pain and what type of angina the patient has. This allows him or her to identify the best treatment method for the patient.
Stable angina can be managed with nonsurgical treatment. Patients are taught relaxation techniques and methods on how they can effectively handle emotional stress. They are also advised against smoking and to make healthy lifestyle changes. These include eating a well-balanced diet and exercising as often as possible.
Other types of angina, on the other hand, must be treated right away. If left untreated, they can lead to a heart attack. Patients may be prescribed with certain medications. These may include blood thinners to prevent blood from clotting. Drugs that make the walls of the arteries more relaxed can also be used. This helps improve blood flow to the heart.
Angioplasty can be an option for more serious cases. This procedure is done to remove plaque that has built up in the arteries. Another option is to bypass the blocked portion of the artery using a graft taken from another part of the patient’s body. This creates another route for oxygen-rich blood to easily reach the heart muscle. In some patients, heart valve repair or replacement may become necessary.
The American Heart Association. http://www.heart.org/HEARTORG/Conditions/HeartAttack/DiagnosingaHeartAttack/Angina-Chest-Pain_UCM_450308_Article.jsp#.WipXXbT1VE7. Accessed December 08, 2017.
Jneid H, et al. 2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/Non-ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update): A report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2012;126:875.
Papadakis MA, ed., et al. Current Medical Diagnosis & Treatment 2014. 53rd ed. New York, N.Y.: The McGraw-Hill Companies; 2014. http://accessmedicine.mhmedical.com/book.aspx?bookId=330.