Angina

Angina may feel like pressure or a squeezing pain in your chest. It may feel like indigestion. You may also feel pain in your shoulders, arms, neck, jaw, or back.

Angina is a symptom of coronary artery disease, the most common heart disease. CAD happens when a sticky substance called plaque builds up in the arteries that supply blood to the heart, reducing blood flow.

There are three types of angina:

• Stable angina is the most common type. It happens when the heart is working harder than usual. Stable angina has a regular pattern. Rest and medicines usually help.
• Unstable angina is the most dangerous. It does not follow a pattern and can happen without physical exertion. It does not go away with rest or medicine. It is a sign that you could have a heart attack soon.
• Variant angina is rare. It happens when you are resting. Medicines can help.

Not all chest pain or discomfort is angina. If you have chest pain, you should see your health care provider.

Prevention

You can prevent or lower your risk for angina and heart disease by making lifestyle changes and treating related conditions.

Healthy lifestyle choices can help prevent or delay angina and heart disease. To adopt a healthy lifestyle, you can:

• Quit smoking and avoid secondhand smoke
• Avoid angina triggers
• Follow a healthy diet
• Be  Maintain a healthy weight
• Learn ways to handle stress and relax
• Take your medicines as your doctor prescribes

You also can help prevent or delay angina and heart disease by treating related conditions, such as high blood cholesterol, high blood pressure, diabetes, and overweight or obesity.

Risk Factors

Angina is a symptom of an underlying heart problem. It’s usually a symptom of coronary heart disease (CHD), but it also can be a symptom of coronary microvascular disease. (MVD). So, if you’re at risk for CHD or coronary MVD, you’re also at risk for angina.

The major risk factors for CHD and coronary MVD include:

• Unhealthy cholesterol levels.
• High blood pressure.
• Smoking.
• Insulin resistance or diabetes.
• Overweight or obesity
• Metabolic syndrome.
• Lack of physical activity.
• Unhealthy diet.
• Older age. (The risk increases for men after 45 years of age and for women after 55 years of age.)
• Family history of early heart disease.

People sometimes think that because men have more heart attacks than women, men also suffer from angina more often. In fact, overall, angina occurs equally among men and women.

Causes

Angina usually is a symptom of coronary heart disease (CHD). This means that the underlying causes of angina generally are the same as the underlying causes of CHD.

Research suggests that CHD starts when certain factors damage the inner layers of the coronary arteries. These factors include:

• Smoking
• High amounts of certain fats and cholesterol in the blood
• High blood pressure
• High amounts of sugar in the blood due to insulin resistance or diabetes

Many factors can trigger angina pain, depending on the type of angina you have. Physical exertion is the most common trigger of stable angina.

Other triggers of stable angina include:

• Emotional stress
• Exposure to very hot or cold temperatures
• Heavy meals
• Smoking

Blood clots that partially or totally block an artery cause unstable angina. If plaque in an artery ruptures, blood clots may form. This creates a blockage. A clot may grow large enough to completely block the artery and cause a heart attack. Blood clots may form, partially dissolve, and later form again. Angina can occur each time a clot blocks an artery.

A spasm in a coronary artery causes variant angina. The spasm causes the walls of the artery to tighten and narrow. Blood flow to the heart slows or stops. Variant angina can occur in people who have CHD and in those who don’t.

The coronary arteries can spasm as a result of:

• Exposure to cold
• Emotional stress
• Medicines that tighten or narrow blood vessels
• Smoking
• Cocaine use

Reduced blood flow in the small coronary arteries may cause microvascular angina. Plaque in the arteries, artery spasms, or damaged or diseased artery walls can reduce blood flow through the small coronary arteries.

Symptoms

Pain and discomfort are the main symptoms of angina. Angina often is described as pressure, squeezing, burning, or tightness in the chest. The pain or discomfort usually starts behind the breastbone.

Pain from angina also can occur in the arms, shoulders, neck, jaw, throat, or back. The pain may feel like indigestion. Some people say that angina pain is hard to describe or that they can’t tell exactly where the pain is coming from.

Signs and symptoms such as nausea, fatigue, shortness of breath, sweating, light-headedness, and weakness also may occur.

Women are more likely to feel discomfort in the neck, jaw, throat, abdomen, or back. Shortness of breath is more common in older people and those who have diabetes. Weakness, dizziness, and confusion can mask the signs and symptoms of angina in elderly people.

Symptoms also vary based on the type of angina you have.

Because angina has so many possible symptoms and causes, all chest pain should be checked by a doctor. Chest pain that lasts longer than a few minutes and isn’t relieved by rest or angina medicine may be a sign of a heart attack. Call 9–1–1 right away.

Diagnosis

The most important issues to address when you go to the doctor with chest pain are:

• What’s causing the chest pain
• Whether you’re having or are about to have a heart attack

Angina is a symptom of an underlying heart problem, usually coronary heart disease (CHD). The type of angina pain you have can be a sign of how severe the CHD is and whether it’s likely to cause a heart attack.

If you have chest pain, your doctor will want to find out whether it’s angina. He or she also will want to know whether the angina is stable or unstable. If it’s unstable, you may need emergency medical treatment to try to prevent a heart attack.

To diagnose chest pain as stable or unstable angina, your doctor will do a physical exam, ask about your symptoms, and ask about your risk factors for and your family history of CHD or other heart diseases.

Your doctor also may ask questions about your symptoms, such as:

• What brings on the pain or discomfort and what relieves it?
• What does the pain or discomfort feel like (for example, heaviness or tightness)?
• How often does the pain occur?
• Where do you feel the pain or discomfort?
• How severe is the pain or discomfort?
• How long does the pain or discomfort last?

If your doctor thinks that you have unstable angina or that your angina is related to a serious heart condition, he or she may recommend one or more tests.

Treatment

Treatments for angina include lifestyle changes, medicines, medical procedures, cardiac rehabilitation, and other therapies.

Lifestyle changes and medicines may be the only treatments needed if your symptoms are mild and aren’t getting worse. If lifestyle changes and medicines don’t control angina, you may need medical procedures or cardiac rehab.

Making lifestyle changes can help prevent episodes of angina. You can:

• Slow down or take rest breaks if physical exertion triggers angina.
• Avoid large meals and rich foods that leave you feeling stuffed if heavy meals trigger angina.
• Try to avoid situations that make you upset or stressed if emotional stress triggers angina. Learn ways to handle stress that can’t be avoided.

You also can make lifestyle changes that help lower your risk for coronary heart disease. One of the most important changes is to quit smoking. Smoking can damage and tighten blood vessels and raise your risk for CHD. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke.

Following a healthy diet is another important lifestyle change. A healthy diet can prevent or reduce high blood pressure and high blood cholesterol and help you maintain a healthy weight.

Other important lifestyle changes include:

• Being physically active. Check with your doctor to find out how much and what kinds of activity are safe for you.
• Maintaining a healthy weight. If you’re overweight or obese, work with your doctor to create a reasonable weight-loss plan. Controlling your weight helps you control CHD risk factors.
• Taking all medicines as your doctor prescribes, especially if you have diabetes.

If lifestyle changes and medicines don’t control angina, you may need a medical procedure to treat the underlying heart disease. Both angioplasty and coronary artery bypass grafting are commonly used to treat heart disease.

Your doctor may recommend cardiac rehab for angina. Cardiac rehab is a medically supervised program that can help improve the health and well-being of people who have heart problems.