Angina

What is angina?

Angina, which is also known as angina pectoris, is a medical condition that causes chest pain or discomfort. It occurs when your heart muscle does not receive enough oxygen-rich blood. This lack of oxygen is often due to narrowed or blocked coronary arteries, which are the blood vessels that supply blood to your heart.

Common symptoms of angina can include a feeling of pressure, squeezing, heaviness, tightness, or pain in the chest. It may also be felt in your arms, shoulders, neck, jaw, or back. Physical exertion, emotional stress, cold temperatures, heavy meals, or smoking often trigger the pain or discomfort associated with angina.

There are several types of angina, including:

  • Stable angina: usually occurs with exertion and goes away with rest or medication
  • Unstable angina: more serious and can occur even at rest; symptoms may not improve with medicine or rest and can last longer
  • Microvascular angina: may be a symptom of coronary microvascular disease (MVD); pain can be more severe and may last longer than stable angina
  • Variant angina (Prinzmetal’s angina): caused by a coronary artery spasm and often occurs at rest, not necessarily related to exertion or emotional stress

Prompt medical evaluation and treatment are crucial for managing angina and preventing complications such as heart attack or death. Treatment may include lifestyle changes, medications, and in some cases, procedures such as angioplasty or coronary artery bypass surgery.

What causes angina?

Angina is primarily caused by reduced blood flow to the heart muscle (ischemia), usually due to narrowing or blockages in the coronary arteries. It can be a warning sign of coronary heart disease (CHD), also known as coronary artery disease (CAD). CAD occurs when plaque builds up inside your coronary arteries (atherosclerosis). Plaque is made up of cholesterol, fat, calcium, and other substances found in your blood. Over time, plaque can harden and cause narrowed arteries, limiting the amount of oxygen-rich blood that reaches your heart.

Several factors increase your risk of CAD and angina:

  • High cholesterol: high levels of low-density lipoprotein (LDL) cholesterol can lead to plaque buildup
  • Hypertension: high blood pressure damages arteries and accelerates hardening
  • Smoking: tobacco smoke contains chemicals that damage blood vessels and promote plaque formation
  • Diabetes: damages blood vessels, leading to plaque buildup
  • Obesity: excess body weight, particularly around the stomach, increases risk
  • Physical inactivity: contributes to obesity, high blood pressure, and abnormal cholesterol levels
  • Family history: a family history of heart disease or angina increases your risk
  • Age and gender: risk increases with age; men tend to develop symptoms earlier, but post-menopausal women’s risk approaches that of men
  • Stress: emotional stress can temporarily increase blood pressure and heart rate, triggering angina
  • Other factors: excessive alcohol consumption, a diet high in saturated and trans fats, and certain medical conditions such as chronic kidney disease and inflammatory diseases

Lifestyle modifications (heart-healthy diet, regular exercise, quitting smoking, and managing conditions like hypertension and diabetes) and medical interventions (cholesterol-lowering medications and blood pressure management) can help reduce your risk.

What are the symptoms of angina?

Symptoms vary but typically involve discomfort or pain in the chest area. Common symptoms include:

  • Chest pain or discomfort: pressure, squeezing, heaviness, tightness, or pain in the chest, often described as a dull ache or constriction; may radiate to arms, shoulders, neck, jaw, or back
  • Pain with exertion: worsens with physical activity or emotional stress, such as walking uphill or carrying heavy objects
  • Relief with rest or medication: typically alleviated by rest or nitroglycerin, which opens coronary arteries
  • Shortness of breath: difficulty breathing, especially during exertion or angina episodes
  • Nausea, fatigue, or sweating: may include nausea, fatigue, lightheadedness, dizziness, or profuse sweating

Some people, particularly older adults, women, and those with diabetes, may experience atypical symptoms or symptoms resembling indigestion or heartburn.

How is angina diagnosed?

Angina diagnosis typically involves:

  • Medical history: discussion of symptoms, triggers, risk factors, and medical history
  • Physical exam: measurement of blood pressure, heart and lung assessment, and general examination
  • Electrocardiogram (ECG or EKG): non-invasive test measuring the heart’s electrical activity; can detect abnormal rhythms and signs of previous heart attacks
  • Stress test: monitoring heart response during exercise to identify abnormal changes in rate, rhythm, or blood flow
  • Echocardiogram: ultrasound imaging of heart structure and function to assess pumping ability, valve damage, and blood flow
  • Coronary angiography: invasive procedure injecting contrast dye into coronary arteries to detect blockages or narrowing
  • Blood tests: measurement of cholesterol, blood sugar, and markers of heart damage (e.g., troponin)

Based on these evaluations, a healthcare provider can confirm angina and develop a treatment plan. Seek prompt medical attention for chest discomfort.

How is angina treated?

Treatment aims to relieve symptoms, reduce angina episodes, and lower risks of heart attack and stroke. Approaches include:

Healthy lifestyle changes

  • Healthy diet: low in saturated fats, trans fats, cholesterol, and sodium; includes fruits, vegetables, whole grains, lean proteins, and healthy fats
  • Regular exercise: improves heart health, lowers blood pressure and cholesterol, and aids weight loss; consult a healthcare provider before starting
  • Stop smoking: smoking cessation programs, counseling, and nicotine replacement can help
  • Stress management: techniques like deep breathing, meditation, yoga, and progressive muscle relaxation

Medications

  • Nitroglycerin: pills or sprays to open coronary arteries and reduce heart workload
  • Beta-blockers: slow heart rate and reduce blood pressure
  • Calcium channel blockers: relax and widen blood vessels
  • Aspirin and antiplatelet medications: prevent blood clot formation
  • Statins: lower cholesterol levels

Medical procedures

  • Angioplasty and stenting: catheter with a balloon widens blocked arteries; stent placement keeps artery open
  • Coronary artery bypass grafting (CABG): surgical bypass using a healthy vessel to reroute blood around blocked arteries

Choice of treatment depends on symptom severity, underlying conditions, and patient preferences. Adhering to medications and lifestyle changes reduces risks of complications.

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