Angina also sometimes called angina pectoris is simply chest pain that occur as a symptom of an underlying heart condition.
Angina occurs when there is a narrowing of the coronary arteries, the blood vessels which supplies the heart with oxygenated blood. Hence, the heart is not getting enough oxygenated blood and as a result, not enough oxygen.
This decrease of oxygen being delivered to the muscle of the heart causes severe chest pain and often happens if one or more coronary arteries are narrowed or blocked by a fatty plaque, a condition known as Atherosclerosis.
While angina does not usually damage the heart, and the pain might only last a few minutes, it is a warning sign that you should not ignore.
As a matter of fact, your body is telling you that you are at an increased risk for a heart attack or cardiac arrest and angina is your heart’s way of getting your attention.
It is important to note that an angina attack is not the same as a heart attack. However, they are connected in that many of the symptoms are the same and that a poorly managed Angina may lead to a heart attack.
An angina attack can be triggered by the following:
- Extremes in emotion (e.g. being very angry or upset).
- Exposure to extremes in temperature (too hot or too cold).
- Doing more exercise than usual (overexerting yourself).
- Eating a large meal or eating it very quickly.
Subsequently, if the angina is a result of physical activity, stopping the activity generally stops the pain. But no matter what the cause of the chest pain or discomfort, it is important that you get medical attention as soon as possible.
What are the symptoms of angina?
The symptoms of angina can vary depending on the individual, but regardless, they are usually experienced after heavy exercise or because of emotional stress.
The most common angina pain symptoms experienced are the following:
- Pain that begins in the middle of your chest and then spreads to your left arm, back, neck or jaw; usually this is not a sharp pain, but a dull pain.
- A feeling of persistent indigestion that is moderate or severe
- Nausea or vomiting, this is a common symptom in women
- Shortness of breath
- A feeling of pressure, tightness or squeezing in your chest or arms numbness, or a lack of feeling in your arms, wrists or shoulders.
Types of Angina and Symptoms
This is the narrowing of the coronary arteries which supply the heart during strenuous activity because your heart has to work harder (e.g. during physical activity).
Stable angina is very predictable, there are no surprises, as it feels the same way each time it happens.
In other words, it usually has a regular pattern, and if you already know that you have stable angina, you will be able to predict the pattern. Once you stop performing the physical activity, or take medication (usually nitrates or nitroglycerin) the pain goes away, usually within a few minutes.
Stable angina generally lasts less than 5 minutes, and stops if you rest or take medication. It may feel like indigestion for some people. But, it is usually relieved with rest or medication.
This is more serious, and may be a sign that a heart attack could happen soon. Unlike stable angina, unstable angina is very unpredictable; it can just as easily occur during exercise as it can while you are sleeping or resting.
It should always be treated as an emergency. Individuals with unstable angina are at increased risk for heart attacks, cardiac arrest, or severe cardiac arrhythmias (irregular heartbeat or abnormal heart rhythm).
In addition, it might last as long as 30 minutes and might become progressively worse each time. It is usually not be relieved with rest or medication. Unstable angina is very common in older adults and individuals with sedentary lifestyle.
Having unstable angina might be a sign of a heart attack that will happen soon.
This is also known as Prinzmetal Angina. It usually occurs while the individual is resting and it has no predictable pattern. It is usually not triggered by exercise or emotion but by vasospasm.
Vasospasm is when the smooth muscle wall of the coronary arteries contracts, causing it to be narrow and thus restricting blood flow to the heart muscle.
Most people who have variant angina have severe atherosclerosis which is the build up of fatty plaque in the arteries that causes the hardening of the arteries, and the spasm is most likely to occur near a buildup of fatty plaque in an artery.
What treatments are available for angina?
Treating angina may require making lifestyle changes that will help you to reduce risk factors.
Reducing pain is an important goal of treatment, and by taking medications, reducing risk factors, and/or treating the narrowed arteries with surgery, this can be accomplished.
In this article, I will be focusing on the pharmacological or medication treatments of angina.
Now let’s look at the pharmacological treatment options one by one.
This medication that falls under the class of Nitrates is the most commonly prescribed for the treatment of angina.
They work by relaxing and widening your blood vessels so that your blood can flow to your heart more easily, and so that your heart doesn’t have to work as hard to keep the flow steady.
Nitroglycerin that can be taken under the tongue (called sublingual) or sprayed into the mouth works very quickly to relieve the pain of an angina attack.
Other forms of nitroglycerin, like tablets or patches, can be taken to help prevent an angina attack from starting.
The most common side effect of taking a nitrate is headache.
This class of medicines are used to treat several kinds of heart disease.
They work by lowering blood pressure, and slowing your heart rate which means your heart doesn’t have to work as hard.
Calcium Channel Blockers
These are also known as calcium antagonists.
They work by lowering blood pressure and slowing your heart rate, and are often used if you cannot take a beta-blocker.
They may be useful to treat coronary artery spasm in patients as well.
These are blood thinners that work by preventing blood clots from forming and blocking your arteries.
The most commonly used antiplatelet medication is Aspirin 81 mg, this used to be called Baby Aspirin at some point.
Aspirin works by preventing platelets from sticking to blood vessel walls. An enteric-coated aspirin is generally recommended because it is easier on the stomach. Other medications can be used to stop platelets from sticking together. They may be used to reduce the risk of clot-induced heart attacks or strokes.
In summary, since angina is implicated by sedentary lifestyle, the best way to prevent angina altogether is by living a health lifestyle and eating food.
It is important to note that the symptoms of angina may vary according to the type of angina and gender. In fact, women tend to have slightly different symptoms which leads to delayed recognition and diagnosis of the condition. Therefore, regular check-up of the heart is essential to prevent this.
Not all chest pain is caused by angina. Other possible causes include:
- acid reflux or indigestion
- inflammation of bones or tissue in your chest or breast bone, or muscular pain in your chest or back
- a spasm of your esophagus
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