Angina - Symptoms, Causes, and Treatment

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Angina - Symptoms, Causes, and Treatment
Source https//specialtycareclinics.com/blog/what
-is-angina/
What is Angina? Angina is a kind of chest pain
caused by decreased blood flow to the heart.
Angina might be a symptom of coronary artery
disease. Angina is otherwise known as angina
pectoris. Angina pain is usually described as
squeezing, pressure, heaviness, tightness, or
pain in the chest. It might feel like a heavy
weight lying on the chest. Angina might be a new
pain that needs to be checked by a health care
provider or recurring pain that goes away with
treatment.
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• Although angina is relatively common, it could
  still be hard to distinguish from other types of
  chest pain, like the discomfort of
• indigestion. If you have unexplained chest pain,
  seek medical help immediately.
• Types
• There are several types of anginas. The type
  depends on the cause and whether rest or
  medication eases symptoms.
• Stable angina - Stable angina is the most
  frequent form of angina. It generally happens
  during activity (exertion) and goes away with
  rest or angina medication. For example, pain
  that comes on when you are walking uphill or in
  the cold
• weather might be angina.
• Stable angina pain is predictable and generally
  similar to previous episodes of chest pain. The
  chest pain generally lasts a short time, perhaps
  five minutes or less.
• Unstable angina (a medical emergency) - Unstable
  angina is unpredictable and happens at rest. Or
  the angina pain is
• worsening and happens with less physical effort.
  It is typically severe and lasts longer than
  stable angina, maybe twenty
• minutes or longer. The pain does not go away with
  rest or the usual angina medications. If the
  blood flow does not improve, the heart is
  starved of oxygen and a heart attack happens.
• Unstable angina is dangerous and needs emergency
  treatment.
• Variant angina (Prinzmetal angina) - Variant
  angina, also known as Prinzmetal angina, is not
  due to coronary artery disease. It is caused by
  a spasm in the heart's arteries that momentarily
  reduces blood flow. Severe chest pain is the
  primary symptom of variant angina. It most often
  occurs in cycles, generally at rest and
  overnight. The pain might be
• relieved by angina medication.

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• Refractory angina - Angina episodes are common
  despite a combination of medications and
  lifestyle changes.
• Symptoms
• Angina symptoms involve chest pain and
  discomfort. The chest pain or discomfort might
  feel like
• Burning
• Fullness
• Pressure
• Squeezing
• Pain might also be felt in the arms, neck, jaw,
  shoulder, or back. Other symptoms of angina are
• Dizziness
• Fatigue
• Nausea
• Shortness of breath
• Sweating
• The severity, duration, and type of angina could
  vary. New or different symptoms might signal a
  more dangerous form of angina (unstable angina)
  or a heart attack.
• Any new or worsening angina symptoms need to be
  evaluated
• immediately by a health care provider who could
  determine whether you have stable or unstable
  angina.

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• Angina in women
• Symptoms of angina in women could be different
  from the classic angina symptoms. These
  differences might lead to delays in seeking
  treatment. For example, chest pain is a common
  symptom in women with angina, but it might not
  be the only symptom or the most prevalent
  symptom for women. Women may also have symptoms
  like
• Discomfort in the neck, jaw, teeth, or back
• Nausea
• Shortness of breath
• Stabbing pain rather than chest pressure
• Stomach (abdominal) pain
• When should you see a doctor?
• If your chest pain lasts longer than a few
  minutes and does not go away when you rest or
  take your angina medications, it might be a sign
  you are having a heart attack. Call 911 or
  emergency medical help immediately. Only drive
  yourself to the hospital unless there is no
  other transportation option.
• If chest discomfort is a new symptom for you, it
  is important to see your health care provider to
  determine the cause and to get proper treatment.
  If you have been diagnosed with stable angina and
  it gets worse or changes, seek medical help
  right away.
• Causes
• Angina is caused by a decrease in blood flow into
  the heart muscle. Blood carries oxygen, which
  the heart muscle requires to survive.
• When the heart muscle is not getting enough
  oxygen, it causes a condition known as ischemia.
• The most frequent cause of reduced blood flow to
  the heart muscle is coronary artery disease
  (CAD). The heart (coronary) arteries can become
  narrowed by fatty deposits known as plaques. This
  is known as atherosclerosis.

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If plaques in a blood vessel rupture or a blood
clot forms, it could quickly block or reduce
flow through a narrowed artery. This could
suddenly and severely decrease blood flow to the
heart muscle. During times of low oxygen demand
when resting, for example the heart muscle
might still be able to work on the reduced
amount of blood flow without triggering angina
symptoms. But when the demand for oxygen goes
up, like when exercising, angina can result.
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• Risk factors
• The following things might increase the risk of
  angina
• Increasing age - Angina is most common in adults
  aged 60 and older.
• Family history of heart disease - Inform your
  health care provider if your mother, father, or
  any siblings have had heart disease or a heart
  attack.
• Tobacco use - Smoking, chewing tobacco, and
  long-term exposure to secondhand smoke could
  damage the lining of the arteries, allowing
  deposits of cholesterol to collect and block
  blood flow.
• Diabetes - Diabetes increases the risk of
  coronary artery disease, which results in angina
  and heart attacks by speeding up atherosclerosis
  and increasing cholesterol levels.
• High blood pressure - With time, high blood
  pressure damages the arteries by accelerating
  the hardening of arteries.
• High cholesterol or triglycerides - Too much bad
  cholesterol low-density lipoprotein (LDL) in
  the blood could cause arteries to narrow. A high
  LDL raises the risk of angina and heart attacks.
  A high level of triglycerides in the blood also
  is not healthy.
• Other health conditions - Chronic kidney disease,
  peripheral artery disease, metabolic syndrome,
  or a history of stroke
• raises the risk of angina.
• Not enough exercise - An inactive lifestyle
  contributes to high cholesterol, high blood
  pressure, type two diabetes, and obesity. Speak
  to your health care provider about the type and
  amount of exercise that is best for you.
• Obesity - Obesity is a risk factor for heart
  disease, which could cause angina. Being
  overweight makes the heart work difficult to
  supply blood to the body.

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• Emotional stress - Too much stress and anger
  could raise blood pressure. Surges of hormones
  produced during stress could narrow the arteries
  and worsen angina.
• Medications - Drugs that tighten blood vessels,
  like some migraine drugs, might trigger
  Prinzmetal's angina.
• Drug misuse - Cocaine and other stimulants could
  cause blood vessel spasms and trigger angina.
• Cold temperatures - Exposure to cold temperatures
  could trigger Prinzmetal angina.

• Complications
• The chest pain that occurs with angina can make
  doing some activities, like walking,
  uncomfortable. However, the most serious
  complication is a heart attack.
• Early warning signs and symptoms of a heart
  attack are
• Pressure, fullness, or a squeezing pain in the
  middle of the chest that lasts for more than a
  few minutes

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• Pain that spreads beyond the chest to the
  shoulder, arm, back, or even to the teeth and
  jaw
• Fainting
• An impending sense of doom
• Increasing episodes of chest pain
• Nausea and vomiting
• Continuous pain in the upper belly area (abdomen)
• Shortness of breath
• Sweating
• If you experience any of these symptoms, look for
  emergency medical attention right away.
• Prevention
• You could help prevent angina by following the
  same lifestyle changes that are used to treat
  angina. These include
• Not smoking
• Eating a healthy diet
• Avoiding or limiting alcohol
• Exercising regularly
• Maintaining a healthy weight
• Managing other health conditions associated with
  heart disease
• Reducing stress

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• arms and legs. Wires join the electrodes to a
  computer, which shows the test results. An ECG
  could show if the heart is beating too fast, too
  slow, or not at all. Your health care provider
  also could look for patterns in the heart rhythm
  to see if blood flow through the heart has been
  slowed or interrupted.
• Chest X-ray - A chest X-ray displays the
  condition of the heart and lungs. A chest X-ray
  might be done to determine if other conditions
  are causing chest pain symptoms and to see if the
  heart is enlarged.
• Blood tests - Specific heart enzymes enter the
  bloodstream when the heart muscle is damaged,
  such as from a heart attack. A cardiac enzyme
  blood test could help detect these substances.
• Stress test At times angina is easier to
  diagnose when the heart is working harder. A
  stress test typically includes walking on a
  treadmill or riding a stationary bike while the
  heart is
• monitored. Other tests might be done at the same
  time as a stress test. If you cannot exercise,
  you may be given drugs that mimic the effect of
  exercise on the heart.
• Echocardiogram - An echocardiogram uses sound
  waves to produce pictures of the heart in
  motion. These pictures can show how blood flows
  through the heart. An echocardiogram might be
  done during a stress test.
• Nuclear stress test - A nuclear stress test helps
  to measure blood flow into the heart muscle at
  rest and during stress. It is similar to a
  routine stress test, but during a nuclear stress
  test, a radioactive tracer is administered into
  the bloodstream. A special scanner displays how
  the tracer moves through the heart arteries.
  Areas that have little or no amounts of the
  tracer indicate poor blood flow.
• Cardiac computerized tomography (CT) - For this
  test, you typically lie down on a table inside a
  doughnut-shaped
• machine. An X-ray tube inside the machine rotates
  around the body and collects pictures of the
  heart and chest. A cardiac

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• CT scan could show if the heart is enlarged or if
  any heart's arteries are narrowed.
• Cardiac magnetic resonance imaging (MRI) - This
  test uses magnetic fields and radio waves to
  create detailed pictures of the heart. You
  typically lie down on a table inside a long,
  tubelike machine that produces detailed pictures
  of the heart's structure and blood vessels.
• Coronary angiography - Coronary angiography uses
  X-ray
• imaging to check the inside of the heart's blood
  vessels. It is part of a general group of
  procedures called cardiac catheterization.
• A health care provider threads a thin tube
  (catheter) through a blood vessel in the arm or
  groin to an artery in the heart and administers
  dye through the catheter. The dye makes the
  heart arteries appear more clearly on an X-ray.
  Your health care provider may call this type of
  X-ray an angiogram.
• Treatment
• Options for angina treatment are
• Lifestyle changes
• Medications
• Angioplasty and stenting
• Open-heart surgery (coronary bypass surgery)
• The goals of angina treatment are to decrease the
  frequency and severity of the symptoms and to
  lower the risk of a heart attack and death.
• You will need immediate treatment if you have
  unstable angina or angina pain that's different
  from what you generally have.

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• Medications
• If lifestyle changes like eating healthy and
  exercising do not
• improve heart health and relieve angina pain,
  medications might be needed. Medications to
  treat angina might include
• Nitrates - Nitrates are frequently used to treat
  angina. Nitrates relax and broaden the blood
  vessels so more blood flows to the heart. The
  most frequent form of nitrate used to treat
  angina is nitroglycerin. The nitroglycerin pill
  is placed below the tongue. Your health care
  provider may recommend taking a nitrate before
  activities that typically trigger angina (such as
  exercise) or on a long-term preventive basis.
• Aspirin - Aspirin lowers blood clotting, making
  it easier for blood to flow through narrowed
  heart arteries. Preventing blood clots could
  reduce the risk of a heart attack. Do not start
  taking a daily aspirin without talking to your
  health care provider first.
• Clot-preventing drugs - Certain medications such
  as clopidogrel (Plavix), prasugrel (Effient),
  and ticagrelor (Brilinta) make blood platelets
  less likely to stick together, so blood does not
  clot. One of these medications might be
• recommended if you cannot take aspirin.
• Beta-blockers Beta-blockers cause the heart to
  beat more slowly and with less force, which
  reduces blood pressure.
• These medications also relax blood vessels, which
  improves blood flow.
• Statins - Statins are drugs used to decrease
  blood cholesterol. High cholesterol is an
  important risk factor for heart disease and
  angina. Statins block a substance that the body
  requires to make cholesterol. They help prevent
  obstructions in the blood vessels.

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• Calcium channel blockers - Calcium channel
  blockers, also known as calcium antagonists,
  relax and broaden blood vessels to improve blood
  flow.
• Other blood pressure medications - Other drugs to
  reduce blood pressure include angiotensin-convert
  ing enzyme (ACE) inhibitors or angiotensin II
  receptor blockers (ARBs). If you have high blood
  pressure, diabetes, signs of heart failure, or
  chronic kidney disease, your health care provider
  might prescribe one of these types of
  medications.
• Ranolazine (Ranexa) - This medication might be
  prescribed for chronic stable angina that does
  not get better with other medications. It might
  be used alone or with other angina
• medications, such as calcium channel blockers,
  beta-blockers, or nitroglycerin.
• Therapies
• Sometimes, a nondrug option known as enhanced
  external counterpulsation (EECP) may be
  recommended to increase blood flow to the heart.
  With EECP, blood pressure-type cuffs are
  positioned around the calves, thighs, and pelvis.
  EECP needs
• multiple treatment sessions. EECP might help
  reduce symptoms in people with frequent,
  uncontrolled angina (refractory angina).
• Surgery and procedures
• If lifestyle changes, medications, or other
  therapies do not reduce angina pain, a catheter
  procedure or open-heart surgery might be needed.
• Surgeries and procedures used to treat angina and
  coronary artery disease are
• Angioplasty with stenting - During an angioplasty
  also known as a percutaneous coronary
  intervention (PCI) a tiny balloon is inserted
  into the narrowed artery. The balloon is
• inflated to widen the artery, and then a small
  wire mesh coil (stent) is generally inserted to
  keep the artery open.
• Angioplasty with stenting improves blood flow to
  the heart,

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• reducing or eliminating angina. Angioplasty with
  stenting might be a good treatment option for
  those with unstable angina or if lifestyle
  changes and medications do not effectively treat
  chronic, stable angina.
• Open-heart surgery (coronary artery bypass
  surgery)- During coronary artery bypass surgery,
  a vein or artery from somewhere else in the body
  is used to bypass an obstructed or narrowed
  heart artery. Bypass surgery raises blood flow to
  the heart. It is a treatment option for both
  unstable angina and stable angina that has not
  responded to other treatments.
• If you or anyone you know is suffering from
  angina our expert providers at Specialty Care
  Clinics will take care of your health and help
  you recover.
• Call 469-545-9983 to book a telehealth
  appointment for an at-home check-up.