Angina

Angina is pain or discomfort in the chest. It often has a squeezing or pressure-like feel. This discomfort can also be felt in the shoulders, arms, neck, jaws, or back. Anginal pain usually lasts for no more than 2-10 minutes. It is relieved by rest or nitroglycerin . Types of angina include:

  • Causes


    Angina is usually a sign of
    coronary artery disease
    (CAD). It occurs when the blood vessels leading to your heart are narrowed or blocked. The blockage decreases the blood and oxygen flow to your heart. When your heart is deprived of oxygen, you will feel chest pain and other symptoms.

    Coronary Artery Disease
    Coronary Artery plaque
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    This type of angina is usually caused by a spasm of a heart vessel. It may indicate that you have one of the following conditions:

    • CAD

    • Extremely
      high blood pressure
    • Hypertrophic cardiomyopathy
    • Diseases of the heart valves

  • Definition


    Angina is pain or discomfort in the chest. It often has a squeezing or pressure-like feel. This discomfort can also be felt in the shoulders, arms, neck, jaws, or back. Anginal pain usually lasts for no more than 2-10 minutes. It is relieved by rest or
    nitroglycerin
    .

    Types of angina include:

    • Stable angina
      —Has a predictable pattern. You generally know what brings it on and relieves it. You may also know what the intensity will be.
    • Unstable angina
      —Is more unpredictable and/or severe. Chest pain may occur while resting or even sleeping (nocturnal angina). The discomfort may last longer and be more intense than that of stable angina.


      • Unstable angina may be a sign that you are about to have a
        heart attack
        . It should be treated as an emergency.
    • Variant or Prinzmetal's angina
      —Caused by temporary spasm (contraction) of coronary arteries. Occurs when you are at rest, most often in the middle of the night. It can be quite severe.
    Typical Angina Pain Areas
    IMAGE
    Women are more likely to experience atypical pain, outside of these areas.
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  • Diagnosis

    Tests will be done right away to see if you are having an episode of angina or a heart attack. If you have a stable pattern of angina, other tests may be done to determine the extent of your disease. The test results will help to create a treatment plan.

    The doctor will ask about your symptoms and medical history. A physical exam will be done.

    Tests may include:

    • Blood tests
    • Electrocardiogram (EKG)
    • Echocardiogram
    • Exercise stress test
      • A medication is used to simulate the effects of physical exertion for those who cannot exercise.
    • Nuclear scanning

    • Electron-beam CT scan
      (coronary calcium scan, heart scan, CT
      angiography
      )

      • American Heart Association (AHA) guidelines state that heart scans are not for everyone and are most likely to benefit patients at intermediate risk of CAD.
    • Coronary angiography

  • Prevention


    If you already have angina, you can
    prevent an onset
    by being aware of what starts it.

    If you don't have angina, preventing the development of CAD may reduce your chance of getting the condition.

    Steps to prevent CAD include managing risk factors:

    • Maintain a healthy weight.
    • Begin a safe exercise program with the advice of your doctor.
    • Stop smoking.
    • Eat a healthy diet. It should be low in saturated fat. It should also be rich in whole grains, fruits, and vegetables.
    • Appropriately treat high blood pressure and/or diabetes.

    • Appropriately treat abnormal cholesterol levels or
      high triglycerides
      .

  • Risk Factors

    Major risk factors for CAD include the following:

    • Gender: male
    • Increased age
    • Strong family history of heart disease
    • Obesity
      and overweight
    • Smoking
    • High blood pressure
    • Sedentary lifestyle
    • High blood cholesterol
      (specifically, high low-density lipoprotein [LDL] cholesterol and low high-density lipoprotein [HDL] cholesterol)
    • Diabetes

    Other risk factors for CAD:

    • Stress
    • Excessive alcohol intake

  • Symptoms


    • Pressure or squeezing chest pain

      • Chest pain or discomfort is the key symptom of angina
      • Some people do not experience the pain as severely
      • Elderly people, women, and people with diabetes are more likely to have atypical or subtle symptoms
      • Some people have silent ischemia (lack of blood supply to the heart) and experience no symptoms of chest pain
      • Chest pain of any kind requires a medical evaluation to determine the cause


    The likelihood of a
    heart attack
    is increased
    when chest discomfort is severe, lasts more than 15 minutes, and is accompanied by other symptoms, such as:

    • Pain in the shoulder(s) or arm(s), or into the jaw(s)
    • Weakness
    • Sweating
    • Nausea
    • Shortness of breath

  • Treatment

    Treatments for angina include: