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Angina

DEFINITION

Angina is the medical name for chest pain caused by decreased blood flow to the muscles in the heart. Normally, blood is supplied to the heart muscle through arteries around the heart. As with all organs in the body, the heart requires the oxygen from blood in order to function properly. Plaques made partly of cholesterol can build in these arteries, a condition called coronary artery disease. These plaques make the arteries smaller and less able to provide blood to the heart muscle. A person may not know he or she has coronary artery disease until having symptoms like angina. This pain can feel like pressure, heaviness, crushing or squeezing. Sometimes, people feel like they have a heavy weight sitting in the center of their chest. Angina is divided into one of three types, stable, unstable or variant. Stable angina is recurrent chest pain that can be brought on by exertion. Stable angina usually comes on predictably with a consistent amount of exertion. Pain from stable angina will go away with rest and generally only lasts a few minutes. Angina is called “unstable” when it is new, has changed in nature, or comes on at rest. Unstable angina is concerning because it can be an indicator of a heart attack. Variant angina (also known as Prinzmetal’s angina) happens as a result of coronary artery spasm, not coronary plaque. Coronary arteries can spasm for no reason at all, but may also spasm in response to cocaine use. Risk factors for coronary artery disease and angina include smoking, diabetes, high blood pressure, high cholesterol, high triglyceride levels, family history of coronary artery disease, older age, sedentary lifestyle (being a couch-potato), obesity, and stress. Angina is concerning because sometimes it can indicate an ongoing heart attack. Clearly, recognizing a heart attack is very important. Symptoms concerning for a heart attack include pain or pressure on the center of the chest lasting a longer than a few minutes, pain going to the neck or arm, repeated episodes of chest pain, upper abdominal pain, sweating, difficulty breathing, nausea, vomiting, dizziness. If you have symptoms of a heart attack, you should go to the emergency room immediately.

SYMPTOMS
Chest pain, squeezing pain, crushing pain, pressure-like pain, nausea, fatigue, difficulty breathing, pain going to the new or arm, anxiety, sweating

DIAGNOSIS
Your doctor will begin with a thorough history and physical exam to determine the cause of your symptoms. Your doctor will likely begin with blood tests and an electrocardiogram (ECG or EKG). An EKG is done by placing small stickers over the chest which are attached to a machine to create a picture of the electrical activity of the heart. This picture can tell a cardiologist what areas may not be working properly. An EKG can help determine if you are having a heart attack and what the next step in treatment should be. Further testing can include various ways of looking at the heart muscle including echocardiograms (ultrasound of the heart), CT scans of the heart to look at the arteries, and stress tests (where the heart is induced to pump faster either by exercise or medicine while a picture of the heart’s motion is taken). A person with ACS may also need an angiogram, a procedure done by a doctor with specialized training called an interventional cardiologist. During this procedure, a thin wire is placed in one of the blood vessels in the leg or wrist and fed up to the heart. The cardiologist then injects dye through that small wire and takes pictures of the arteries of the heart. If vessels are found which are too small, the cardiologist may be able to either use small balloons to open them or place stents (tube-shaped wire meshes) which helps keep the arteries open.

TREATMENT
Treatment for angina depends on whether your angina is stable, unstable, or variant angina. If you have coronary artery disease, your doctor may recommend medications called statins (to decrease cholesterol), aspirin, and nitrates for when you have an episode of chest pain. Your doctor may recommend other medications, such as calcium channel blockers, ACE inhibitors and ranolazine depending on the cause of your angina pain. If your angina is not improved by medications, your cardiologist may perform some of the procedures like an angiogram with balloon angioplasty or stent placement described in the diagnosis section in order to try to restore blood flow to your heart. Sometimes, your cardiologist may recommend coronary artery bypass grafting, a procedure in which veins harvested from the legs are used to replace some of the arteries in the heart to restore blood flow. This surgery is generally not done unless you have serious coronary artery disease. If you are having symptoms of a heart attack, you need to get to the nearest emergency room immediately. Delaying treatment for these symptoms can be deadly. To decrease your risk of heart attack you should stop smoking, lose weight, manage your stress and get your diabetes under control. You should talk with your doctor to discuss an appropriate exercise plan.

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