What is Angina?
Angina, medically referred to as angina pectoris, is a type of chest pain resulting from reduced blood flow to the heart. This condition serves as a key symptom of coronary artery disease (CAD) and is often described as a feeling of squeezing, pressure, heaviness, or tightness in the chest. Angina can be alarming and may vary in its presentation, necessitating prompt medical attention for accurate diagnosis and treatment.
Types of Angina
Angina can be classified into several types based on its characteristics and underlying causes:
- Stable Angina: Stable angina is the most common form and typically occurs during physical activity or emotional stress. The pain is predictable, often triggered by exertion, and tends to subside with rest or angina medications. Episodes usually last for a short duration, around five minutes or less.
- Unstable Angina: Unstable angina is a medical emergency characterized by unexpected chest pain that can occur at rest or with minimal exertion. The pain may last longer than stable angina (up to 20 minutes or more) and does not improve with rest or usual medications. This type can precede a heart attack and requires immediate medical intervention.
- Variant Angina (Prinzmetal Angina): Unlike stable and unstable angina, variant angina is caused by spasms in the coronary arteries rather than by plaque buildup. This type often occurs at rest, especially during nighttime, and is typically relieved by medication. The pain can be severe and occurs in cycles.
- Refractory Angina: This refers to angina that persists despite optimal medical therapy and lifestyle changes, indicating a more severe underlying heart condition.
Symptoms of Angina
The hallmark symptom of angina is chest pain or discomfort, which may manifest in various forms:
- Burning or squeezing sensations
- Fullness or pressure in the chest
- Pain radiating to the arms, neck, jaw, shoulder, or back
Additional symptoms can include:
- Dizziness
- Fatigue
- Nausea
- Shortness of breath
- Sweating
It is essential to recognize that symptoms may vary between individuals, particularly in women, who may experience atypical manifestations such as jaw or back pain, nausea, and general fatigue.
When to Seek Medical Attention
Any new or worsening chest pain warrants immediate medical evaluation. Chest pain lasting more than a few minutes, especially if accompanied by additional symptoms like shortness of breath or nausea, may indicate a heart attack. In such cases, calling emergency services is crucial.
Causes of Angina
Angina results from reduced blood flow to the heart muscle, often due to:
- Coronary artery disease (CAD): The primary cause, where coronary arteries narrow due to plaque buildup (atherosclerosis).
- Blood clots: Plaque rupture can lead to clot formation, severely obstructing blood flow.
When the heart’s oxygen demand exceeds supply—such as during exercise or stress—angina symptoms can arise.
Risk Factors
Several factors increase the likelihood of developing angina:
- Age: More common in adults over 60.
- Family history: A genetic predisposition to heart disease.
- Tobacco use: Smoking and secondhand smoke damage arterial linings.
- Diabetes and high blood pressure: These conditions accelerate arterial damage.
- High cholesterol: Elevated low-density lipoprotein (LDL) levels contribute to artery narrowing.
- Obesity and sedentary lifestyle: Both increase cardiovascular strain.
- Emotional stress: Can provoke angina symptoms by raising blood pressure.
Diagnosis
Diagnosis involves a thorough medical history, physical examination, and various tests:
- Electrocardiogram (ECG): Measures the heart’s electrical activity and can indicate prior heart attacks.
- Stress tests: Assesses how the heart performs under physical stress.
- Echocardiograms and nuclear stress tests: Provide images of heart function and blood flow.
- Coronary angiography: Visualizes blockages in coronary arteries using X-ray imaging after injecting a contrast dye.
Treatment Options
Surgical and Procedural Interventions
For those with severe angina, procedures may be necessary:
- Angioplasty and stenting: A balloon is used to open narrowed arteries, often followed by the placement of a stent.
- Coronary artery bypass grafting (CABG): Involves creating a bypass around blocked arteries to improve blood flow
Medications
If lifestyle changes alone do not alleviate symptoms, medications may include:
- Nitrates: Relieve chest pain by relaxing blood vessels.
- Aspirin and antiplatelet drugs: Prevent clot formation.
- Beta-blockers: Reduce heart workload and lower blood pressure.
- Statins: Lower cholesterol levels to minimize atherosclerosis progression.
- Calcium channel blockers: Relax and widen blood vessels.
Lifestyle Changes
- Dietary adjustments: Adopting a heart-healthy diet low in saturated fats and cholesterol.
- Regular exercise: Engaging in physical activity as advised by a healthcare provider.
- Weight management: Maintaining a healthy weight to reduce cardiovascular strain.
- Stress reduction: Practicing relaxation techniques and ensuring adequate sleep.
Complications of Angina
The most serious complication associated with angina is a heart attack, which can occur if blood flow to the heart is not restored. Other complications may include heart failure or arrhythmias, emphasizing the importance of effective management and monitoring.