Angina: Recognizing and Treating Chest Pain

Chest pain can be caused by a variety of factors, and there are different types of chest pain. One condition, called angina, is chest pain caused by reduced blood flow to the heart. Angina is relatively common, but it’s also tough to differentiate among other causes of chest pain in many cases. Technically, angina is not a disease, but rather a symptom of another underlying heart problem.

In many cases, this is a moderate condition that subsides with time and rest. In others, though, it can be a serious and even life-threatening condition.

 

Types of Angina

 

There are general types of angina:

• Stable angina: Also called angina pectoris, this is the most common type of angina. It tends to develop when the heart is forced to exert itself and work harder, and it lasts a short period—usually five minutes or less. Attacks of stable angina pain can often be predicted, and pain is typically familiar. With proper rest and medication, this type can be relieved.
• Unstable angina: Unstable angina is a far more dangerous condition. It can occur while the body is at rest, rather than during exertion, and is an unexpected change from typical patterns of angina. This type is more severe, and pain can last up to 30 minutes. It is also less affected (or often not affected at all) by rest and medication. In some cases, unstable angina signals a heart attack.
• Variant angina: Also called Prinzmetal’s angina, this is a rare attack that can be very painful. It’s caused by a spasm in the coronary arteries. Luckily, it can often be controlled with medication.
• Microvascular angina: This could be a symptom of coronary microvascular disease (MVD), which affects small coronary artery blood vessels. Microvascular angina is accompanied by a shortness of breath, difficulty sleeping and lack of energy.

 

Symptoms, Recognition and Complications

 

The symptoms of angina vary between each type, but some consistent symptoms include:

• Pain: chest pain or discomfort, or arm, neck, jaw, shoulder or back pain
• Fatigue
• Nausea or dizziness
• Shortness of breath
• Sweating

 

The chest pain associated with angina is often described as a pressure, squeezing or fullness in the center of the chest. Many people report feeling as if a heavy weight is on the chest, where others describe it similarly to indigestion.

Women may experience different symptoms, including abdominal pain or discomfort in the neck, jaw or back—or in some cases, women may feel a stabbing pain rather than pressure.

It’s important to note anytime your symptoms change. Changing symptoms are often a sign of complications, including heart attack—if you notice any of the precursor signs of a heart attack, call 911 right away. Other more minor complications include discomfort during normal activities.

 

Causes and Risk Factors

 

The direct cause of angina is reduced blood flow to the heart, most commonly brought on by coronary artery disease. Individual causes vary for each type of angina:

• • Stable angina: Stable angina is generally triggered by physical activity—the heart needs more blood while you are active, but narrowed arteries make it more difficult for blood to travel to the heart. It can also be caused by emotional stress, cold temperatures, smoking and heavy metals.
• • Unstable angina: This type can occur if fat deposits, called plaques, rupture in a blood vessel and form a clot. These clots can quickly reduce blood flow to the heart and potentially cause a heart attack if the blood flow doesn’t improve.
• • Variant angina: This is caused by a spasm in the coronary artery, which reduces blood flow.

 

Several factors can raise your risk of angina:

• Age: Men over 45 and women over 55 have higher risk levels.
• Obesity/Blood Pressure/Cholesterol: These related areas all have an effect on angina risk.
• Diabetes: Diabetes increases the risk of coronary artery disease, the most common cause of angina.
• Tobacco: Smoking, secondhand smoke and chewing tobacco all causes damage to the interior walls of arteries, and allows buildups that might limit blood flow.
• History: If you have a history of coronary artery disease or heart attack, you’re at higher risk.
• Exercise: Inactivity can lead to high cholesterol, high blood pressure, diabetes and an unhealthy weight. Because exercise can also impact angina, speak with your doctor about the right methods for you.
• Stress: Stress can increase blood pressure and produce hormones that narrow the arteries.

 

Treatment and Prevention

 

For cases of stable angina and others that don’t require immediate medical attention, there are a few care options. One of the primary methods of treatment is a change in lifestyle habits to help reduce symptoms and the likelihood of complications—practicing these habits also help prevent angina altogether. These include:

• • Quitting tobacco/smoking
• Losing weight if you’re overweight
• Pacing yourself during exercise—speak to your doctor about specific recommendations
• Avoiding large meals and eating a healthy diet high in grains, fruits and vegetables
• Controlling diabetes, including proper exercise and diet
• Avoiding stress and practicing relaxation techniques

 

Your doctor might recommend one of several medications:

• Nitrates: These are medications that relax the blood vessels and help them widen, letting more blood in. They’re used to treat angina-related discomfort and are often taken before exertion that commonly leads to symptoms. Nitrates can also be used as a preventive medication.
• Aspirin: Aspirin reduces the blood’s clotting ability, making blood flow easier.
• Beta blockers: These are drugs meant to block adrenaline, which makes the heart beat more slowly and reduces blood pressure. They can also relax and open up blood vessels.
• Clot-prevention: Drugs that prevent clots help reduce angina symptoms.
• Statins: These are drugs used for low cholesterol. They can also help reabsorb cholesterol that’s already forming on artery walls.
• Calcium channel blockers: These relax and widen blood vessels.
• Ranolazine: This can be used either with other drugs or on its own, and unlike other medications for angina, it can be used along with oral erectile dysfunction medicines.

 

A couple procedures or surgeries can be used for certain cases of angina:

• Angioplasty and stenting: In this procedure, your doctor will insert a balloon into the artery, then use a coil, called a stent, to keep the artery open. This is a good treatment for unstable or chronic angina.
• Coronary artery bypass surgery: This involves a vein or artery from a different place in the body being used to bypass an affected artery. It’s good for many types of angina, including cases where other medications or surgeries failed.

 

If you’re developing the symptoms of angina or other chest complications, speak to your doctor about the right treatment options.

 

For patients in Utah County, our internists provide a wide variety of care for diseases, disease prevention and other illnesses for adolescents and adults. We offer immunizations, health management counseling for chronic conditions such as diabetes, physicals and screenings for hypertension, osteoporosis and sleep disorders.

 

Sources:

 

“Angina (Chest Pain).” American Heart Association. http://www.heart.org/HEARTORG/Conditions/HeartAttack/DiagnosingaHeartAttack/Angina-Chest-Pain_UCM_450308_Article.jsp#.WN6OUDvythE

“Angina.” The Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/angina/basics/definition/con-20031194