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Angina

What is angina?

Angina is a symptom of ischemic heart disease or blockages in the coronary arteries. It is a symptom that signals a temporary lack of oxygen and blood flow to the heart muscle, as compared to the demands placed on the heart. It affectsover 5 million Americans and, in most cases, the episodes are similar in type. However, angina can herald a heart attack.

Angina is often described as a pressure or tightness in the chest, a dull (not sharp) pain. It is usually brought on by physical stress (walking, stair climbing, housework, sexual intercourse, etc), or emotional stress (anxiety, fright, fear other strong emotions). Angina can also be provoked by cold weather, after heavy meals, smoking and alcohol consumption.

What should I do when I experience angina?

• Stop what you are doing and sit down
• If the discomfort does not lessen, immediately upon sitting down, place a nitroglycerin tablet under your tongue.
• If no relief in 5 minutes, repeat the nitroglycerin
• If no relief in 5 minutes, repeat the nitroglycerin one more time for a total of 3 doses.
• If pain continues after the third dose or for a total of 20 minutes, call 911!

The discomfort of angina typically goes away within minutes of stopping the stressful activity. It is not a heart attack. However, if your typical pattern of angina changes, or if the symptoms are those of a heart attack, call 911 and have it evaluated in an emergency room.

How is angina treated?

Angina is treated with one of three methods once diagnosed: 1) medications to reduce the workload of the heart, 2) Angioplasty or other interventional procedure that utilizes a catheter that is threaded into the coronary artery to widen the passageway and improve bloodflow, or 3) bypass surgery which creates new pathways of circulation around existing blockages or narrowings. Despite these treatments, many people still have recurrent episodes of angina. These should be treated with nitroglycerin as described above. In addition, minimizing individual cardiac risk factors will improve quality of life and can decrease further heart injury.

What is the difference between stable and unstable angina?

Stable angina is the most common variety. It means that angina recurs in a predictable pattern.

Unstable angina refers to a pattern that is new or changing. It requires prompt medical attention. Unstable angina may be provoked by far less exercise than in the past, or it may appear at rest. Unstable angina is a term that is used when the warning signs of heart disease are experienced and diagnostic tests may not yet support diagnosis of a heart attack, yet clinical evidence confirms the presence of heart disease (for example, a positive stress test).

Are there other forms of angina?

Yes, Vasospastic or Prinzmetals Angina occurs at rest or sleep. It results from a temporary spasm of the coronary artery, not from an atherosclerotic narrowing in the blood vessel. This occurs, most frequently, in smokers and in younger adults.

Syndrome X or Microvascular Angina is less common. It is caused by an impaired dilation of the tiniest vessels within the heart muscle.