Angina

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Angina is chest pain or discomfort caused by insufficient blood flow and oxygen to the muscle of the heart. In most cases the lack of blood flow is due to a narrowing of the coronary arteries. Angina isn't a disease; it is a symptom of an underlying heart problem. Angina usually is a symptom of coronary heart disease (CHD), also called coronary artery disease.

Angina usually occurs during exertion, severe emotional stress, or after a heavy meal. During these periods, the heart muscle demands more blood oxygen than the narrowed coronary arteries can deliver.

Symptoms

Diagnoses

Treatments

Management

Angina attacks can be prompted by exertion or physical exercise, when the hard-working heart muscle requires greater amounts of oxygen. The pain usually fades away with rest.

Pain and discomfort are the main symptoms of angina and is described as pressure, squeezing, burning, or tightness in the chest. The pain may feel like indigestion. Some people say that angina pain is hard to describe or they can't tell exactly where the pain is coming from.

The most common symptoms of angina can include:

Pain or discomfort in the middle of the chest
Pain may be accompanied by breathlessness and sweating
Pressure or a feeling of tightness in the chest
Radiating pain to the neck, jaw and left arm, or both arms
Sometimes, radiating pain in the upper back and shoulders.

Signs and symptoms such as nausea, fatigue, shortness of breath, sweating, light-headedness, or weakness also may occur.

Your doctor may use one or more of the below tests to diagnose angina.

ECG
An ECG is a simple, painless test that detects and records the heart’s electrical activity. An ECG also records the strength and timing of electrical signals as they pass through each part of the heart. An ECG can show evidence of heart damage due to CHD and signs of a previous or current heart attack. However, some people who have angina have a normal ECG.

Stress testing
During stress testing, you exercise (or are given medicine if you’re unable to exercise) to make your heart work hard and beat fast while heart tests are done. As part of some stress tests, pictures are taken of your heart while you exercise and while you rest. These imaging stress tests can show how well blood is flowing in various parts of your heart and/or how well your heart squeezes out blood when it beats.

Chest x-ray
A chest x-ray takes pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels. A chest x-ray can reveal signs of heart failure. However, a chest x ray alone is not enough to diagnose angina or CHD.

Blood tests
Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels may show that you have risk factors for CHD. Your doctor may recommend a blood test to check the level of a protein called C-reactive protein (CRP) in your blood. Some studies suggest that high levels of CRP in the blood may increase the risk of CHD and heart attack.

Treatments for angina include lifestyle changes, medicines, medical procedures, cardiac rehabilitation (rehab), and other therapies. The main goals of treatment are to:

Reduce pain and discomfort and how often it occurs
Prevent or lower the risk of heart attack and death by treating the underlying heart condition

Medicines
Nitrates are the medicines most commonly used to treat angina. They relax and widen blood vessels. This allows more blood to flow to the heart, while reducing the heart’s workload. Nitroglycerin is the most commonly used nitrate for angina. Nitroglycerin that dissolves under your tongue or between your cheek and gum is used to relieve angina episodes.

You also may need other medicines to treat angina. These medicines may include beta blockers, calcium channel blockers, ACE inhibitors, oral antiplatelet medicines, and anticoagulants (blood thinners). These medicines can help:

Lower blood pressure and cholesterol levels
Slow the heart rate
Relax blood vessels
Reduce strain on the heart
Prevent blood clots from forming

Lifestyle changes and medicines may be the only treatments needed if your symptoms are mild and are not getting worse. If lifestyle changes and medicines don't control angina, you may need a medical procedure to treat the underlying heart disease.

Making lifestyle changes can help prevent episodes of angina. You can:

Slow down and take rest breaks
Avoid large and heavy meals
Avoid stressful situations
Be smoke-free
Be physically active
Take your medicines as prescribed
Maintain a healthy body weight

Following a healthy diet is an important lifestyle change. A healthy diet can prevent or reduce high blood pressure and high blood cholesterol and help you maintain a healthy weight.