Coronary artery disease
Angina is chest pain or a sensation of pressure that occurs when the heart muscle is not getting enough oxygen. It is usually brought on by exercise and then relieved by rest.
Unstable angina is a more serious condition. Symptoms may be increased pain, more frequent attacks or occurrence at lesser levels of activity or at rest. It could mean that the coronary artery disease is getting worse rapidly and the risk of a heart attack is high. Unstable angina should be considered a medical emergency.
Another form - variant angina - occurs from a spasm in the arteries on the surface of the heart. It produces pain during rest rather than physical activity. It also produces changes that are detectable with electrocardiography (ECG) while it is happening.
There is a form of angina called Syndrome X. In this form, there is neither a spasm nor any detectable block in the coronary arteries. In some people, the pain and pressure in the chest may be a result of a temporary narrowing of the smaller arteries of the heart. No one knows what causes this, but it may be the result of a chemical imbalance in the heart or abnormalities in the arteries.
Symptoms of angina
Angina symptoms usually first appear during physical activity or emotional distress, both of which make the heart work harder and need more oxygen. But if the reduced blood flow is severe enough, angina can occur when a person is at rest.
When angina occurs it usually lasts only a few moments and goes away with rest. Sometimes it is worse when a person is active after having eaten. It is usually worse in cold weather or when moving from a warm room to a cold one. Sometimes experiencing a strong emotion while resting (or having a bad dream) can trigger it.
Typically, a person will feel pain or an ache or a sensation of pressure just beneath the breastbone. Many people describe the feel as discomfort or heaviness rather than pain. The ache or pressure might also be felt in either shoulder or down the inside of the arms, the back or in the throat, jaw or teeth
The symptoms of angina that are felt by older people or by women may be different and easily misdiagnosed. Pain may be felt in the stomach area, especially after a meal. It may resemble indigestion.
Causes of angina
The main causes are due to fatty deposits in the arteries that feed the heart or other abnormalities that interfere with the flow of blood to the heart muscle. Not everyone with coronary artery disease has angina.
Angina can also be caused by severe anaemia - a condition in which the body has fewer red blood cells or less haemoglobin, which carries oxygen. Rarer causes of angina are severe high blood pressure, a narrowing of the aortic valve (aortic stenosis), leakage from the aortic valve, thickening of the walls of the ventricles. All these factors make the heart work heart and increase its need for oxygen. Abnormalities of the aortic valve may also reduce the blood flow through the arteries of the heart. The openings for the coronary arteries are just above the aortic valve.
Diagnosing angina
Angina is usually diagnosed on the basis of the symptoms. If the symptoms are typical, it's usually easy for a doctor to diagnose the condition. The kind of pain, its location and its association with exertion, meals, weather and other factors are also helpful.
This is especially so if there are other risk factors for coronary artery disease present. These tests may be done to determine if the person has coronary artery disease.
Treating angina
Angina is a symptom of coronary artery disease. How the angina is treated depends on the stability and severity of the symptoms. Treatment may include:
- Eliminating or minimizing risk factors of coronary artery disease by treating high blood pressure, lowering cholesterol levels, stopping smoking, taking more exercise and weight loss if needed.
- Lowering LDL cholesterol levels as much as possible using drugs
- Drug therapy, including beta-blockers, nitrates, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors and anti-clotting drugs
- Hospitalisation if the symptoms get worse quickly
- Angiography may be performed if symptoms do not improve to help determine if coronary artery bypass surgery or angioplasty is needed