What is Angina and what are common Angina Mistakes?

Angina is a fairly common type of chest pain that results from less than adequate blood supply to the heart muscles.

Common causes of angina

Common causes of angina include several types of coronary artery diseases. Common types of coronary artery disease include aortic stenosis, hypertension, and hypertrophic cardiomyopathy. People with normal arteries can still suffer from angina.

The heart normally receives its blood supply from the coronary arteries during the relaxation phase of a heart muscle contraction (the pumping action of the heart). When the heart needs more blood, the vessels dilate. But, when plaque lines the vessels, they cannot dilate. They lose their flexibility. Therefore, disorders involving the condition of the coronary vessels cause low blood oxygen levels and poor circulation. An obstruction of the blood vessels results in a decrease in the blood supply to the heart muscles. This is called ischemia.

What does an angina attack feel like?

Most people experience angina pain behind the sternum (breast bone) or just to the left. The angina pain commonly radiates to the left shoulder/upper arm. Then it travels to the left elbow, wrist and fingers. Angina pain may radiate to the right shoulder, neck, jaw or just above the stomach area. Patients say that angina pain is NOT sharp like a knife, but is felt in terms of a burning, pressing, aching, or pressure as experienced with gas or indigestion.

Angina attacks may come on slowly or quickly. Usually the duration of an angina attack is less than 5 minutes, but can last as long as 15 to 20 minutes. Longer angina episodes may occur after experiencing an extreme emotional outburst or eating a large meal due to the extra demands placed on the heart.

Angina pain usually is accompanied by any or all of these signs and symptoms:

1. difficulty breathing
2. pale face/skin
3. sweating
4. faintness
5. heart palpitations
6. dizziness
7. digestive disturbances.

Why is angina so painful?

When the coronary artery is closed off (occluded), heart cells become deprived of blood supply within only 10 seconds. In several minutes, the heart decreases its pumping action. Subsequently, oxygen and glucose cannot feed the muscle. The cells then convert to a different kind of metabolism: anaerobic metabolism. This kind leaves lactic acid as a waste product. The heart muscle becomes less healthy and needs to work harder as it rids itself of the lactic acid. (This is like an extreme case of muscle cramping after doing too many sit-ups.)

Diagnosis of Angina

Your doctor may choose to use tests or x-rays to properly evaluate the condition of the heart muscles. An electrocardiogram (ECG) is a heart-monitoring test conducted while a patient is at rest or on a treadmill/bike during exercise. An angiogram is an x-ray test that allows the doctor to identify blocked arteries in a patient who has been injected with a dye-like substance that defines blood vessels in the heart. Other various radiology tests can be used to evaluate the heart muscle for areas of ischemia (poor blood supply to heart tissue).

Angina Risk Factors

There are some precipitating factors a patient should be able to recognize in order to successfully prevent an episode of angina:

1. Exertion - When the patient's level of physical energy is overly strenuous
2. Emotion - When the patient's level of emotion becomes overwhelming
3. Exposure - When either the patient's blood supply is decreased or the heart's need for more oxygen is increased, angina can occur.

Types of Angina

Stable Angina

Once diagnosed, Stable Angina is a condition that the patient is able to manage. By understanding the pattern of onset and duration, the patient can respond to the signs and symptoms by using relieving factors such as rest and medication. This type of angina is reasonably predictable given certain stressors.

Unstable Angina

Unstable Angina is very unpredictable condition and can unexpectedly occur at night.

Prinzmetal's Angina

Prinzmetal's Angina has the classic signs/symptoms of angina, but happens at rest - usually in the early hours of the day. This may be due to coronary artery spasms.

Nocturnal Angina

Nocturnal Angina is thought to be associated associated with REM (rapid eye movement) - a phase of deep sleep.

Intractable Angina

Intractable Angina is chronic and incapacitating. Unfortunately, this type of angina does not respond well to treatment.

Post-Infarction Angina

After a heart attack/MI (myocardial infarction) the residual damages can result in episodes of Post-Infarction Angina.

Angina Treatment

The goals for treatment include:

1. relieving the acute attacks
2. preventing future attacks in order to preclude a heart attack
3. prevent coronary artery disease
4. resolve angina before actual heart damage occurs.

The following medications may be recommended by your doctor for treating angina:

Nitroglycerine - This drug reduces the oxygen requirements on the heart by dilating the blood vessels, decreasing blood pressure and the ventricular wall tension. Nitroglycerin pills are placed under the patient's tongue at onset of angina symptoms.

Beta Blockers - This drug reduces the oxygen requirements on the heart by blocking complex factors affecting how the heart contracts.

Calcium Channel Blockers - This drug is used in combination with other drugs. This type of drug is involved in the electrical activity of the heart cells and contraction of the vessels.

Antiplatelet Medicine - i.e., Aspirin - It is said that in unstable angina, use of Aspirin can reduce the chances of a heart attack and therefore reduce mortality by 50 percent.

What can the patient do?

The American Heart Association recommends that a person seek prompt medical treatment for chest pain episodes. Additionally, the American Heart Association encourages people to work to reduce their coronary heart disease risk by lifestyle modifications. Daily exercise and weight management along with blood pressure management will go a long way to maximize cardiac circulation and prevent angina.

Look at the statistics!

Stop smoking - reduces angina risk by 37 percent
Reduce cholesterol by 10 percent - reduces angina risk by 20 percent
Reduce blood pressure -especially the diastolic measure (bottom number) by 6 points - reduces angina risk by 10 percent
What specifically can exercise do for you?
If you exercise vigorously at least 30 minutes, 3-4 times a week, at 50-75 percent of the maximum heart rate by age, you will be able to substantially improve your health. (Even 30 minutes of strolling in the mall beats sitting on the couch!)

Exercise increases:

your heart's ability to pump blood
the amount of blood that the heart pumps per beat
the levels of good cholesterol
your survival chances after a heart attack

Exercise decreases:

your blood pressure
the formation of blood clots that cut off circulation
the chance of a stroke
the rate of the heart at rest
the risk of heart disease