What is Angina?

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

What Causes Angina?

For the most part, coronary artery diseases cause angina.Some coronary artery diseases include aortic stenosis, hyper tension, and hypertrophic cardiomyopathy. However, people with normal arteries can sometimes suffer with 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 level sand 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 (breastbone) or just to the left. Angina pain commonly radiates to the left shoulder/upper arm. Then it travels to the left elbow, wristand fingers. Angina pain may radiate to the right shoulder, neck,jaw or just above the stomach area. Patients say that angina painis 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 durationis less than 5 minutes, but can last as long as 15 to 20 minutes.Longer angina episodes may occur after experiencing an extremeemotional outburst or eating a large meal due to the extra demandsplaced on the heart.

Signsand Symptoms of Angina Attacks

If you experience the following signs or symptoms, you may behaving an angina attack:

• difficulty breathing
• pale face/skin
• sweating
• faintness
• heart palpitations
• dizziness
• digestive disturbances

What Happens During an Angina Attack?

Angina attacks happen when the coronary artery is closed off (occluded).When this happens, heart cells become deprived of blood supplywithin only 10 seconds. Several minutes after the beginning ofthe angina attack, the heart decreases its pumping action. Subsequently,oxygen and glucose cannot feed the muscle. The cells then convertto a different kind of metabolism: anaerobic metabolism. This kindleaves lactic acid as a waste product. The heart muscle becomesless healthy and needs to work harder as it rids itself of thelactic acid. An angina attack is like an extreme case of musclecramping after doing too many sit-ups.

Diagnosis of Angina

For diagnosis of angina, your doctor may choose to use tests orx-rays to properly evaluate the condition of the heart muscles.An electrocardiogram (ECG) is a heart-monitoring test conductedwhile a patient is at rest or on a treadmill/bike during exercise.An angiogram is an x-ray test that allows the doctor to identifyblocked arteries in a patient who has been injected with a dye-likesubstance that defines blood vessels in the heart. Other variousradiology tests can be used to evaluate the heart muscle for areasof ischemia. Ischemia is a poor blood supply to heart tissue.

Risk Factors for Angina

There are some precipitating factors a patient should be ableto recognize in order to successfully prevent an angina attack:

• Exertion - When the patient's level of physical energy is overly strenuous
• Emotion - When the patient's level of emotion becomes overwhelming
• 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 patientis able to manage. By understanding the pattern of onset and duration,the patient can respond to the signs and symptoms of stable anginaby using relieving factors such as rest and medication. Stableangina is reasonably predictable given certain stressors.

Unstable Angina

This is very unpredictable condition and can unexpectedly occurat night.

Prinzmetal's Angina

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

Nocturnal Angina

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

Intractable Angina

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

Post-Infarction Angina

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

Treatment of Angina

Treatment for Angina Includes:

• relievingacute angina attacks
• preventing future angina attacks in order to preclude a heart attack
• prevent coronary artery disease
• resolve angina before actual heart damage occurs

Medications for Treating Angina

The following medications may be recommended by your doctor fortreating angina:

Nitroglycerine - This drug reduces the oxygen requirements onthe heart by dilating the blood vessels, decreasing blood pressureand the ventricular wall tension. Nitroglycerin pills are placedunder the patient's tongue at onset of the symptoms.

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

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

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

Prevention of Angina

For prevention of Angina, the AmericanHeart Association recommends that a person seek promptmedical treatment for chest pain episodes. Additionally, the AmericanHeart Association encourages people to work to reduce their coronaryheart disease risk by lifestyle modifications. Daily exercise andweight management along with blood pressure management will goa long way to maximize cardiac circulation.

Angina 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 (bottomnumber) by 6 points - reduces Angina risk by 10 percent

Exercise to Prevent Angina

If you exercise vigorously at least 30minutes, 3-4 times a week, at 50-75 percent of the maximum heartrate by age, you will be able to substantially improve your health.(Even 30 minutes of strolling in the mall beats sitting on thecouch!)

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 offcirculation
• the chance of a stroke
• the rate of the heart at rest
• the risk of heart disease
  

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Angina Resources

HeartAttack and Angina Statistics

Glossary of CardiovascularTerms - Texas Hear...

Angina and Heart Disease-- familydoctor.org

ClinicalTrials.gov- Information on Clinical ...

AnginaPectoris

Angina - Texas HeartInstitute Heart Informat...