Here’s everything you need to know about angina, including:
What is angina?
Angina pectoris, often simply referred to as angina, is a medical term used to describe a type of chest discomfort that occurs due to a reduction in blood flow and oxygen to the heart muscle from blocked arteries in the heart.
Angina symptoms
While it is often described as a pressure, heaviness or squeezing in the chest, it can also present in a variety of other ways, which are called anginal equivalents. These equivalents can masquerade as shortness of breath, fatigue or arm pain.
Other associated symptoms include:
It is important to note that women often have more “atypical” presentations of angina. Rather than the more common heaviness or tightness in the chest, they may present with fatigue and shortness of breath. This makes it more difficult to diagnose angina in women and often leads to delays in care and treatment.
When should you seek help for angina symptoms?
Anyone who is experiencing angina for the first time should seek emergency medical attention because the first episode of angina can be a heart attack. In addition, anyone who has angina but with a worsening of symptoms (such as the angina coming with less exertion or a change in the quality of the angina) should also seek emergency medical attention.
Stable angina is often managed with medications and lifestyle changes under the guidance of a cardiologist.
Types of angina
Angina is most commonly caused by blocked arteries in the heart, but it can have other causes as well, including spasm and disease of the small blood vessels in the heart.
Stable angina: This type is chronic and occurs with predictability and consistency.
Unstable angina: This is when blocked arteries suddenly worsen. This is defined as angina that’s of new onset or a case of stable angina that’s worsening in quality or frequency.
Microvascular angina: This type occurs in the absence of the larger arteries in the heart being blocked and is due to the poor function of the tiny blood vessels in the heart. This type is more common in women.
Vasospastic angina: This type occurs due to spasm of the arteries that supply the heart muscle, leading to a temporary lack of blood flow, leading to discomfort.
Risk factors for angina
Since angina is a disease of the coronary (heart) arteries, the traditional risk factors include:
Other risk factors include a sedentary lifestyle, stress, air pollution, excess alcohol use and illicit drug use.
How is angina diagnosed?
If you suspect someone has angina, they should see a cardiologist. The cardiologist will perform a physical exam and an EKG (electrocardiogram). This is often followed by the performance of a stress test or cardiac computed tomography (CT) scan.
Stress test: During this test, a patient is asked to walk on a treadmill using a set protocol of increasing speed and incline while the EKG and blood pressure are monitored. If a patient is unable to exercise (for example, due to bad joint pain or trouble breathing), the stress test can be done by giving intravenous medicine to increase the heart rate or dilate the blood vessels in the heart.
Cardiac CT scan: While the stress test tries to indirectly find blocked arteries using the EKG and symptoms, the CT scan (with intravenous contrast) looks directly at the arteries themselves and can detect both calcium and plaque (when cholesterol deposits in the walls of the arteries).
Angina treatments
Cardiologists have different kinds of medicines that can help reduce the symptoms of angina. These medicines mostly work by decreasing the demand on the heart muscle and/or helping the arteries in the heart dilate and relax more, allowing more blood flow.
At the same time, cardiologists treat the risk factors for coronary artery disease, which is what led to the blocked arteries in the first place. This consists of medication to help lower cholesterol and control diabetes and high blood pressure.
In addition, lifestyle modifications play an essential role in helping patients with angina. The most important is stopping smoking, followed by an improved diet and regular exercise.
As an interventional cardiologist at Mount Sinai Fuster Heart Hospital, I’ve seen that patients can live quite comfortably with angina, as it is a symptom of coronary artery disease. The medications and lifestyle changes are usually continued for the rest of a person’s life to help reduce the risk of a heart attack and progression of the disease.
