Angina (Chest Pain): Types, Causes, Symptoms, Risks, Complications, Diagnosis, Treatment and Prevention

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women having Angina (Chest Pain)

1Overview

Angina is chest pain or discomfort that occurs when the heart muscle has not enough supply of oxygen that is being carried by the blood. This happens because there is the narrowing of the arteries supplying the heart. The narrowing may be due to plaque (fatty substance) that builds up in arteries causing a reduced blood flow.

When this happens, an individual may feel tightness, pressure or squeezing pain in the chest that radiates to the arm, neck, jaw, back and sometimes to stomach.
Most individuals experience it during activity or when a stressful situation arises. But after that stressful situation, unlike a heart attack, the discomfort goes away quickly giving the individual a sense of relief.

2Types of angina

Stable angina

It is also called angina pectoris which is the common type of angina. It is predictable and is usually precipitated by physical activity or emotional stress thus increasing the workload of the heart. Reducing physical exertion and medicines (nitroglycerin) usually help.

Unstable angina

This chest pain does not follow a certain pattern and unpredictable making it the most treacherous type of angina. It can happen during rest and even without physical exertion or stress. The chest pain is not relieved with rest and medicines that are why an immediate medical treatment is needed. Otherwise, if left untreated, it could lead to life- threatening conditions like heart attack, heart failure, or arrhythmias (irregular heart rhythms).

Variant angina

It is also known as Prinzmetal’s angina. It is a rare type of angina, and it happens when an individual is at rest. It does not follow a physical exertion or emotional stress. It can be managed with medicines.

Microvascular Angina

This type lasts longer than other types which can be more severe and medicine may not relieve this type of angina.

3Causes

In cases of angina, the heart muscle is not receiving enough oxygen because of the narrowing of the arteries (atherosclerosis). The narrowing is caused by the presence of plaque or fat deposits in the arteries causing the artery to be thick (arteriosclerosis) and damaged. A damaged coronary artery might lead to coronary heart disease (CHD).

The following are underlying causes of angina:

  • Smoking (causes vasoconstriction; damages the wall of the arteries)
  • High blood pressure
  • Increased cholesterol in the blood
  • Blood clots (blocks the artery and cause heart attack); pulmonary embolism (blockage of major artery of lungs
  • Physical exertion (stable angina)
  • Stress (emotional)
  • Exposure to extreme weather conditions might cause spasm of the artery
  • Heavy meals
  • Some medicines that tighten blood vessels
  • Cardiomyopathy (an enlarged or thickened heart)
  • Aortic Stenosis (narrowing of valve in the heart)

4Symptoms

The main symptoms of angina are pain and discomfort. Pain starts behind the breastbone and sometimes it occurs in the arm (left), neck, shoulders, jaw then radiates at the back. Pain that lasts longer than few minutes and is not relieved by rest or medicine needs emergency medical treatment immediately.

  • Pressure, tightness, squeezing or burning sensation in the chest
  • Nausea
  • Fatigue
  • Shortness of breath (common in elderly or diabetics)
  • Light-headedness, confusion
  • Sweating
  • Weakness

5Risk Factors

Angina is not a disease. It’s a symptom of underlying diseases like Coronary Heart Disease (CHD), which is a common heart disease in adults where the coronary arteries become narrowed due to plaque (waxy substance) building up in the walls of the arteries.

If an individual has CHD, it is most likely that the following risk factors of CHD are also risk factors of angina.

  • High cholesterol and triglyceride levels in the blood
  • Diabetes
  • High blood pressure
  • Smoking/ tobacco use
  • Overweight/ obesity
  • Sedentary lifestyle/ lack of physical activity or exercise
  • Unhealthy diet
  • Age
  • Metabolic syndrome (a collection of symptoms leading to diabetes or heart disease
  • Family history of Heart Disease
  • Stress or anger

6Complications

The most serious complications of angina are heart attack and strokes. A heart attack is triggered when the walls of the coronary arteries are blocked causing the supply of oxygenated blood going to the heart restricted.

Stroke or brain attack cuts off blood flow and oxygen going to the brain. This happens due to the presence of clots in the blood vessels feeding the brain.

7Diagnosis

The following will help the physician confirm that the individual has angina.

Physical examination

The doctor will gather the following information:

  • Symptoms he/she is experiencing like the location of pain, its characteristics (SOCRATES: site, onset, character( stabbing, heaviness, tightness ), radiation, association, time course, exacerbating/relieving factors, severity)
  • Risk factors and familial history of heart diseases coronary heart diseases.

Diagnostic Tests and Procedures

These tests and procedures are usually recommended by physicians if the chest pain/angina is related to serious heart problems.

  • Electrocardiogram ( EKG/ECG)

This is a simple test that measures and records the electrical activity of the heart. It is a routine exam to screen for heart disease and also used to detect and study heart problems like heart attacks, abnormal heart rhythms, and heart failure. However, some individuals who have angina have a normal electrocardiogram.

  • Chest X-ray

This is used to visualize organs inside the chest like the heart and lungs. It reveals signs of heart failure; however, this test alone does not confirm angina or coronary heart diseases.

  • Stress Test

This is also known as stress EKG, graded exercise test or treadmill test. This is a test of cardiovascular capacity made by monitoring the heart rate during strenuous exercise like walking on a treadmill or pedal a stationary bike. The speeds change to make the client walk faster thus increasing the workload of the heart. During the activity, the doctor also observes for the presence of shortness of breath, chest pain or whether there are abnormal changes in the heart rate or blood pressure of the client

  • Computed Tomography Angiography (CTA)

This uses dye and special x-rays to show blood flow through the coronary arteries. During the scan, the dye is injected through the IV line highlighting the blood vessels. It would then reveal any blockage of the blood vessels if there’s any. An x-ray tube located inside the scan produces three-dimensional (3D) picture of the whole heart.

  • Coronary Angiography and Cardiac catheterization

This also uses dye and special x-ray to view the coronary arteries. The doctor inserts a small catheter through the skin into an artery in the arm, neck or groin. It then advances to the opening coronary artery where the radiographic contrast is released into the blood stream. The special x-rays are taken while the dye flows to the blood stream. These images produced are called angiogram.

  • Blood tests

Complete blood count (CBC)

This test screens disorders that can affect blood cells like anemia, where there is a low level of hemoglobin, an iron-rich protein in red blood cells that carries oxygen.

C-reactive protein

This checks the level of protein in the blood. Increase protein level in the blood means a higher risk of developing a heart attack or coronary heart diseases.

Lipid profile test/ lipid panel

This checks the level of cholesterol and triglycerides in the blood.

Treatment

Medications

The following medications can improve symptoms of angina

  • Nitrates (nitroglycerin)

These drugs relax and widen blood vessels allowing more blood to flow to the heart muscle

  • Anticoagulants

These drugs prevent a blood clot. One example is Aspirin.

  • Beta blockers

Beta blockers make the heart beats more slowly with less force thereby reducing the workload of the heart, and they improve blood flow.

  • Angiotensin-converting enzyme (ACE) inhibitors

These medications dilate the blood vessels thereby reducing blood pressure.

  • Calcium channel blockers

These drugs lower blood pressure and slow the movement of calcium into the heart, making the heart easier to pump and not strained.

  • Statins

These drugs work by lowering the blood cholesterol levels.

  • Lifestyle changes
    • Have a healthy diet. Eat fruits and vegetables more often and avoid large meals.
    • Relax and take rest after physical exertion.
    • Have a stress-free environment
    • Avoid stressful situations and know how to manage your stress
    • Quit smoking
    • Avoid second-hand smoke
    • Exercise more often, be physically active and maintain a healthy weight
  • Medical procedures

Commonly used medical procedures in treating heart disease are angioplasty and coronary artery bypass grafting (CABG). Angioplasty is done to widen a narrowed or blocked artery thereby restoring the blood flow through the artery.

CABG can treat coronary heart diseases. A healthy artery or vein from the body is grafted to the blocked coronary artery. This makes a new path for oxygen-rich blood to flow smoothly to the heart muscle.

After angioplasty and CABG, cardiac rehabilitation may be recommended by the doctor that help clients improve their health and well- being.

8Prevention

Can Angina Be Prevented?

Yes, angina can be prevented by reducing the risk factors early in life. Have a healthy life style.

  • Quit smoking or using nicotine in any form; avoid second-hand smoke
  • Have healthy diet (low fat; low sodium)
  • Control high blood pressure (BP)
  • Control diabetes or blood sugar
  • Maintain a healthy weight
  • Be physically active; exercise daily
  • Know how to do stress management
  • Take your medicines as prescribed
  • Treat related conditions, like high blood pressure, high cholesterol, diabetes, overweight and obesity