Angina — causes, risk factors, symptoms, diagnosis and treatment

Do you often feel a nagging pain in your chest? It’s time you stop blaming indigestion and heart burn for the same. You could have an anginal attack.

What is angina?

Angina is the medical term used to describe chest pain originating from the circulatory system and the heart. It is not a disease or condition by itself. It is rather a crucial symptom that indicates an underlying heart disease.

Causes and types of angina

‘Angina is chest discomfort caused due decreased oxygen supply to a part of the heart muscle. It is caused due to partial or complete obstruction to arteries supplying the heart,’ says Dr Vineet Sankhala, consultant cardiologist, CIMS Hospital, Ahmedabad.

Depending on the type of pain and the duration for which it lasts, angina is classified into 4 different types:

• Stable angina: It occurs when the heart muscle has to work harder in order to pump blood. Situations like emotional stress, physical exertion and cold temperature may cause angina by interrupting the blood flow to the heart. This type of angina lasts for a short while and is relieved with medicines and rest.
• Unstable angina: It is also called angina pectoris. It can occur without any exertion, while you’re at rest. Building plaque and obstruction of main coronary arteries usually is the primary reason causing unstable angina. The pain may last for 10-15 minutes.
• Prinzmetal angina/Variant angina: It occurs due to spasms in the coronary arteries. Pain occurs at rest, particularly between midnight and early morning.    
• Microvascualar angina: It is mild pain that usually lasts for longer than 10 minutes and may continue for 30 minutes or more. It occurs due to interrupted blood flow through the smallest coronary arteries.

Signs of angina

Dr Vineet explains a few feature of angina that differentiates it from regular chest pain due to other reasons not originating from the heart.

‘Angina is usually felt as pressure, heaviness, tightening, squeezing or aching across the chest, particularly behind the breastbone. This pain often radiates to the neck, jaw, arms, back or even the teeth. Patients may also suffer from indigestion, heart burn, weakness, sweating, nausea and shortness of breath.’

‘Any chest pain or discomfort which occurs at rest and continues for more than 10 minutes requires medical attention if it is associated with:

• Profuse sweating
• Giddiness
• Weakness
• Nausea
• Light headedness

‘The threshold to consult a doctor should be low if the subject has risk factors for atherosclerosis (fat acculumation in arteries) like advanced age, smoking, diabetes, hypertension, family history of heart disease and obesity/sedentary life style,’ he explains.

Diagnosis of angina:

According to Dr Vineet, angina can be difficult to differentiate from chest pain arising from other systems of the body. Therefore he suggests that it is best for you to let the doctor decide the cause of chest pain because self diagnosis could be misleading and may result in complications.

‘Chest pain can occur from almost any organ in chest other than heart like lungs, ribs, esophagus (swallowing tube), aorta (largest artery of body) and pericardium (layers of heart).  Any chest pain which typically precipitates on exertion and gets relieved on rest favours heart origin. A well localised pain, varying with phases of respiration or posture and any chest pain which is reproducible on palpation are unlikely to be coming from heart.

Depending on your explanation of chest pain and physical examination your doctor may recommend you the following tests to confirm angina and its underlying cause.

Blood tests: Certain blood markers like cholesterol and triglycerides can help identify the chances the artery blockage and plaque formation causing angina

ECG: Electrocardiogram is used to check the electrical activity of your heart using an ECG device

Echocardiography: It is a test that helps the doctor to visualise the heart real time to analyse how effectively it works

Coronary angiography: In this test, a specific dye is injected in the blood stream to check the rate at which blood flows through the arteries. It is an important test to identify CHD.

Stress test: A simple exercise test can determine the electrical activity and functioning of your heart while you’re exercising.

Treatment and prevention:

‘An untreated angina can result into full blown heart attack with severe damage to heart muscle. It can also result into shock like state resulting into irreversible damage to heart and abnormal heart rhythms,’ says Dr Vineet. Therefore, early medical attention is important to get appropriate treatment at the right time. Here are some medicines that your doctor may prescribe you:

Medicines for unstable angina:

• Blood thinning agents like heparin and nitroglycerin may be prescribed to improve blood blow though narrow arteries
• Aspirin and clopidrogel may be prescribed to prevent blood clotting and reduce the chances of heart attack
• Medicine to control blood pressure may be required if you are hypertensive
• Statins may be prescribed to lower cholesterol

Medicines for stable angina:

• Nitrates are given to prevent angina
• Nitroglycerin, aspirin and clopidrogel may be prescribed to prevent blood clotting and improve blood flow through the arteries
• Beta blockers may be given to lower heart rate and help it work smoothly

Surgical procedures:

• Angioplasty: It is the most common surgery performed to open up blocked arteries using a small device called stent. 
• Bypass surgery: In this procedure, a healthy blood vessel (called a graft) is used to form a bypass or another route to supply blood to the heart
• Stent placement: A stent is a small device that is placed in the blocked artery to open it up and improve blood flow 

Since, heart disease is the underlying cause of angina, preventative measures include controlling risk factors that could lead to heart disease.

• Eating healthy food, avoid junk is the mainstay for controlling cholesterol levels and maintaining a good lipid profile
• Exercising regularly, at least 30 minutes every day, will help you lose weight, boost your good cholesterol levels and improve your heart function.
• Smoking is the main cause of atherosclerosis that can lead to angina. So if you smoke, you should quit now.

Source: http://www.thehealthsite.com/diseases-conditions/angina-causes-risk-factors-symptoms-diagnosis-and-treatment/