Angina

Angina, also known as angina pectoris, is a chest pain or pressure, usually caused by not enough blood flow to the heart muscle. Vascular spasms create a pressing pain over the chest. The pain is not constant but comes in waves that last about ten minutes. The attacks are often brought on by physical exertion, strong emotions, stress or cold weather. It is important to take early preventative measures to reduce the risk of angina, in order to prevent cardiovascular disease developing long term.

Causes

Angina is usually caused by not enough blood flow to the heart muscle. In one or more of the heart’s coronary vessels there is a constriction that prevents the blood carrying oxygen. When the heart, like other muscles, does not get enough oxygen, it reacts with pain.

There are certain factors that increase the risk of angina. They include:

Age (≥ 45 years for men, ≥ 55 for women)
Smoking
Diabetes mellitus
Family history of premature cardiovascular disease (men <55 years, female <65 years old)
Hypertension
Kidney disease (microalbuminuria or GFR<60 mL/min)
Obesity (BMI ≥ 30 kg/m2)
Physical inactivity

Symptoms

Angina pectoris can be quite painful, but many patients with angina complain of chest discomfort rather than actual pain: the discomfort is usually described as a pressure, heaviness, tightness, squeezing, burning, or a choking sensation. Apart from chest discomfort, anginal pains may also be experienced in the epigastrium (upper central abdomen), back, neck area, jaw, or shoulders. This is explained by the concept of referred pain, and is due to the fact that the spinal cord receives visceral sensation from the heart while simultaneously receiving cutaneous sensation from parts of the skin, specified by that spinal nerve’s dermatome, without an ability to discriminate between the two. Typical locations for referred pain are arms (often inner left arm), shoulders, and neck into the jaw. Angina is typically precipitated by exertion or emotional stress. It is exacerbated by having a full stomach and by cold temperatures. Pain may be accompanied by breathlessness, sweating, and nausea in some cases. In this case, the pulse rate and the blood pressure increases. Chest pain lasting only a few seconds is normally not angina (such as precordial catch syndrome).

Prevention and protection

To avoid the coronary arteries becoming clogged/hardened over time, you should:

exercise regularly
stop smoking
eat a healthy diet to keep cholesterol levels low and stable

Treatment

Treatment of angina pectoris aims to relieve pain and prevent myocardial infarction. Vascular spasm means that there is a temporary blockage in any of the heart’s coronary vessels. The blockage is transient and does not cause oxygen deficiency with damage to the heart muscle – as myocardial infarction does.

Different types of drugs are used to treat angina. Those called beta blockers or calcium flow inhibitors can be taken preventatively. Nitroglycerin can relieve pain. Cholesterol-lowering drugs reduce the risk of heart attack by preventing atherosclerosis in the blood vessels. There are also medicines that reduce the risk of heart attack by thinning out the blood. It is important to take any medicines that you are prescribed correctly.
If the drugs do not help or if the risk of heart attack is severe, an intervention, such as balloon enlargement or bypass surgery, may be necessary.

When to consult a doctor

Seek emergency care if you:

have chest pain together with shortness of breath, cold sweats or irregular heartbeats
have an unpleasant feeling in your chest for more than 15mins, without a natural explanation
feel strong, pressing pain in the chest.