Angina

Angina is chest pain or a sensation of pressure that occurs when the heart muscle is not getting enough oxygen. It tends to develop in women at a later age than in men.

A form of angina - angina decubitus - occurs when a person is lying down (not necessarily during sleep). It occurs because the fluids in the body are redistributed in this position due to gravity, and the heart has to work harder.

Another form - variant angina - occurs from a spasm in the arteries on the surface of the heart. It produces pain during rest rather than physical activity. It also produces changes that are detectable with electrocardiography (ECG) while it is happening.

Unstable angina is when the pattern of symptoms changes. Usually, the condition in each individual usually remains constant, so any change - increased pain, more frequent attacks or occurrence at lesser levels of activity or at rest - is a serious matter. It could mean that the coronary artery disease is getting worse rapidly and the risk of a heart attack is high. Unstable angina should be considered a medical emergency.

There is a form of angina called cardiac syndrome X. In this form, there is neither a spasm or any detectable block in the coronary arteries. In some people, the pain and pressure in the chest may be a result of a temporary narrowing of the smaller arteries of the heart. No one knows what causes this, but it may be the result of a chemical imbalance in the heart or abnormalities in the arteries.

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Symptoms

Angina symptoms usually first appears during physical activity or emotional distress, both of which make the heart work harder and need more oxygen. But if the reduced blood flow is severe enough, angina can occur when a person is at rest.

When angina occurs it usually lasts only a few moments and goes away with rest. Sometimes it is worse when a person is active after having eaten. It is usually worse in cold weather or when moving from a warm room to a cold one. Sometimes experiencing a strong emotion while resting (or having a bad dream) can trigger it.

Typically, a person will feel pain or an ache or a sensation of pressure just beneath the breastbone. Many people describe the feel as discomfort or heaviness rather than pain. The ache or pressure might also be felt in either shoulder or down the inside of the arms, the back or in the throat, jaw or teeth.

The symptoms of angina that are felt by older people or by women may be different and easily misdiagnosed. Pain may be felt in the stomach area, especially after a meal. It may resemble indigestion.


Causes and Risk Factors

Fatty deposits in the arteries that feed the heart or sometimes because of other abnormalities that interfere with the flow of blood to the heart muscle are the main causes. Not everyone with coronary artery disease has angina.

Angina can also be caused by severe anemia - a condition in which the body has fewer red blood cells or less hemoglobin, which carries oxygen. Rarer causes of angina are severe high blood pressure, a narrowing of the aortic valve (aortic valve stenosis), leakage from the aortic valve, thickening of the walls of the ventricles. All of these factors make the heart work harder and increase its need for oxygen. Abnormalities of the aortic valve may also reduce the blood flow through the arteries of the heart. The openings for these arteries are just beyond the aorta.

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Diagnosis

Angina is usually diagnosed on the basis of the symptoms that an individual describes. If the symptoms are typical, it's usually easy for a doctor to diagnose the condition. The kind of pain, its location and its association with exertion, meals, weather and other factors are also helpful.

This is especially so if there are other risk factors for coronary artery disease present. These tests may be done to determine if the person has coronary artery disease and how severe it is:

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Treatments

Angina is a symptom of coronary artery disease. How the angina is treated depends on the stability and severity of the symptoms. 

Treatment may include:

  • Eliminating or minimizing risk factors of coronary artery disease by treating high blood pressure, lowering high cholesterol levels, quitting smoking, exercise and weight loss if needed.
  • Lowering LDL cholesterol levels as much as possible using drugs
  • Drug therapy, including beta-blockers, nitrates (such as nitroglycerin), calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors and anti-clotting drugs
  • Hospitalization if the symptoms get worse quickly
  • Angiography may be performed if symptoms do not improve to help determine if coronary artery bypass surgery or angioplasty is needed
  • Ultimately treatment of the coronary artery disease is required.
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