Summary
- Angina is chest pain caused by reduced blood flow to the heart muscle.
- Symptoms include chest tightness triggered by physical activity or stress.
- Treatment involves lifestyle changes, medications, and addressing underlying conditions.
Introduction
Angina, which people call angina pectoris, is chest pain due to less blood flow to the heart, causing ischemia. It feels like pressure, heaviness, tightness, or discomfort in the chest and can spread to the arms, shoulders, neck, jaw, or back.
Angina usually signals coronary artery disease (CAD), where arteries that supply blood to the heart get narrow or blocked by plaque.
There are two types of angina: stable, which happens during physical activity, and unstable, which is more unpredictable and can indicate a heart attack.
Understanding and treating angina is key to avoiding serious problems and enhancing life quality.
Causes
Angina mainly happens because of less blood flow to the heart, mostly from coronary artery disease (CAD).
CAD forms when plaque made of cholesterol, fat, and other materials builds up in coronary arteries, narrowing them and limiting heart blood supply. Other causes of angina include:
- Coronary Artery Spasm: Temporary spasms in the coronary artery that limit blood flow, also known as variant or Prinzmetal angina.
- Coronary Microvascular Disease: Affects smaller coronary arteries and causes chest pain, particularly in women.
- Anemia: Severe anemia lowers the blood’s oxygen capacity, which can cause chest pain similar to angina.
- Aortic Stenosis: Narrowing of the aortic valve creates extra work for the heart, leading to angina symptoms.
Symptoms
Symptoms of angina change by type but have some common signs:
- Chest Pain or Discomfort: A feeling of pressure, heaviness, or tightness in the chest, often likened to “an elephant sitting on the chest.”
- Pain Radiating to Other Areas: Pain may move to the shoulders, arms (typically the left), neck, jaw, or back.
- Shortness of Breath: Many individuals find it hard to breathe, especially during exercise.
- Fatigue and Weakness: General feelings of tiredness or weakness, especially during or after physical exertion.
- Sweating, Nausea, and Lightheadedness: Often seen with unstable angina.
Types of Angina
- Stable Angina: Predictable episodes during physical activity or stress, easing with rest or medication.
- Unstable Angina: Unpredictable, may occur at rest, and could indicate a heart attack, requiring emergency care.
- Variant (Prinzmetal) Angina: Caused by coronary artery spasms, typically at rest and often at the same time daily, usually in the early morning.
- Microvascular Angina: Chest pain from issues in small coronary arteries, often more prolonged and less predictable.
Risk Factors
Several risk factors raise the chance of developing angina, mainly linked to coronary artery disease:
- Age: Risk increases particularly after age 45 for men and 55 for women.
- Family History: A family history of heart issues, especially among close relatives, increases angina risk.
- High Blood Pressure: Puts more strain on the heart, risking artery damage.
- High Cholesterol Levels: High LDL cholesterol leads to plaque build-up in arteries.
- Diabetes: High blood sugar harms blood vessels and raises atherosclerosis risk.
- Smoking: Damages arteries and promotes plaque creation, greatly heightening angina risk.
- Obesity: Excess weight leads to high blood pressure, diabetes, and high cholesterol.
- Sedentary Lifestyle: Lack of exercise contributes to obesity and other risk factors.
- Stress: Ongoing stress can raise blood pressure and lead to unhealthy choices. such as eating too much and smoking.
- Unhealthy Food Choices: Diets that have a lot of saturated fats, trans fats, and junk food add to the risk of atherosclerosis.
Differential Diagnosis
Signs of angina can look like other issues, so a careful differential diagnosis is needed:
- Heart Attack (Myocardial Infarction): Chest pain is similar, but heart attacks often come with more severe pain, sweating, nausea, and a feeling of impending doom. Heart attacks need urgent medical help.
- Gastroesophageal Reflux Disease (GERD): Acid reflux can lead to chest pain that feels like angina but usually comes with a burning feeling in the throat and gets worse after eating.
- Costochondritis: This is when the cartilage linking the ribs inflames, leading to chest pain, especially when touching the chest or during deep breaths.
- Pulmonary Embolism: Sudden sharp pain in the chest, usually with short breath, fast heartbeat, and sometimes coughing up blood. This is a medical emergency.
- Panic Attack: Panic attacks can feel like angina with chest tightness, sweating, fast heartbeat, and a feeling of doom, but do not usually have a trigger from physical activity.
- Pneumonia or Pleuritis: Lung infections that cause inflammation can create chest pain, often with fever, cough, and other respiratory symptoms.
Differential Diagnosis | Definition | Symptoms | Treatment |
---|---|---|---|
Angina | Chest pain caused by reduced blood flow to the heart muscle. | Pressure or tightness in the chest, triggered by physical activity or stress, relieved by rest. | Lifestyle changes, nitroglycerin, beta-blockers, and addressing underlying conditions. |
Heart Attack (Myocardial Infarction) | Severe chest pain due to complete blockage of blood flow to the heart. | Intense chest pain, sweating, nausea, shortness of breath, and a sense of impending doom. | Immediate medical attention, aspirin, thrombolytics, and coronary intervention. |
Gastroesophageal Reflux Disease (GERD) | Acid reflux causing chest pain similar to angina. | Burning sensation in the chest or throat, worsened after eating or lying down. | Antacids, proton pump inhibitors, and dietary modifications. |
Costochondritis | Inflammation of cartilage connecting ribs to the sternum. | Localized chest pain, tenderness to touch, and pain during deep breaths. | NSAIDs, rest, and physical therapy. |
Pulmonary Embolism | A blood clot in the lungs causing sharp chest pain. | Sudden chest pain, shortness of breath, rapid heartbeat, and coughing up blood. | Immediate anticoagulant therapy and possibly thrombolytics. |
Panic Attack | Episodes of intense fear mimicking angina symptoms. | Chest tightness, sweating, rapid heartbeat, and a feeling of doom. | Cognitive behavioral therapy, relaxation techniques, and anxiolytics if needed. |
Pneumonia or Pleuritis | Inflammation or infection of the lungs causing chest pain. | Chest pain with breathing, fever, cough, and other respiratory symptoms. | Antibiotics for infection, anti-inflammatory medications, and supportive care. |
Investigation
To diagnose angina, a careful evaluation is needed that includes medical history, physical exam, and various tests to confirm the condition and measure its severity:
- Medical History and Physical Examination: The doctor will ask about symptoms, lifestyle, family history, and risk factors. A physical check-up looks at vital signs and may find unusual heart or lung sounds.
- Electrocardiogram (ECG): An ECG captures the heart’s electrical activity, which helps spot signs of less blood flow, past heart attacks, or ongoing ischemia.
- Stress Test: In an exercise stress test, the person exercises while their heart rate, blood pressure, and ECG are tracked. This shows how the heart reacts to physical activity.
- Echocardiogram: This ultrasound test checks heart function, showing areas of poor blood flow and evaluating the heart’s chambers and valves.
- Coronary Angiography: This is an invasive but clear method that injects contrast dye into the coronary arteries to see blockages. It is often done if surgery or angioplasty might be needed.
- Blood Tests: These tests can check cholesterol, blood sugar, and other heart disease markers. If unstable angina is suspected, cardiac markers like troponin may be measured.
- Cardiac CT or MRI: These imaging tests offer detailed pictures of the heart and blood vessels, helping find coronary artery disease or assess blockages.
Treatment
The goal of angina treatment is to relieve symptoms, stop heart attacks, and enhance quality of life. Treatments include lifestyle changes, medications, and sometimes surgery.
1. Lifestyle Changes
- Diet: Eating heart-healthy foods full of fruits, vegetables, whole grains, and lean proteins can help manage cholesterol and blood pressure.
- Exercise: Regular aerobic exercise boosts heart health, helps with weight loss, and lowers blood pressure. Patients should consult a doctor before starting any exercise plan.
- Quit Smoking: Stopping smoking is one of the best ways to improve heart health and lower angina risk.
- Weight Control: Keeping a healthy weight aids in managing blood pressure, cholesterol, and blood sugar, easing strain on the heart.
- Stress Management: Methods like mindfulness, meditation, and deep breathing can help handle stress, which is a major factor in angina.
2. Medications
- Nitrates: Nitrates, such as nitroglycerin, are common medications that relieve angina by widening blood vessels and enhancing blood flow to the heart.
- Beta-Blockers: These medications lower heart rate and blood pressure. Heart’s oxygen need reduced with these treatments, working well for angina.
- Calcium Channel Blockers: These meds widen blood vessels and decrease heart’s effort, helping to avoid angina, especially for those not taking beta-blockers.
- Antiplatelet Agents: Drugs like aspirin or clopidogrel help stop blood clots, lowering heart attack chance in angina patients.
- Statins: Statins cut cholesterol, slowing down plaque build-up in arteries and aiding blood flow to the heart.
- Ranolazine: This drug treats chronic angina when other options fail. It reduces angina attacks without impacting heart rate or blood pressure.
3. Surgical and Interventional Options
- Percutaneous Coronary Intervention (PCI): Also known as angioplasty, this is when a small balloon inflates in a narrowed artery to open it, often with a stent to keep it open.
- Coronary Artery Bypass Grafting (CABG): This surgery connects a healthy blood vessel to go around a blocked artery, improving heart blood flow. CABG is often for severe cases or multiple blockages.
Outlook and Prevention
Many with angina can keep a good life with proper care. Preventive steps include a heart-healthy lifestyle, risk factor management, and taking prescribed meds.
Regular check-ups are important to check heart health and adjust treatments as necessary.
Conclusion
Angina shows less blood flow to the heart, often from coronary artery disease. It feels like chest pain or discomfort that varies in how bad it is and how long it lasts.
Early detection and treatment of angina are key to stopping heart attacks and enhancing life quality. With lifestyle changes, medications, and sometimes surgeries, angina sufferers can find relief and better heart health.
Ongoing research in treatments and prevention gives hope for more progress in handling angina.
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