Angina

Angina pectoris or angina is a recurring pain or discomfort in the chest. It happens when some part of the heart does not receive enough blood.

According to the American Heart Association (AHA) angina might feel like a squeezing or pressing pain; it might also extend into your arm and neck. In addition, there may be difficulty catching your breath. Or, you may start sweating.

Causes of angina

The National Heart, Lung and Blood Institute (NHLBI) says angina is a common symptom of coronary heart disease (Read about "Coronary Heart Disease"), which occurs when vessels that carry blood to the heart become narrowed and blocked due to atherosclerosis. (Read about "Arteriosclerosis & Atherosclerosis") Less common forms of angina are caused when a spasm narrows the coronary artery and lessens the flow of blood to the heart (variant angina), or by problems with the smaller vessels that feed the heart muscle (Read about "Coronary Microvascular Disease"), as well as the arms and legs (microvascular angina).

Frequently, the pain of angina and its accompanying sensations occur during physical exertion. Good examples would be when you're walking or shoveling snow. According to the U.S. Food and Drug Administration, women with angina may experience extreme fatigue. Once you stop the activity, the pain or other symptoms might go away. But that doesn't mean the problem has gone away. Angina can be an important warning sign of heart disease. In other words, there may be damage or blockage in the arteries that supply blood to your heart. So, if you're experiencing angina, it's important to seek medical help.

Stable and unstable angina

Angina can often be described as stable or unstable angina. Stable angina is the most common type of angina, according to NHLBI, affecting some seven million Americans. It recurs in a regular or characteristic pattern, and the level of activity or stress causing the angina is somewhat predictable. But sometimes, an established stable pattern of angina may change sharply; it may be provoked by far less exercise than in the past, it may appear at rest, it may feel more severe or it may occur more often. Angina like this is referred to as "unstable angina" and needs prompt medical attention. That's because unstable angina can be the warning sign of a heart attack. NHLBI says that when the pattern of angina changes - if episodes become more frequent, last longer, or occur without exercise - the risk of heart attack in subsequent days or weeks is much higher. (Read about "Heart Attack")

Who's at risk

If you're reporting bouts of chest pain that sounds like angina, a doctor may decide you need tests to determine if heart disease is in fact present. (Read about "Cardiovascular Tests") While heart disease can develop in anyone, AHA says a number of conditions put you at a higher risk. These risk factors can include:

• high blood pressure (Read about "Hypertension: High Blood Pressure")
• high cholesterol (Read about "Cholesterol")
• diabetes (Read about "Diabetes")
• family history of heart disease (Read about "Family Health History")

Having a sedentary lifestyle, being overweight or being a smoker can also increase your risk. (Read about "Obesity" "Quit Smoking")

Treatment options

There are several tests that can be used to help diagnose angina. A chest x-ray or cardiac CT scan may be used to check for any abnormalities or signs of an enlarged heart. (Read about "X-rays" "CT Scan - Computerized Tomography" "Enlarged Heart") An electrocardiogram (Read about "EKG - Electrocardiogram") can be used to record electrical signals as they travel through your heart. Your doctor may conduct a stress test (Read about "Stress Test"), in which your heart is monitored while you exercise or are given medication to elevate your heart rate. An echocardiogram, angiography or other tests may be used as well. (Read about "Cardiovascular Tests")

If heart disease is present, the doctor may suggest several courses of action to treat the heart disease. Lifestyle changes such as controlling cholesterol and blood pressure, following a healthy diet, exercising, and maintaining an ideal weight, can all help to reduce the risk of heart disease. (Read about "Exercise and Your Heart" "Losing Weight")

Medication may be needed too. The National Heart, Lung, and Blood Institute (NHLBI) says there are several classes of drugs that can be used for angina. Nitroglycerin is in a class of drugs that relieve pain by widening blood vessels. Beta blockers slow the heart rate and lessen the force of the heart muscle contraction. Calcium channel blockers can also be effective in reducing the frequency and severity of angina attacks. Ranolazine is a newer type of drug for the treatment of chronic angina that hasn't responded to other medications. It may not be appropriate for everyone. Aspirin therapy is sometimes used as well to reduce the chance of heart attack; however, it's important to use aspirin on a regular basis only under a doctor's supervision. (Read about "Aspirin and Heart") If you've been put on medication and start to notice any side effects, call your doctor right away. However, don't suddenly stop the medication without your doctor's OK.

Sometimes, lifestyle and medication aren't enough and surgery is needed. In some cases, angioplasty can provide relief. (Read about "Angioplasty") Angioplasty can be combined with the use of stents. (A stent is a tiny mesh tube, inserted in the area where the artery is narrowed to keep it open.) Bypass surgery is another option, using healthy veins or arteries to increase the flow of blood to the heart. (Read about "Coronary Bypass Surgery")

The most important thing is to pay attention to chest pain. AMA stresses that even if someone has been diagnosed with angina, they should get help immediately if they develop untypical symptoms such as pain at rest or during sleep. Pain that doesn't go away can indicate a heart attack (Read about "Heart Attack") which requires immediate medical treatment.

And in the case of angina, even if the pain does go away, chest pain can be a warning sign of underlying problems that need help as well, so always contact a doctor if you're experiencing this type of chest pain.

Related Information:

    Cardiac Rehabilitation

    The Heart and Its Valves

    Cardiomyopathy

    Glossary of Heart Terms