Angina and heart disease
Angina causes chest pain and discomfort when the heart doesn't receive enough oxygen. Angina is managed with lifestyle modifications, medication and cardiac procedures.
When your heart doesn't get enough oxygen because of decreased blood flow, you experience chest pain or discomfort. It's not always a painful sensation. Many people describe it as pressure or heaviness. Sometimes it can feel like a squeezing in your chest. It can also cause discomfort in your jaw, neck, shoulders, arms, or back.
Angina pain can be the first warning sign of coronary heart disease (CHD), which occurs when one or more of the arteries that carry blood to your heart is narrowed or blocked. Angina can also be a sign of coronary microvascular disease (CMD). This type of heart disease affects the smallest coronary arteries. It is more common in women than in men.
What is angina pain?
There are many types of angina, and the symptoms may vary depending on the type that you have.
Stable angina
Stable angina is also called angina pectoris. It is a symptom of coronary heart disease. This is the most common type of angina. Stable angina pain:
- May feel like chest pain that spreads to areas such as the jaw, arms, shoulders, or back
- Occurs when the heart works harder, such as during physical exertion
- Usually lasts around five minutes or less
- Gets better with rest or medication
- May feel like gas or indigestion
Triggers of unstable angina may include:
Unstable angina
Unstable angina is also called acute coronary syndrome and should be treated as an emergency. If you are having unstable angina, you should go to the emergency room immediately. Unstable angina pain:
- Can occur when you are resting or sleeping
- Is not associated with physical exertion
- Might last longer than stable angina
- Is not usually relieved if you rest or take medicine
- Can get worse over time
- Might lead to a heart attack
Variant angina
Variant angina is also called Prinzmetal angina, Prinzmetal's angina, or angina inversa. This is a rare type of angina that only accounts for two percent of angina cases. It is caused by a spasm in the coronary arteries. Variant angina pain:
- Usually occurs when you are resting, during late night or early morning hours
- Is usually severe
- Can be relieved if you take medicine
The spasms that cause variant angina pain may be triggered by:
- Cold weather
- Stress
- Some medications that cause tightening or narrowing of your blood vessels
- Using cocaine
- Smoking
Microvascular angina
Microvascular angina can be a symptom of coronary microvascular disease. CMD affects the smallest coronary arteries. Microvascular angina is caused by spasms of these small coronary arteries. These spasms reduce the blood flow to the heart. Microvascular angina pain:
- Can be more severe and longer-lasting than other types of angina
- Can be accompanied by sleep problems, tiredness, lack of energy, or shortness of breath
- May first be noticed during times of stress or normal daily activities
Anyone at risk for coronary artery disease is also at risk for angina. The major risk factors for both include:
- A family history of early heart disease
- Metabolic syndrome
- Smoking
- High blood pressure
- Unhealthy cholesterol levels
- Being overweight
- Diabetes
- Unhealthy diet
- Inactivity
- Older age (over age 45 for men or 55 for women)
Diagnosis of angina pain
If you are having any type of chest pain, you should see your doctor. Your doctor will discuss your symptoms and family history with you to determine the most likely cause of your angina. If you are having unstable angina you may need emergency treatment to prevent a heart attack. Your doctor may order some other tests as well including:
- Stress test
- Blood tests
- Chest X-ray
- Cardiac catheterization, when a tube is put in one of your large coronary arteries
- Cardiac Computed Tomography Angiography, a very fast type of computed tomography (CT) scan that can show blockages in your heart
Treatments for angina pain
Treatment of angina is focused on easing pain and discomfort as well as lowering your risk of heart attack or death by improving your heart health. The following treatments can help with immediate angina pain as well as reducing your risk of further cardiovascular disease.
Lifestyle changes
- Stop smoking
- Eat a healthy diet
- Maintain healthy cholesterol levels
- Lower your blood pressure
- Be physically active, starting slow, work up to 150 minutes per week of moderately intensive physical activity
- Maintain a healthy weight
- If you have diabetes, keep it well controlled
- Manage your stress
- Limit your alcohol use to no more than two drinks daily for men and one drink daily for women
Medication
Several types of medications can help with angina pain including:
- Beta-blockers, which slow the heart down, reducing its demand for blood
- Calcium channel blockers, which relax and widen blood vessels
- Nitrates, which also relax blood vessels.
Additionally, your doctor may prescribe other medications depending on the underlying cause of your angina. There are many combinations and types of medications that can be used to treat coronary artery disease.
Cardiac rehabilitation
Cardiac rehabilitation is a medically-supervised program designed to improve your cardiac health and prevent further problems. Cardiac rehabilitation includes three components:
- Exercise
- Education to make healthy choices and reduce cardiac risk
- Stress reduction
Cardiac procedures
Depending on the cause of your angina and underlying cardiac disease, your doctor may recommend any of the following procedures:
- Angioplasty
- Heart valve surgery
- Atherectomy
- Bypass surgery
- Cardiomyoplasty
- Heart transplant
- Minimally invasive heart surgery
- Catheter ablation
- Stent placement
- Transmyocardial Revascularization
Possible complications and side effects
Untreated angina can lead to a heart attack or even death. The medicines used to treat angina pain can also have some side effects including:
Beta-blockers
- Tiredness
- Dizziness
- Sleeping problems
- Cold hands or feet
Calcium channel blockers
- Low blood pressure
- Dizziness
- Headache
- Constipation
- Flushing
- Drowsiness
- Swelling in your tissues, called edema
Nitrates