Angina Pectoris

Stable angina is chest pain or discomfort that typically occurs with activity or stress. The pain usually begins slowly and gets worse over the next few minutes before going away. It quickly goes away with medication or rest, but may happen again with additional activity or stress.

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Angina or angina pectoris is a recurring pain or discomfort in the chest developed when part of the heart muscle does not receive enough blood. Angina is a common symptom of coronary artery disease (CAD) caused by narrowing of coronary arteries. Angina usually resolves within a few minutes by rest or with angina medications.

Three major types of angina have been described based on the cause, pattern and duration of pain.

• Stable angina
• Unstable angina
• Variant angina

The heart pumps oxygen-rich blood to body cells through the arteries and our veins carry deoxygenated blood from body cells to the heart and then lungs for oxygenation. Coronary arteries supply pure blood to the heart muscle. Narrowing or blockage of the coronary arteries reduces blood flow and deprives the heart muscle of oxygen. The heart responds to the lack of oxygen by sending impulses in the form of angina pain.

One of the causes for narrowing of arteries in atherosclerosis. It is the deposition of fatty material called plaque on the arterial walls. Plaque becomes thick, hard and narrows the space for blood flow until finally blocking the arteries.

Certain factors can increase the risk of developing angina and some factors trigger angina pain.

The risk factors include:

• Family history
• Uncontrolled hypertension
• High blood cholesterol
• Sedentary lifestyle
• Diabetes
• Cigarette smoking
• Increased consumption of high-fat foods

Triggers of angina include:

• Physical exertion
• Emotional stress
• Extreme cold or heat
• Heavy meals
• Alcohol consumption
• Cigarette smoking

Chest pain is the characteristic symptom of all types of angina. Other symptoms may vary depending on the type of angina.

• Stable angina — Pain develops during strenuous activities, is predictable with a similar pattern of pain, lasts for short duration, may radiate towards arms and back, and resolves with rest or medication.
• Unstable angina —Unpredictable pain pattern, develops on exertion or even at rest, lasts longer than stable angina and may not resolve with rest or medication. This is a warning sign for heart attack necessitating emergency treatment.
• Prinzmetal angina or variant angina — A rare type that is caused by spasm in a coronary artery. Pain is severe and occurs at rest, usually developing during the night or early morning hours and can be relieved with medication.

Chest pain may be due to angina or other conditions. To confirm the diagnosis, your physician will perform certain tests.

• History and Physical examination
• Electrocardiogram (ECG/EKG) to measure the electrical activity of the heart, rhythm, size of the heart chambers and any damage to the heart.
• Exercise tolerance test (Stress EKG or Stress Test) records electrical activity of the heart under stressful activities such as patient exercising on a treadmill or a stationary bike.
• Nuclear heart scans to assess the blood flow to the heart and any damage to the heart muscle. A radioactive dye and a special camera are used to check the abnormalities.
• Stress echocardiogram:
  Echocardiogram shows still and motion images of the heart using sound waves. In stress echocardiogram images are obtained at rest and again under stress while exercising on a treadmill or stationary bike.
• Angiography involves threading a tiny catheter through a small incision into a large artery, usually in your groin. Once the catheter reaches the site of the blood vessel to be viewed, a dye is injected and X-ray images are taken to assess the area of vessel abnormality and extent of damage.

Treatment of angina requires multiple approaches. Different treatment options include:

• Lifestyle modifications
• Anti-angina medications
• Surgery

Lifestyle Modifications

Make certain modifications in your life style to prevent or lower risk of complications, such as:

• A healthy diet low in fat, salt, and cholesterol.
• Avoid smoking
• Regular exercise reduces stress, improves sleep, helps lose weight and improves quality of life
• Weight Loss: Being overweight puts extra strain on your heart. Discuss with your doctor and follow their advice.

Angina Medications

Medications remain the main stay of treatment as they help to control the symptoms and also improve heart health. Several medications are available for angina and in some cases multiple medications may be prescribed.

Antiplatelet agents help prevent heart attacks by stopping clot formation in arteries.

Vasodilating agents available as pills to be placed under tongue, sprays, or patches act by dilating blood vessels and increasing blood flow to the heart providing instant relief from angina pain.

Other medications such as blood pressure lowering agents, anti-anxiety agents, and cholesterol-lowering agents may also be prescribed.

Surgery

When lifestyle changes and medications are not sufficient to control angina, your doctor may suggest surgery or invasive procedures.

• Angioplasty involves advancing a thin tube with a balloon attached at one end into the blocked arteries through a blood vessel in the groin and inflating it. This widens the blocked portion of the artery and restores the normal blood flow to the heart muscle. In some cases a metallic stent is placed inside the artery to prevent the artery from closing again.
• Coronary artery bypass graft surgery: In this surgery, the blocked coronary artery is bypassed with a graft prepared from a vein or artery from the leg or forearm.

Most patients do not have complications after angioplasty and bypass graft surgery, however certain complications may occur, and they include:

• Bleeding from the insertion site
• Irregular heart beat
• Chest pain
• Blood vessel damage
• Kidney damage from the dye used for angiogram
• Restenosis- Rebuilding of plaque
• Blood clot formation
• Dislocation of stent

Specific complications of bypass graft surgery include:

• Heart attack
• Stroke
• Deep wound infection
• Irregular heart beat
• Nerve damage
• Blood vessel damage
• Recurrent angina

Angina is a threatening condition so it is better to take precautions and prevent its development. Discuss with your cardiologist and adopt certain lifestyle modifications to stay healthy.