Overview

Angina pain is a type of chest discomfort that occurs when the heart muscle does not receive enough oxygen-rich blood. It is commonly a symptom of underlying coronary artery disease (CAD), where the blood vessels supplying the heart become narrowed or blocked. Angina is not a disease itself but serves as an important warning sign of potential heart problems. The pain is typically triggered by physical exertion, emotional stress, or other factors that increase the heart’s demand for oxygen. While angina pain is often temporary, it is a serious condition that requires proper diagnosis and treatment to prevent more severe complications like heart attacks.

Causes

The primary cause of angina pain is reduced blood flow to the heart muscle, usually because of blockages in the coronary arteries. Several factors can contribute to this reduced blood flow:

• Coronary artery disease (CAD): The most common cause of angina, where fatty plaques build up in the arteries, restricting blood flow to the heart.
• Coronary artery spasm: Temporary narrowing of the coronary arteries due to spasms can cause angina, even without significant blockage.
• Microvascular disease: Damage to the small arteries of the heart, more commonly seen in women, can lead to angina symptoms without major artery blockage.
• High blood pressure: Increased workload on the heart can lead to angina by raising oxygen demand.
• Severe anemia: A low red blood cell count reduces oxygen delivery to the heart, potentially causing chest pain.
• Heart valve diseases: Conditions like aortic stenosis can limit blood flow and contribute to angina pain.
• Other triggers: Smoking, obesity, diabetes, high cholesterol, emotional stress, and physical overexertion are key risk factors for developing angina.

Symptoms

The main symptom of angina is chest pain or discomfort, but it can present in various ways. Typical symptoms include:

• Chest pain or pressure: A sensation of squeezing, pressure, heaviness, or tightness in the chest, often behind the breastbone.
• Radiating pain: Pain may spread to the neck, jaw, shoulders, arms (especially the left arm), or back.
• Shortness of breath: Difficulty breathing may accompany the chest discomfort, especially during exertion.
• Nausea or dizziness: Some people experience nausea, lightheadedness, or general weakness during angina episodes.
• Fatigue: Unusual tiredness or a sense of exhaustion, particularly in women, may be a subtle symptom of angina.
• Sweating: Cold sweats or clamminess can occur during episodes of angina.
• Types of angina:
  • Stable angina: Predictable chest pain triggered by exertion or stress, relieved by rest or medication.
  • Unstable angina: Unexpected, more severe pain that may occur at rest and signals a higher risk of heart attack.
  • Prinzmetal (variant) angina: Chest pain caused by artery spasms, typically occurring at rest, often at night.

Diagnosis

Diagnosing angina involves a thorough assessment of symptoms, physical examinations, and diagnostic tests to determine the underlying heart condition. Common diagnostic steps include:

• Medical history: The doctor reviews symptoms, risk factors, family history of heart disease, and lifestyle habits.
• Physical examination: Checking heart rate, blood pressure, and listening for abnormal heart sounds.
• Electrocardiogram (ECG): Measures the electrical activity of the heart to detect abnormal rhythms or signs of reduced blood flow.
• Exercise stress test: Evaluates how the heart performs under physical stress, usually monitored on a treadmill or stationary bike.
• Cardiac imaging: Tests such as echocardiogram, stress echocardiogram, or nuclear imaging assess heart function and blood flow.
• Coronary angiography: Involves injecting dye into the coronary arteries to identify blockages via X-ray imaging.
• Blood tests: Checking cholesterol, blood sugar, and markers of heart damage, especially if a heart attack is suspected.

Treatment

Treatment of angina focuses on relieving pain, improving heart function, and preventing heart attacks. Management includes lifestyle changes, medications, and in some cases, procedures or surgery:

• Lifestyle modifications: Adopting a heart-healthy lifestyle with regular exercise, a balanced diet, quitting smoking, and managing stress significantly reduces symptoms.
• Medications:
  • Nitrates: Such as nitroglycerin, used to quickly relieve angina symptoms by dilating blood vessels.
  • Beta-blockers: Reduce heart rate and oxygen demand.
  • Calcium channel blockers: Relax arteries and decrease heart workload.
  • Antiplatelet agents: Aspirin or other blood thinners help prevent clots.
  • Statins: Lower cholesterol and slow the progression of artery blockages.
  • ACE inhibitors or ARBs: Manage blood pressure and protect heart health.
• Interventional procedures:
  • Angioplasty and stenting: Opens blocked arteries to restore blood flow.
  • Coronary artery bypass surgery: Reroutes blood flow around severely blocked arteries in advanced cases.

Prognosis

The prognosis for angina depends on the underlying cause, severity of coronary artery disease, and adherence to treatment. With proper management, many individuals with stable angina can lead active, fulfilling lives with reduced risk of heart attack. Lifestyle changes combined with medications greatly improve long-term outcomes.

Unstable angina is a more serious condition with a higher risk of heart attack, requiring urgent medical attention. Early diagnosis, prompt treatment, and regular follow-up care are crucial to improving survival rates and quality of life. Overall, many people with angina experience significant improvement and risk reduction with modern medical care.