Angina
(Unstable Angina; Stable Angina; Angina Pectoris; Cardiac Angina; Variant Angina)
by
Rosalyn Carson-DeWitt, MD
Definition |
Causes |
Risk Factors |
Symptoms |
Diagnosis |
Treatment |
Prevention
What is Angina Pectoris?
Definition
Angina is a pain or discomfort in the chest. It often has a squeezing or pressure-like feel. This discomfort can also be felt in the shoulders, arms, neck, jaws, or back. Anginal pain usually lasts for no more than 2-10 minutes. It is relieved by rest or
nitroglycerin.
Types of angina include:
- Stable angina-has a predictable pattern. You generally know what brings it on and relieves it. You may also know what the intensity will be.
-
Unstable angina-is more unpredictable or severe. Chest pain may occur while resting or even sleeping (nocturnal angina). The discomfort may last longer and be more intense than that of stable angina.
-
Unstable angina may be a sign that you are about to have a
heart attack. It should be treated as an emergency.
- Variant or prinzmetal's angina-occurs when you are at rest. It most often occurs in the middle of the night. It can be quite severe.
Typical Angina Pain Areas
Women are more likely to experience atypical pain, outside of these areas.
© 2009 Nucleus Medical Media, Inc.
Causes
Angina is usually a sign of
coronary artery disease
(CAD). It occurs when the blood vessels leading to the heart are blocked. The blockage decreases the blood and oxygen flow to the heart muscle. When the heart muscle is deprived of oxygen you will feel chest pain and other symptoms.
Coronary Artery Disease
© 2009 Nucleus Medical Media, Inc.
Stable or Unstable Angina
Angina occurs when your heart's need for blood and oxygen is increased by:
- Exercise, exertion
- Cold weather
- A large meal
- Emotional stress
Stable angina becomes unstable when symptoms:
- Occur more often
- Last longer
- Are triggered more easily
Variant or Prinzmetal's Angina
This type of angina is usually caused by a spasm of a heart vessel. It may indicate that you have one of the following conditions:
Risk Factors
Major risk factors for CAD include the following:
- Gender: male
- Advancing age
- Strong family history of heart disease
- Obesity
and overweight
- Smoking
- High blood pressure
- Sedentary lifestyle
- High blood cholesterol
(specifically, high LDL cholesterol and low HDL cholesterol)
- Diabetes
Other risk factors for CAD:
Symptoms
-
Pressure or squeezing chest pain
- Some people do not experience the pain as severe
- Elderly people, women, and people with diabetes more likely to have atypical or subtle symptoms
- Some people have silent ischemia and experience no symptoms of chest pain
- Chest pain of any kind deserves a medical evaluation to determine its cause
- Chest pain or discomfort is the hallmark symptom of angina
The likelihood of a
heart attack
is increased
when chest discomfort is severe, lasts more than 15 minutes, and is accompanied by other symptoms such as:
- Pain in the shoulder(s) or arm(s), or into the jaw
- Weakness
- Sweating
- Nausea
- Shortness of breath
Diagnosis
Tests will be done right away to see if you are having an episode of angina or a heart attack. If you have a stable pattern of angina, other tests may be done to determine the extent of your disease. The test results will help to create a treatment plan.
The doctor will ask about your symptoms and medical history. A physical exam will be done.
Tests may include:
- Blood tests-to look for certain blood markers to determine if you are having a heart attack
- Electrocardiogram (ECG, EKG)
-a record of the heart's electrical activity, to look for evidence of past heart attacks, acute heart attacks, or heart rhythm problems
- Echocardiogram
-high-frequency sound waves (ultrasound) to examine the structure and function of the heart
- Exercise stress test
-records the heart's electrical activity during increased demand
- A medication is used to simulate the effects of physical exertion for those that can not exercise
- Nuclear scanning-radioactive material is injected into a vein to highlight areas with low blood flow
-
Electron-beam CT scan
(coronary calcium scan, heart scan, CT
angiography)-a type of x-ray that uses a computer to make detailed pictures of the heart, coronary arteries, and surrounding structures
-
Type of
CT scan
measures the amount of calcium deposits in the coronary arteries to determine the risk of heart disease or heart attacks
- American Heart Association (AHA) guidelines state that heart scans are not for everyone and are most likely to benefit patients at intermediate risk of CAD
- Coronary angiography
-dye is injected into the arteries to highlight abnormalities (narrowing or blockage) in the arteries
Treatment
Treatments for angina include:
Medications
-
Nitroglycerin-usually given during an attack of angina as a tablet that dissolves under the tongue or as a spray
- Longer-lasting types may be used to prevent angina before an activity. May be given as pills, or applied as patches or ointments.
-
Blood thinners-a small, daily dose of
aspirin
has been shown to decrease the risk of heart attack
-
Some may benefit from the addition of
warfarin
(eg coumadin). There is an increased risk of bleeding with this drug.
*
- Talk to your doctor before taking aspirin daily or warfarin.
- Beta-blockers and calcium-channel blockers-may reduce the occurrence of angina
- Cholesterol-lowering medications-may prevent the progression of CAD; may even improve existing CAD
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)-lower blood pressure and decrease the workload on the heart
Surgery
Patients with severe angina or unstable, progressing angina may benefit from:
Prevention
If you already have angina, you can
prevent an onset
by being aware of what starts it.
If you don't have angina, preventing the development of CAD may reduce your chance of getting the condition.
Steps to prevent CAD include managing risk factors:
- Maintain a healthy weight.
- Begin a safe exercise program with the advice of your doctor.
- Stop smoking.
- Eat a healthful diet. It should be low in saturated fat. It should also be rich in whole grains, fruits, and vegetables.
- Appropriately treat high blood pressure and/or diabetes.
-
Appropriately treat abnormal cholesterol levels or
high triglycerides.
RESOURCES:
American Academy of Family Physicians
http://familydoctor.org/
American Heart Association
http://www.americanheart.org/
National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov/
CANADIAN RESOURCES:
Canadian Cardiovascular Society
http://www.ccs.ca/
Canadian Family Physician
http://www.cfpc.ca/
REFERENCES:
Dambro MR.
Griffith's 5-Minute Clinical Consult
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Dickstein K, Kjekshus J. Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial infarction: the OPTIMAAL randomised trial.
Lancet.
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Lopez-Sendon J, Swedberg K, McMurray J, et al. Expert consensus document on angiotensin converting enzyme inhibitors in cardiovascular disease. The Task Force on ACE-inhibitors of the European Society of Cardiology.
Eur Heart J
. 2004;25:1454.
Reenan J. Clinical Pearl: Indications for bypass surgery. American Medical Association website. Available at:
http://www.ama-assn.org/ama/pub/category/11853.html
. Accessed November 16, 2006.
What is angina? American Heart Association website. Available at:
http://www.americanheart.org/presenter.jhtml?identifier=3007460
. Accessed June 16, 2008.
What is angina? National Heart, Lung, and Blood Institute. Available at:
http://www.nhlbi.n...
. Accessed June 16, 2008.
Updated section on Blood Thinners on 7/14/06 according to the following study, as cited by
http://www.epnet.com/dynamed/what.php
: Andreotti F, Testa L, Biondi-Zoccai GG, et al. Aspirin plus warfarin compared to aspirin alone after acute coronary syndromes: an updated and comprehensive meta-analysis of 25,307 patients.
Eur Heart J
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Last reviewed September 2009 by David N. Smith, MD
Last Updated: 9/30/09
