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Angina Pectoris

What is angina pectoris?

Illustration of the heart and arteries, as well as plaque build-up in arterial wall
Click Image to Enlarge

Angina pectoris (or simply angina) is recurring chest pain or discomfort that happens when some part of the heart does not receive enough blood and oxygen. Angina is a symptom of coronary artery disease (CAD), which occurs when arteries that carry blood to the heart become narrowed and blocked due to atherosclerosis or a blood clot.

What are the symptoms of angina pectoris?

Angina pectoris occurs when the heart muscle (myocardium) does not receive an adequate amount of blood and oxygen needed for a given level of work (insufficient blood supply is called ischemia). The following are the most common symptoms of angina. However, each individual may experience symptoms differently. Symptoms may include:

  • A pressing, squeezing, or crushing pain, usually in the chest under the breast bone, but may also occur in the upper back, both arms, neck or ear lobes 

  • Pain radiating in the arms, shoulders, jaw, neck, and/or back

  • Shortness of breath

  • Weakness and/or fatigue

The chest pain associated with angina usually begins with physical exertion. Other triggers include emotional stress, extreme cold and heat, heavy meals, excessive alcohol consumption, and cigarette smoking. Angina chest pain is usually relieved within a few minutes by resting or by taking prescribed cardiac medications, such as nitroglycerin.

The symptoms of angina pectoris may resemble other medical conditions or problems. Always consult your doctor for more information.

Angina pectoris and heart attack risk

An episode of angina does not indicate that a heart attack is occurring, or that a heart attack is about to occur. Angina does indicate, however, that coronary artery disease is present and that some part of the heart is not receiving an adequate blood supply. Persons with angina have an increased risk of heart attack.

A person who has angina should note the patterns of his or her symptoms--what causes the chest pain, what it feels like, how long episodes usually last, and whether medication relieves the pain. Call for medical assistance if the angina episode symptoms change sharply. This is called unstable angina.

Diagnosing angina pectoris

In addition to a complete medical history and medical exam, a doctor can often diagnose angina pectoris by noting the patient's symptoms and how/when they occur. Certain diagnostic procedures may also determine the severity of the coronary artery disease, and may include:

  • Electrocardiogram (ECG or EKG). A test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.

  • Stress test (usually with ECG; also called treadmill or exercise ECG). A test that is given while a patient walks on a treadmill or pedals a stationary bicycle to monitor the heart during exercise. Breathing and blood pressure rates are also monitored. A stress test may be used to detect coronary artery disease, and/or to determine safe levels of exercise following a heart attack or heart surgery.

  • Cardiac catheterization. With this procedure, X-rays are taken after a contrast agent is injected into an artery to locate the narrowing, occlusions, and other abnormalities of specific arteries.

Treatment of angina pectoris

Specific treatment for angina pectoris will be determined by the doctor based on:

  • Your age, overall health, and medical history

  • Extent of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

The underlying coronary artery disease that causes angina should be treated by controlling existing risk factors: high blood pressure, cigarette smoking, high blood cholesterol levels, high saturated fat diet, lack of exercise and excess weight.

Medications may be prescribed for people with angina. The most common is nitroglycerin which helps to relieve pain by widening the blood vessels. This allows more blood flow to the heart muscle and decreases the workload of the heart.

Other types of angina pectoris

There are two other forms of angina pectoris, including:

Variant angina pectoris
(or Prinzmetal's angina)

Microvascular angina

  • Is rare

  • Occurs almost exclusively when a person is at rest

  • Often does not follow a period of physical exertion or emotional stress

  • Attacks can be very painful and usually occur between midnight and 8 a.m.

  • Is related to spasm of the artery

  • Is more common in women

  • Can be helped by medications

  • A recently discovered type of angina

  • Patients with this condition experience chest pain but have no apparent coronary artery blockages

  • Doctors have found that the pain results from poor function of tiny blood vessels nourishing the heart as well as the arms and legs

  • Can be treated with some of the same medications used for angina pectoris

  • Was once called Syndrome X

  • Is more common in women

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