Angina

Definition
Angina is a type of chest pain or discomfort caused by reduced blood flow to the heart muscle. Angina (an-JI-nuh or AN-juh-nuh) is a symptom of coronary artery disease. When your heart muscle (myocardium) doesn't get enough oxygen-rich blood, you may have chest pain. Angina is typically described as squeezing, pressure, heaviness, tightness or pain in your chest. Many people with angina say it feels like someone is standing on their chest.

Angina, also called angina pectoris (pectoris means chest), may be stable or unstable:

Stable angina (also called chronic stable angina)
Unstable angina (signals an impending heart attack)

A third, a rare type of angina called variant angina (also called Prinzmetal's angina) is caused by a coronary artery spasm.

Angina is relatively common. More than 6 million people in the United States have angina. Angina can be hard to distinguish from other types of chest pain, such as the pain or discomfort of indigestion. If you have unexplained chest pain, seek medical attention right away.

Symptoms
Chest pain and chest discomfort are the main symptoms or characteristics of angina. Nausea, fatigue, shortness of breath, anxiety, sweating or dizziness are other symptoms that may accompany angina.

Characteristics of angina The chest pain and discomfort common with angina may be described as pressure, squeezing, fullness or pain in the center of your chest. Some people with angina symptoms describe angina as feeling like a vise is squeezing their chest, or feeling like a heavy weight has been placed on their chest. This pressure can extend to the arm, especially the left arm, neck, jaw, shoulder or back.The severity, duration and type of angina can vary. It's important to recognize if you have new or changing chest pain. New or different symptoms may signal a more dangerous form of angina (unstable angina) or a heart attack.



Stable angina:

Develops when your heart works harder, such as when you exercise or climb stairs

Can usually be predicted and the pain is usually similar to previous types of chest pain you've had

Lasts a short time, perhaps 5 minutes or less

Disappears if you rest or use your angina medication

Could feel like indigestion

Might spread to your arms, back or other areas

Can be triggered by mental or emotional stress



Unstable angina:

Occurs even at rest

Is a change in your usual pattern of angina

Is unexpectedIs usually more severe and lasts longer than stable angina; maybe as long as 30 minutes

May not disappear with rest or use of angina medication

Might signal a heart attack



Variant angina:Usually happens when you're resting

Is often severe

May be relieved by angina medication



Angina in women A woman's angina symptoms can be different from the classic angina symptoms. For example, a woman may have chest pain that feels like a stabbing, pulsating or sharp form of chest pain rather than the more typical vise-like pressure. Women are also more likely to experience symptoms such as nausea or abdominal pain. These differences may lead to delays in seeking treatment.Stable angina is the most common form of angina. If this is a new symptom for you, it's important to see your health care provider to establish the diagnosis and proper treatment. If your stable angina gets worse or changes, becoming unstable, seek medical attention immediately.



Causes

Angina is caused by reduced blood flow to your heart muscle. Your blood carries oxygen, which your heart muscle needs to survive. When your heart muscle isn't getting enough oxygen, it causes a condition called ischemia.



The most common cause of reduced blood flow to your heart muscle is coronary artery disease (CAD). Your heart (coronary) arteries can become narrowed by fatty deposits called plaques. This is called atherosclerosis.



This reduced blood flow is a supply problem — your heart is not getting enough oxygen-rich blood. You may wonder why you don't always have angina if your heart arteries are narrowed due to fatty buildup. This is because during times of low demand — when you're resting, for example — your heart muscle may be able to get by on the reduced amount of blood flow without triggering angina symptoms. But when you increase the demand for oxygen, such as when you exert yourself, this can cause angina.



Stable angina. Stable angina is triggered by physical exertion. When you climb stairs, exercise or walk, your heart demands more blood, but it's harder for the muscle to get enough blood when your arteries are narrowed. Besides physical activity, factors such as emotional stress, cold temperatures, heavy meals and smoking also can narrow arteries and trigger angina.



Unstable angina. If fatty deposits (plaques) in your blood vessel rupture or a blood clot forms, it can quickly block or further reduce flow through the already narrowed artery, suddenly and severely decreasing blood flow to the heart muscle. Unstable angina can also be caused by conditions such as severe anemia, especially if an individual already has narrowed coronary arteries. Unstable angina worsens and is not relieved by rest or your usual medications. If the blood flow doesn't improve, heart muscle deprived of oxygen dies — a heart attack. Unstable angina is dangerous and requires emergency treatment.



Variant angina. Variant angina, also called Prinzmetal's angina, is caused by a spasm in a coronary artery in which the artery briefly narrows. This narrowing reduces blood flow to your heart. Variant angina is relatively rare and accounts for about 2 percent of angina cases.



Risk factors

Having coronary artery disease increases your risk of angina. If you've had a heart attack, this also increases your risk. Unstable angina is more common in older adults.



The following risk factors increase your risk of coronary artery disease and angina:



Tobacco smoke. Smoking and long-term exposure to secondhand smoke damage the interior walls of arteries — including arteries to your heart — allowing deposits of cholesterol to collect and hamper blood flow.



High blood pressure. Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. Over time, high blood pressure damages arteries that feed your heart by accelerating atherosclerosis. High blood pressure can be an inherited problem. The risk of high blood pressure increases as you age, but the main culprits for most Americans are eating a diet too high in salt, stress, inadequate exercise and being overweight.



High blood cholesterol or triglyceride levels. Cholesterol is a major part of the deposits that can narrow arteries throughout your body, including those that supply your heart. A high level of the wrong kind of cholesterol in your blood increases your risk of angina and heart attacks. Low-density lipoprotein (LDL) cholesterol (the "bad" cholesterol) is most likely to narrow arteries. A high LDL level is undesirable and is often a byproduct of a diet high in saturated fats and cholesterol. A high level of triglycerides, a type of blood fat related to your diet, also is undesirable. However, a high level of high-density lipoprotein (HDL) cholesterol (the "good" cholesterol) is desirable and lowers your risk of angina and heart attacks.



Lack of physical activity. An inactive lifestyle contributes to high blood cholesterol levels and obesity. Conversely, people who get regular aerobic exercise have a lower overall risk of coronary artery disease, angina and heart attacks. Exercise is beneficial in lowering high blood pressure, which may account for much of the benefit. However, it is important to consult with your doctor before starting an exercise program.



Obesity. Obesity involves having a high proportion of body fat. Obesity raises the risk of angina and heart disease because it's associated with high blood cholesterol levels, high blood pressure and diabetes. Also, your heart has to work harder to supply blood to the excess tissue.



Diabetes. Diabetes is the inability of your body to produce or respond to insulin properly. Insulin, a hormone secreted by your pancreas, allows your body to use glucose, which is a form of sugar from foods. Diabetes can occur in childhood, but it appears more often in middle age and among overweight people. Diabetes greatly increases the risk of coronary artery disease, which leads to angina and heart attacks by speeding up atherosclerosis and negatively affecting blood cholesterol levels.



Stress. You may respond to stress in ways that can increase your risk of angina and heart attacks. If you're under stress, you may overeat or smoke from nervous tension. Too much stress, as well as anger, can also raise your blood pressure. Adrenaline surges produced during stress can constrict arteries and worsen angina.



Alcohol. Consumed in moderation, alcohol may help raise HDL levels — the "good" cholesterol — and can have a protective effect against heart attack. On the other hand, excessive drinking can damage your heart muscle and raise your blood pressure and triglyceride levels, increasing your risk of angina and heart attacks.



Lifestyle and home remedies

Because heart disease is often the underlying cause of most forms of angina, you can reduce or prevent angina by working on reducing your heart disease risk factors. Lifestyle changes are the most important step you can take:

If you smoke, stop smoking.

Eat a healthy diet with limited amounts of saturated fat, lots of whole grains, and many fruits and vegetables.

Talk to your doctor about starting a safe exercise plan.

If you're overweight, talk to your doctor about weight-loss options.

Take anti-angina medications as prescribed and follow your doctor's directions closely.

Treat diseases or conditions that can increase your risk of angina, such as diabetes, high blood pressure and high blood cholesterol.

Because angina is often brought on by exertion, it's helpful to pace yourself and take rest breaks.

Avoid large meals that make you feel really full.

Avoiding stress is easier said than done, but try to find ways to relax. Talk with your doctor about stress-reduction techniques.