chest pain or angina

Angina is a sort of chest pain that happens due to insufficient blood flow to a part of your heart. It might feel like a heart attack, with acute pressure, squeezing, pain, heaviness, or tightness in the chest. It is also referred to as "angina pectoris" or "ischemic chest pain."

 

Angina is a symptom of coronary artery disease (CAD), and it occurs when something obstructs your arteries or when there isn't adequate blood flow in the arteries that carry oxygen-rich blood to your heart.

 

What Does Angina Feel Like?

 

Some people having angina have reported that they feel like a vise squeezing their chest or as if there's a heavyweight lying on their chest. It may be a new pain that a doctor needs to diagnose or a persistent pain that subsides with treatment.

 

Angina is relatively common and often goes away quickly. Still, it can be a warning sign of a life-threatening heart condition. Most people cannot distinguish angina from other types of chest pain, like the discomfort caused due to indigestion. Consult your healthcare specialist immediately if you have unexplained chest pain to help prevent a heart attack from occurring.

 

Most cases of angina can be managed with medications and lifestyle modifications. However, some people with severe angina may also require surgery. The doctor may also use a stent to treat your condition. 

 

What Are The Different Types Of Angina?

 

There are various types of angina. Knowing about them and how they differ is crucial. 

 

Stable Angina / Angina Pectoris

 

  • This is the most common type of angina. 
  • It happens when your heart works more than usual. For example: during physical activity or stress.
  • It generally lasts for five minutes and goes away with rest or medication.
  • It isn’t a heart attack but can be a warning sign that you are more likely to have one.
  • Consulting a doctor is advised to minimize the risk of a future heart attack.

 

Unstable Angina

 

  • It can occur when you are at rest or not very active.
  • It may cause intense, persistent pain, which may recur again and again.
  • It lasts longer than stable angina, maybe 30 minutes or even more.
  • It may not disappear with rest or medication.
  • It may be a warning sign that you are about to have a heart attack, so consult your doctor without any delay.

 

Microvascular Angina

 

  • It occurs when your smallest coronary artery isn’t working appropriately. As a result, your heart doesn’t receive adequate amounts of blood.
  • This type of angina causes pain but no blockage in your coronary artery.
  • The pain generally persists for more than 10 minutes.
  • Microvascular angina is more common in women than in men.

 

Variant (Prinzmetal) Angina

 

  • This type of angina is rare.
  • It usually occurs at night when you are resting or sleeping.
  • It happens when your coronary arteries suddenly tighten or contract.
  • It might get relieved with angina medication. You should consult your doctor immediately and get it treated.

 

What Are The Symptoms Of Angina?

 

Angina involves any of the following sensations in the chest:

 

  • Pressure
  • Squeezing
  • Tightening
  • Heaviness
  • Aching or burning in the chest, starting behind the breastbone

 

The pain usually extends to the neck, jaws, teeth, shoulders, arms, throat, or back. Other prospective symptoms include:

 

  • Heartburn
  • Indigestion
  • Nausea
  • Shortness of breath
  • Sweating
  • Cramping
  • Weakness

 

The type of angina will decide the duration of your symptoms. Anyone who experiences intense or persistent pain in the chest should call 911 or immediately consult their doctor.

 

Angina symptoms in females

 

Angina usually stems from MVD or CHD. MVD affects more females than men, and women may experience various symptoms that accompany angina. Females may experience severe chest pain, along with:

 

  • Abdominal pain
  • Nausea and vomiting
  • Shortness of breath
  • Fatigue 

 

Females should be extra cautious in recognizing the signs of heart disease. Studies suggest that cardiovascular disease is the leading cause of death among females in the United States.  

 

What Causes Angina?

 

Angina generally occurs due to heart disease. A fatty substance called plaque gets accumulated in your arteries, obstructing blood flow to your heart muscles. This compels your heart to work with lesser oxygen, which causes pain. You can also have blood clots in the arteries of your heart, which may lead to a heart attack. 

 

Some less common causes of chest pain include:

 

  • An enlarged or thickened heart (hypertrophic cardiomyopathy)
  • A blockage in a major artery of your lungs (pulmonary embolism)
  • Swelling of the sac around your heart 
  • Narrowing of a valve in the central part of your heart (aortic stenosis)
  • Tearing in the wall of your aorta, the largest artery in your body (aortic dissection)

 

Who Is At Risk For Angina?

 

Following factors can increase your risk for Angina:

 

  • Stress
  • Overuse of alcohol or recreational drugs
  • Smoking
  • Unhealthy diet
  • Exposure to particulate pollution, for instance, at work.
  • Low physical activity
  • Overweight or obesity
  • Genetic factors
  • High cholesterol levels
  • Certain medical treatments and procedures
  • Conditions such as low blood pressure, diabetes, heart disease, anemia, or metabolic syndrome
  • An age of over 45, for males, and 55, for females

 

Also Read: FAQs: Severe Acute Respiratory Syndrome(SARS)

 

How Is Angina Diagnosed?

 

To diagnose angina, your healthcare provider will start by doing a physical exam and questioning about your symptoms. You will also be asked about any risk factors, including whether you have a personal or family history of heart disease.

 

Some of the following tests will help your doctor confirm the diagnosis.

 

  • Stress test: This heart-monitoring test is used to check how well your heart is performing when it's working harder. During a stress test, you will be asked to perform a physical exercise like pedaling a stationary bicycle or walking on a treadmill. As your exercise, the doctor will record your blood pressure and ECG readings. Other tests also can be performed at the same time as a stress test. If you are unable to exercise, drugs that mimic the heart's response to exercise can be used.

 

  • Electrocardiogram (ECG or EKG): Each of your heartbeats is triggered by an electrical impulse produced from special cells in your heart. An electrocardiogram is a device that records these electrical signals as they traverse through your heart. Your healthcare specialist will look for patterns among these heartbeats to check if the blood flow through your heart has been decelerated or interrupted or if you have a heart attack.

 

  • Echocardiogram: During this test, a transducer that generates high-frequency sound waves is used to produce moving pictures of the heart. The movement of the walls of the heart is monitored. If there is reduced motion within a part of the wall of the heart, this might indicate reduced blood flow from the tapering of the coronary artery. Imaging tests may also be conducted with a pharmaceutical substance stressing the heart to identify decreased motion in a part of the heart muscle with stress.

 

  • Nuclear stress test: This test helps evaluate blood flow to your heart muscle at rest and during stress. It is analogous to a standard stress test, but during a nuclear stress test, radioactive material is introduced into your bloodstream. This material combines with your blood and moves to your heart. A special scanner, which identifies the radioactive substance in your heart, demonstrates how the substance travels with the blood in your heart muscle. Inadequate blood flow to any portion of your heart can be viewed on the images as not much of the radioactive material is getting there.

 

  • Blood tests: The blood tests can detect certain enzymes, including troponin, that may leak into your bloodstream after your heart has experienced severe angina or a heart attack. These tests can also see increased LDL, cholesterol, and triglycerides that puts you at an elevated risk for coronary artery disease (CAD) and, therefore, angina.

 

  • Chest x-ray: This noninvasive imaging test helps your doctor to rule out the possibility of other conditions that mimic similar symptoms like angina, such as pneumonia. Imaging with x-rays includes exposing the chest to a little amount of radiation to generate pictures of the chest and heart.

 

  • CT scan: Chest CT scan is a more sensitive test than chest x-ray that can help detect other causes of chest pain, including aortic disease or blood clots in the lungs' blood vessels. This test integrates special x-ray equipment with advanced computers to create a series of images of your chest and heart.

 

  • Cardiac MRI: This test's key objective is to detect whether there is adequate blood flow to the heart muscle. If there are some regions with reduced blood flow, this may indicate plaque with blood vessel constricting. This blood flow test can be performed twice during the exam by using contrast material. The first time can be conducted after the administration of a medication, which stresses the heart like exercise. The second time, it will be conducted at rest. Performing the assessment, both with stress and rest, helps identify if the reduced blood flow only takes place with exercise. MRI also helps evaluate the function of your heart and specify if there is any scar in your heart muscle. MRI machines tend to use a strong magnetic field, radio waves, and a computer to create extensive images.

 

  • Coronary angiography: This test uses X-ray imaging to assess the inside of your heart's blood vessels. It is a constituent of a customary group of procedures called cardiac catheterization. During coronary angiography, a kind of dye that is visible by an X-ray machine is introduced into the blood vessels of your heart. The X-ray machine swiftly generates multiple images (angiograms), providing a comprehensive view of the inside of your blood vessels.

 

How Is Angina Treated?

 

There are various treatment alternatives for angina, including lifestyle modifications, medications, medical procedures, and surgery. All these treatments aim to alleviate the severity and frequency of your symptoms and minimize your risk of heart attack and death. Although, if you have unstable angina or angina pain that’s quite different from what you generally have, you require immediate treatment in a hospital. 

 

Lifestyle and Home Remedies

 

In some cases, angina recovers only with some lifestyle modifications. Here are some healthy lifestyle changes you can consider and prevent angina or minimize your risk of developing a heart disease:

 

  • If you smoke, quit smoking. Also, avoid exposure to second-hand smoke.
  • If you are overweight/obese, talk to your doctor about your weight-loss alternatives.
  • Work with your doctor to create a safe exercise program for you.
  • Eat a healthy diet comprising lots of fresh fruits and vegetables, whole grains, and limited amounts of saturated fats. 
  • As angina most often occurs due to exertion, it can help pace yourself and take frequent rests.
  • If you consume alcohol, do it in moderation - 01 standard drink for women, and 02 standard drinks for men. 
  • Please avoid large meals, which can make you overly full.
  • Treat conditions or diseases that may increase your risk of angina, including high blood pressure, high cholesterol, and diabetes. 
  • Avoid stress as much as possible. 

 

Medication

 

If lifestyle changes alone, don’t cure your angina, you may need to take medications. Some medicines generally prescribed for angina are:

 

  • Nitrates
  • Aspirin
  • Beta-blockers
  • Statins
  • Clot-preventing drugs
  • Blood pressure regulating medicines
  • Calcium channel blockers
  • Ranolazine

 

Medical Procedures and Surgery

 

In most cases, lifestyle changes, along with medications, are enough to ease angina. Although severe cases may demand a medical procedure such as:

 

 

 

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