Angina is a form of chest discomfort or pain that occurs when the heart muscle does not receive an adequate supply of oxygen-rich blood. This reduced blood flow, usually due to narrowed or blocked coronary arteries, results in temporary chest pain, pressure, or a feeling of tightness.  
 

Features of Angina and Common Related Symptoms: 

Angina is characterized by specific features and symptoms that help distinguish it from other types of chest pain. Understanding these features is essential for early recognition and prompt medical attention. The common related symptoms of angina include: 

• Chest Pain or Discomfort: The primary feature of angina is a sensation of pressure, tightness, heaviness, or pain in the chest. The discomfort is often described as squeezing or burning and is typically felt behind the breastbone (sternum). The pain may also radiate to the left arm, shoulder, jaw, neck, or back. 
• Triggered by Physical Exertion or Stress: Angina is often induced or worsened by physical activity, emotional stress, or situations that increase the heart’s demand for oxygen. Activities such as walking uphill, climbing stairs, or even intense emotions can bring on angina symptoms. 
• Temporary Nature: Angina is usually of short duration, typically lasting only a few minutes. If the underlying cause of reduced blood flow is promptly addressed (e.g., by rest or medications), the symptoms typically subside. 
• Shortness of Breath: Angina can cause a feeling of breathlessness, especially during physical activity or when chest pain is severe.  
• Nausea and Indigestion. 
• Fatigue. 
• Dizziness or Lightheadedness. 
• Sweating. 
• Anxiety. 

What are types of angina? 

Angina can be classified into several types based on its characteristics and triggers. The main types of angina include: 

1. Stable Angina (Angina Pectoris): This is the most common type of angina. It occurs predictably and is typically triggered by physical activity or emotional stress. Chest pain or discomfort is usually relieved by rest or nitroglycerin medication. Stable angina is caused by narrowed coronary arteries, restricting blood flow to the heart during periods of increased demand. 

1. Unstable Angina: Also known as acute coronary syndrome, unstable angina is more serious and unpredictable than stable angina. It can occur at rest or with minimal exertion and often has no specific pattern. Unstable angina may be a warning sign of an impending heart attack and requires immediate medical attention. 

1. Variant Angina (Prinzmetal’s Angina): This type of angina is relatively rare and occurs due to temporary coronary artery spasms. The spasms cause the arteries to narrow, leading to reduced blood flow and chest pain. Variant angina often occurs at rest and can be triggered by exposure to cold temperatures or emotional stress. 

1. Silent Angina: Some individuals may have “silent” or “asymptomatic” angina, where they experience reduced blood flow to the heart without noticeable chest pain or discomfort. However, they are still at risk of heart damage and should be identified and managed by healthcare professionals. 

Angina and Heart Attack.

Angina is a warning sign of underlying heart disease, and chest pain is usually temporary and relieved with rest or medication. On the other hand, a heart attack is a life-threatening condition caused by a sudden blockage of a coronary artery, leading to permanent damage to the heart muscle if not treated promptly.  

What are the causes and risk factors of Angina? 

Angina is primarily caused by an insufficient supply of oxygen-rich blood to the heart muscle. The reduced blood flow is typically due to atherosclerosis, a condition where fatty deposits (plaque) build up within the coronary arteries that supply the heart. These deposits can narrow or block the arteries, restricting blood flow and leading to angina symptoms. The main causes of angina include: 

• Coronary Artery Disease (CAD): CAD is the most common cause of angina. It develops when plaque accumulates in the coronary arteries, narrowing their diameter and reducing blood flow to the heart. CAD is often a result of risk factors like high blood pressure, high cholesterol levels, smoking, diabetes, and an unhealthy lifestyle. 
• Coronary Artery Spasm: In variant angina (Prinzmetal’s angina), the coronary arteries may experience temporary spasms, causing them to constrict and reduce blood flow. The exact cause of these spasms is not always clear, but they may be related to abnormal muscle activity or sensitivity within the artery walls. 
• Microvascular Dysfunction: In microvascular angina, the small blood vessels (microvessels) that supply the heart muscle may have impaired function, leading to reduced blood flow to the heart. This dysfunction can occur independently of significant blockages in the major coronary arteries. 
• Emotional Stress: Emotional stress can trigger angina episodes, particularly in individuals with a history of angina or underlying heart disease. Stress-induced angina is primarily due to increased heart rate and blood pressure, demanding more oxygen from the heart. 
• Physical Exertion: Activities that require increased oxygen demand from the heart, such as brisk walking, climbing stairs, or lifting heavy objects, can provoke angina symptoms in individuals with narrowed coronary arteries. 
• Cold Weather: Some individuals with variant angina may experience angina attacks when exposed to cold temperatures. The mechanism is believed to involve coronary artery spasm triggered by cold weather. 
• Cocaine Use: Cocaine and certain other illicit drugs can constrict blood vessels, including the coronary arteries, leading to decreased blood flow and potential angina. 
• Anemia: Severe anemia, a condition characterized by low red blood cell count or hemoglobin levels, can lead to reduced oxygen-carrying capacity in the blood, potentially triggering angina in susceptible individuals. 

Risk Factors: 

• Age: As individuals get older, the risk of developing angina and coronary artery disease increases. 

• Gender: Men are generally at higher risk for angina and coronary artery disease than premenopausal women. However, the risk for women increases after menopause. 
• Family History: Having a family history of angina, heart disease, or stroke can elevate the risk, suggesting a genetic predisposition. 
• Smoking: Tobacco smoking is a significant risk factor for angina and coronary artery disease, as it damages blood vessels and accelerates atherosclerosis. 
• High Blood Pressure: Hypertension (high blood pressure) puts additional strain on the heart and increases the risk of angina. 
• High Cholesterol Levels: Elevated levels of LDL (low-density lipoprotein) cholesterol, often referred to as “bad” cholesterol, can lead to plaque formation in the coronary arteries. 
• Diabetes: People with diabetes are at higher risk of developing coronary artery disease due to high blood sugar levels and related metabolic changes. 
• Obesity: Being overweight or obese increases the risk of developing various risk factors, including high blood pressure, diabetes, and high cholesterol levels. 
• Sedentary Lifestyle: Lack of regular physical activity is associated with an increased risk of heart disease, including angina. 
• Unhealthy Diet: A diet high in saturated and trans fats, cholesterol, salt, and refined sugars increases the risk of coronary artery disease. 
• Chronic Kidney Disease: Impaired kidney function is associated with an increased risk of cardiovascular disease, including angina. 
• Stress and Depression: Chronic stress and untreated depression can influence heart health and contribute to angina risk. 

How is Angina diagnosed? 

Diagnosing angina involves a combination of medical history assessment, physical examination, and specific diagnostic tests. The process is aimed at evaluating the patient’s symptoms, risk factors, and heart health to determine if angina or another heart-related condition is present. Here are the key steps and diagnostic tests used in the diagnosis of angina: 

• Medical History and Physical Examination: The healthcare provider will start by taking a detailed medical history, including information about the patient’s symptoms, risk factors, family history of heart disease, and lifestyle habits. They will conduct a thorough physical examination, checking for signs of heart disease, such as abnormal heart sounds or murmurs. 
• Electrocardiogram (ECG/EKG): An ECG is a common and initial test used to evaluate heart function. It records the electrical activity of the heart and can show signs of reduced blood flow to the heart muscle during angina episodes. 
• Exercise Stress Test: During an exercise stress test, the patient walks on a treadmill or pedals a stationary bike while being monitored with an ECG. This test helps to induce angina-like symptoms in a controlled environment and assesses how the heart responds to physical exertion. 
• Stress Echocardiography or Nuclear Stress Test: These tests combine exercise or medication-induced stress with echocardiography (ultrasound imaging) or nuclear imaging to evaluate the heart’s function and blood flow during stress. 
• Coronary Angiography (Cardiac Catheterization): If non-invasive tests are inconclusive or if a patient has high-risk features, coronary angiography may be performed. During this procedure, a contrast dye is injected into the coronary arteries through a catheter to visualize any blockages or narrowing in the coronary arteries. 

• Blood Tests: Blood tests may be conducted to check for specific markers indicative of heart muscle damage, such as troponin levels, especially if a heart attack is suspected. 
• Echocardiogram: An echocardiogram uses ultrasound to create images of the heart’s structure and function, helping assess the heart’s pumping capacity and the presence of any structural abnormalities. 
• Others: CT scan, MRI, Holter Monitor, or Event Recorder. 

What are the treatments for Angina? 

The treatment for angina aims to relieve symptoms, improve the patient’s quality of life, and reduce the risk of complications. The specific treatment plan may vary based on the type and severity of angina, individual patient characteristics, and the presence of other medical conditions. The main treatments for angina include: 

 Medications: 

• Nitroglycerin: Nitroglycerin is a fast-acting medication used to relieve acute angina symptoms during an angina attack. It works by dilating (widening) the blood vessels, which improves blood flow to the heart and reduces chest pain. Nitroglycerin is available in various forms, including sublingual tablets, sprays, patches, and ointments. 
• Beta-Blockers: Beta-blockers are commonly prescribed to treat stable angina. These medications work by blocking the effects of adrenaline on the heart, resulting in a lower heart rate and reduced force of heart contractions. By doing so, beta-blockers reduce the heart’s workload and oxygen demand, making it less likely to trigger angina episodes. Examples of beta-blockers include metoprolol, atenolol, and propranolol. 
• Calcium Channel Blockers: Calcium channel blockers are used to treat stable angina and variant angina. They work by relaxing and widening the blood vessels, allowing for improved blood flow to the heart. Additionally, calcium channel blockers reduce the heart’s workload and can help prevent or reduce angina symptoms. Examples of calcium channel blockers include amlodipine, diltiazem, and verapamil. 
• Long-Acting Nitrates: Long-acting nitrates, such as isosorbide mononitrate and isosorbide dinitrate, are used to prevent angina episodes and reduce the frequency and severity of attacks.  
• Antiplatelet Agents: Medications like aspirin and clopidogrel are antiplatelet agents used to reduce the risk of blood clot formation. They are often prescribed to individuals at high risk of heart attack or stroke, including those with stable angina. 
• Statins: Statins are used to lower cholesterol levels in the blood, which can help stabilize plaque in the arteries and reduce the risk of future cardiac events.  
• ACE Inhibitors or ARBs: they are medications used to treat high blood pressure and heart failure. They can also be beneficial for some individuals with angina, as they help relax blood vessels and reduce the heart’s workload. 
• Ranolazine: Ranolazine is a medication specifically approved for chronic angina treatment. It works by reducing the heart’s oxygen demand and improving the heart’s efficiency in using available oxygen.  

Angioplasty and Stenting: In some cases, if coronary angiography reveals significant blockages, angioplasty and stenting may be performed. During this procedure, a small balloon is used to widen the blocked artery, and a stent (a tiny mesh tube) is inserted to keep the artery open and improve blood flow. 

Coronary Artery Bypass Grafting (CABG): CABG may be recommended for individuals with severe, widespread blockages in multiple coronary arteries. It involves creating a bypass using a healthy blood vessel from another part of the body to reroute blood around the blocked arteries. 

Cardiac Rehabilitation: Cardiac rehabilitation programs provide supervised exercise, education, and support to individuals with heart conditions, including angina. These programs help improve heart health, manage risk factors, and promote a healthier lifestyle. 

What are the complications of angina? 

Angina itself is a warning sign of an underlying heart condition, most commonly coronary artery disease (CAD). If left untreated or poorly managed, angina can lead to various complications. The potential complications of angina include: 

• Heart Attack (Myocardial Infarction, MI): Angina caused by reduced blood flow to the heart can progress to a heart attack if there is a complete blockage of a coronary artery. A heart attack occurs when a portion of the heart muscle is deprived of oxygen and nutrients, leading to permanent damage (necrosis) if not treated promptly. 
• Unstable Angina: Unstable angina is a more severe and unpredictable form of angina that can occur at rest or with minimal exertion. It is considered a medical emergency as it may indicate a higher risk of a heart attack. 
• Heart Failure: Chronic or severe angina can weaken the heart muscle over time, leading to heart failure. Heart failure occurs when the heart is unable to pump blood effectively, causing fluid buildup in the lungs and other parts of the body. 
• Arrhythmias: Reduced blood flow to the heart can disrupt the heart’s electrical signals, leading to abnormal heart rhythms (arrhythmias), such as atrial fibrillation or ventricular arrhythmias. 
• Cardiac Arrest: In some cases, severe angina or a heart attack can lead to cardiac arrest, where the heart suddenly stops beating. Cardiac arrest is a life-threatening emergency requiring immediate cardiopulmonary resuscitation (CPR) and defibrillation. 
• Disabling Angina: Chronic and severe angina can significantly impair a person’s quality of life, limiting their ability to perform daily activities and reducing overall physical function. 
• Psychological Impact: Living with angina and the fear of potential complications can cause emotional distress and anxiety, affecting the patient’s mental health. 

What are the expected outlook and prognosis of angina?  

The outlook and prognosis of angina can vary based on several factors, including the type and severity of angina, the effectiveness of treatment and lifestyle changes, the presence of other medical conditions, and the individual’s overall health status. Generally, the prognosis for angina is relatively positive if the condition is properly managed and risk factors are controlled. 

Tips for a healthy life, how to prevent Angina and reduce the risk factors? 

Preventing angina and reducing the risk factors for heart disease involves adopting a heart-healthy lifestyle. Here are some tips to promote a healthy life and reduce the risk of angina: 

Quit Smoking: If you smoke, quitting is the single most important step you can take to improve heart health and reduce the risk of angina. Seek help from healthcare professionals or support groups to quit successfully. 

Follow a Heart-Healthy Diet: 

• Eat a well-balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. 
• Limit intake of saturated and trans fats, cholesterol, sodium, and added sugars. 
• Choose low-fat or fat-free dairy products, lean meats, and fish rich in omega-3 fatty acids. 

Engage in Regular Physical Activity: 

• Aim for at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity exercise per week. 
• Incorporate activities like walking, swimming, cycling, or dancing into your routine. 
• Consult with a healthcare provider before starting a new exercise program, especially if you have existing health conditions. 

Maintain a Healthy Weight: If you are overweight or obese, losing weight can significantly reduce the risk of heart disease and angina. Even modest weight loss can have substantial benefits. 

Control Blood Pressure: High blood pressure (hypertension) is a significant risk factor for heart disease. Regularly monitor blood pressure and follow healthcare provider’s recommendations for managing hypertension. 

Manage Cholesterol Levels: High levels of LDL (low-density lipoprotein) cholesterol contribute to plaque formation in the arteries. Follow prescribed treatments and lifestyle changes to maintain healthy cholesterol levels. 

Control Diabetes: If you have diabetes, manage blood sugar levels through diet, exercise, and medications as prescribed by your healthcare provider. 

Limit Alcohol Intake: If you drink alcohol, do so in moderation. For men, this means up to two drinks per day, and for women, up to one drink per day. 

Managing Stress: Practice stress-reducing techniques such as deep breathing, meditation, yoga, or engaging in hobbies and activities that bring joy and relaxation. 

Follow Medication and Treatment Plans: If prescribed medications for heart conditions or other health issues, take them as directed by your healthcare provider. 

Regular Check-ups: Attend regular check-ups with your healthcare provider to monitor your heart health, manage risk factors, and address any concerns. 

By incorporating these tips into your lifestyle, you can reduce the risk of developing angina and other heart-related conditions. It is essential to take proactive steps towards heart health and to seek professional advice for personalized guidance and support. 

In conclusion,

your heart health is of utmost importance, and understanding the signs and risks of angina is essential. If you experience any symptoms like chest pain, shortness of breath, or related discomfort, we urge you not to delay seeking medical care. 

Consult with a healthcare professional for proper evaluation and guidance. Through early detection and appropriate management, you can take charge of your heart health and prevent potential complications. 

From the AORTA family, we send our warmest wishes for your well-being and vitality. May you embark on a heart-healthy journey, prioritizing your health, and embracing a fulfilling life. Remember, your heart matters, and seeking medical care is a proactive step towards a healthier future. Best wishes and take care.