Angina:cause,treatment and prevention

Angina refers to chest pains that happen when there is reduce blood supply to heart muscles.

Angina, which may also be called angina pectoris, is often described as squeezing, pressure, heaviness, tightness or pain in 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. Angina may be a new pain that needs evaluation by a doctor, or recurring pain that goes away with treatment.

Types and Symptoms of Angina:

There are several types of angina, namely:

Stable angina
Unstable angina
Variant angina or Prinzmetal angina

1.Stable Angina: Angina pectoris refers to a chest pain or discomfort due to coronary heart disease. It happens when the heart muscles do not get enough blood due to narrowing and hardening of coronary blood vessels, a condition known as ischemia.

It occurs when the heart muscles are deprived of blood and oxygen during strenuous physical activity or strong emotions. Extremely narrowed arteries might supply enough blood to the heart muscles in rest conditions. During exertion, the heart works harder and requires more oxygen which these blood vessels fail to supply.

Common symptoms of Angina are as follows:

Chest pains, which might spread to the arms, back and other areas
Shortness of breath
Nause
Fatigue
Dizziness
Profuse sweating
Anxiety

The symptoms of stable angina last for short duration (5 minutes or less) and disappear if the person takes rest or have angina medication.

2.Unstable Angina: Unstable angina is sometimes referred to as acute coronary syndrome and causes unexpected chest pain which generally occurs when the person is resting. The most common cause of unstable angina is decreased blood flow to the heart muscle. This occurs due to narrowing of coronary blood vessels due to fat deposition, called plaques. These plaques can rupture, causing injury to the coronary blood vessel, leading to clotting of blood which blocks blood flow. This is a condition of medical emergency.

Symptoms are:

Chest pains radiating to shoulder, arm, jaw, back and other areas
Discomfort in which a patient experiences the sensation of tightness, squeezing,
crushing, burning, choking or aching
Shortness of breath
Sweating
Sudden onset
Decreased blood pressure

These symptoms last longer than 15 to 20 minutes and do not respond to a medicine, nitroglycerin.

3. Variant Angina: It occurs when a person is at rest, usually between midnight and morning. These anginas can be very painful. It is a rare form of angina. and it is present only in about 2 out of 100 cases. It is found in younger patients. It occurs due to spasm in coronary blood vessels.

Symptoms are:

Severe pain in chest radiating to neck, shoulder, back and other areas
Loss of consciousness

The symptoms, which occur when a person is at rest, are relieved by taking medicines. There is an elevation of the ST segment in ECG. Typically, the symptoms appear at the same time each day, between midnight and 8 am.

Risk factors:

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

Tobacco use. Chewing tobacco, 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 block blood flow.
Diabetes. Diabetes is the inability of your body to produce enough 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 increases the risk of coronary artery disease, which leads to angina and heart attacks by speeding up atherosclerosis and increasing your cholesterol levels.
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 by accelerating hardening of the arteries.

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, known as low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol), increases your risk of angina and heart attacks. A high level of triglycerides, a type of blood fat related to your diet, also is undesirable.
Family history of heart disease. If a family member has coronary artery disease or has had a heart attack, you’re at a greater risk of developing angina.
Older age. Men older than 45 and women older than 55 have a greater risk than do younger adults.
Lack of exercise. An inactive lifestyle contributes to high cholesterol, high blood pressure, type 2 diabetes and obesity. However, it is important to talk with your doctor.
Obesity. 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.
Stress. Stress can increase your risk of angina and heart attacks. Too much stress, as well as anger, also can raise your blood pressure. Surges of hormones produced during stress can narrow your arteries and worsen angina.

Complications:

The chest pain that occurs with angina can make doing some normal activities, such as walking, uncomfortable. However, the most dangerous complication is a heart attack.

Common signs and symptoms of a heart attack include:

Pressure, fullness or a squeezing pain in the center of your chest that lasts for more than a few minutes
Pain extending beyond your chest to your shoulder, arm, back, or even to your teeth and jaw
Increasing episodes of chest pain
Prolonged pain in the upper abdomen
Shortness of breath
Sweating
Impending sense of doom
Fainting
Nausea and vomiting

If you have any of these symptoms, seek emergency medical attention immediately.

Prevention:

You can help prevent angina by making the same lifestyle changes that might improve your symptoms if you already have angina. These include:

Quitting smoking
Monitoring and controlling other health conditions, such as high blood pressure, high cholesterol and diabetes
Eating a healthy diet and maintaining a healthy weight
Increasing your physical activity after you get your doctor’s OK. Aim for 150 minutes of moderate activity each week. Plus, it’s recommended that you get 10 minutes of strength training twice a week and to stretch three times a week for 5 to 10 minutes each time.
Reducing your stress level
Limit alcohol consumption to two drinks or fewer a day for men, and one drink a day or less for women.
Get an annual flu shot to avoid heart complications from the virus

Diagnosis and tests for angina:

Following tests are performed to diagnose angina:

ECG
Stress testing
Chest X-ray
Coronary angiography and cardiac catheterization
CTA
Blood tests
Echocardiogram
The main aims of the treatment are:
Decrease pain and discomfort
Decrease the frequency of anginal attacks
Prevent or decrease the risk of heart attack and death
Lifestyle changes and medicines are prescribed to manage angina in its early stages.
When these don’t work, medical procedures and cardiac rehab are done. Unstable angina, however, is a case of medical emergency.

Medications:

Nitrates: These are commonly used to treat angina. They relax and expand blood vessels, thereby improving the blood flow to the heart, reducing the heart’s workload. Nitroglycerine is commonly prescribed for treating angina.
Aspirin: Aspirin in doses of 75 mg to 325 mg as immediate release tablet and 162 mg as an extended-release tablet is used for protecting the patient against angina. It acts as a blood thinner and helps the blood to flow. It also lowers blood clotting ability which decreases the risk of heart attack. It is advised to take aspirin only under medical supervision.
Clot Preventing Drugs: Drugs like clopidogrel, prasugrel, ticagrelor, etc. can be used to prevent blood clots from forming. They make the platelets less likely to stick with each other.
Beta Blockers: They work by blocking the effect of adrenalin on heart, which causes slowing of the heart, particularly, during strenuous physical activity and reduction of force with which heart muscles contract. These effects decrease the requirement of oxygen.
Statins: These are drugs which lower blood cholesterol levels, thereby decreasing the risk of angina. They also help in reabsorbing cholesterol which has accumulated in the plaques. Hence it reduces the incidence of angina
Calcium channel blockers: These expand and relax by affecting the cells of arteries. This increases the blood flow to the heart muscles and prevents the development of ischemic conditions and angina.
Ranolazine: It is used as a second-line treatment in curing chronic angina. It can be taken along with the medications used for erectile dysfunction.