Angina pectoris refers to chest pain due to heart disease. Your heart is made up of muscles that contract to pump the blood throughout the body. These muscles themselves are fed by the blood vessels called the coronary arteries. Insufficient blood supply to the heart muscles with regards to the demand, most commonly due to the problems of the coronary arteries, results in the symptom of chest pain called angina. The other causes of angina include anemia(decreased oxygen-carrying capacity of the blood), abnormalities of heart rhythms, and heart failure. The chest pain feels like squeezing or heaviness in the center of the chest. You may also feel pain or discomfort along the jaw, arm, and back.
Most commonly, it is caused by a partial or complete blockage of the coronary vessels due to atherosclerosis. Atherosclerosis refers to the deposition of small fatty deposits in the blood vessels causing obstruction and impedance to the blood flow. Abnormal spasms of the coronary vessels can also cause it in the case of Prinzmetal angina. Other conditions such as left ventricular hypertrophy, collagen vascular diseases, anemia may also cause angina.
People may suffer from different types of angina,
1- Stable angina: Stable angina is caused by fixed obstruction by atherosclerotic plaque. The cardinal feature is pain felt during increased physical activity or stress that is relieved by rest or sublingual nitroglycerine.
2- Unstable angina: unstable angina is caused by an active unstable atherosclerotic plaque, which attracts platelets, undergoes thrombosis, and increases in size day by day, ultimately causing complete blockage resulting in myocardial ischemia (heart attack). Its cardinal features are worsening, severe, or new-onset chest pain that occurs even at rest and is unpredictable. It is an emergency as it can lead to a heart attack.
3- Prinzmetal's angina: it is also known as variant angina. It is not caused by atherosclerotic plaques. Instead, it is due to abnormal spasms of the coronary arteries leading to the diminished blood supply to the heart muscles. It can happen during stress or at rest and is relieved by nitroglycerine.
Having one or more of the following risk factors may increase your chances of developing angina;
1- Family history: If any of your family members have a history of the early development of coronary artery disease (CAD), it predisposes you to the same.
2- Smoking: Smoking tobacco increases the risk of coronary artery disease and angina.
3- Diabetes mellitus: suffering from DM predisposes you to angina.
4- Hypertension: High blood pressure is an important risk factor. It can increase the resistance to blood flow and can also cause enlargement of the left ventricle of the heart.
5- Abdominal obesity: increased waist circumference of >40 inches for men or >35 inches for women can put you at risk of developing coronary artery disease.
6- High triglycerides, low HDL cholesterol: HDL cholesterol is the good cholesterol that saves you from developing CAD. Lower HDL levels and high levels of triglycerides can increase your chances of having CAD and angina.
Annually, around 9.8 million Americans have reported experiencing angina, with the number of new cases being 500,000 every year. It affects the age groups between 45b to 64 years and is found more in African Americans, especially women.
It would be beneficial for you to be aware of the signs and symptoms of angina to keep yourself safe from an impending heart attack, described as follows:
If your symptoms are progressing and are now felt even at rest, you must visit your physician as it may point towards unstable angina.
After taking a detailed history and physical examination, your doctor may advise you to undergo one or more of the following tests to confirm the chest pain.
The electrical activity of the heart is measured in this fast procedure. Adhesive plugs (electrodes) are applied to the chest and the arms or legs in some cases. The electrodes are connected to a computer through wires, which shows findings. An Electrocardiogram can reveal whether the heart is beating excessively quickly, slowly, or not at all. The ECG may suggest that you've had or are experiencing a heart attack because wounded muscle tissue doesn't conduct electrical signals in a regular pattern.
Increased amounts of specific proteins or enzymes found in cardiac muscle may be detected by blood testing. Injury to cardiac tissue caused by a heart attack may enable these proteins or enzymes to escape into the bloodstream over several hours.
X-ray of the chest
A chest X-ray can reveal the state of the lungs and the size and form of the heart and main blood channels. A chest X-ray can also show lung disorders such as pneumonia or a collapsed lung.
These tests are performed to check your heart’s response to exercise and find out if the chest pain you are having is due to heart disease or not.
Coronary catheterization is a procedure that involves inserting a catheter into the coronary artery. This procedure allows doctors to see any obstructions in the heart vessels. A catheter is a long, narrow, flexible tube placed into a blood channel and directed to the heart, generally in the pelvis or forearm. Dye is delivered to the heart vessels via the catheter. The dye makes X-ray video and photos show the arteries more effectively. This test is also known as coronary angiogram.
Chest pain can be caused by some other conditions also like;
A holistic approach is required to treat angina that includes lifestyle changes, smoking cessation, treatment of the risk factors (like Diabetes Mellitus, hypertension), medications, angioplasty, or bypass heart surgery. The goal of the treatment is to manage the symptoms and reduce the risk of a heart attack.
These are some medications used to treat chest pain caused by the heart.
Nitroglycerin: This allows blood to flow more freely through the restricted gaps as it relaxes the arteries.
Aspirin: If your chest pain is thought to be linked to your heart, you'll most likely be prescribed aspirin.
Thrombolytic medications: They remove the clot that prevents blood from flowing to the heart muscle. Examples include; streptokinase, t-PA, reteplase.
Blood thinners are drugs that thin the blood. If you have a blockage in an artery that feeds your heart or lungs, you'll almost certainly be prescribed anticoagulant medicines to stop future clots formation. For example Clopidogrel.
Beta-blockers: These are medicines that slow down the heart rate, so the oxygen demand of the heart muscle is lessened. They also improve blood flow to the heart by relaxing the blood vessels. For example; Metoprolol, Propranolol.
Calcium channel blockers: These medicines improve blood flow to the heart by relaxing the blood vessels. Examples include; Amlodipine, Verapamil.
The prognosis depends on how well the patient adheres to the treatment plan, the degree of obstruction, comorbid diseases, and their control. Smoking cessation is very important. If a patient takes all his medicines regularly and adopts a healthy lifestyle, the outcome is usually good. Otherwise, untreated angina will ultimately lead to a heart attack. In 2005, about 1 of every 5 deaths were recorded in the United States due to coronary heart disease.
Angioplasty: This is the most common treatment for chest pain due to an obstruction in a heart artery. A catheter with a balloon on the tip is inserted into a big blood channel, generally in the pelvis, and guided to the obstruction. The balloon is inflated to expand the vessel, then deflated, and the catheter is removed. A tiny stent is frequently kept outside the catheter's balloon tip. The stent expands and seals into position, keeping the artery intact.
Bypass surgery: It is a procedure that involves the removal of a portion of a blood vessel from some other body part to establish a passage for blood to bypass the clogged artery.
Adopting the following lifestyle changes may prevent you from developing coronary heart disease and angina.
Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 04, 2023.