Angina

Complete Guide with FAQs

Introduction

  • Angina is chest pain or discomfort caused by reduced blood flow to the heart muscles, often due to coronary artery disease (CAD).
  • It is a symptom of underlying heart problems, not a disease itself.
  • Commonly described as pressure, heaviness, or tightness in the chest, angina can also radiate to the arms, neck, jaw, or back.
  • Prompt diagnosis and treatment are crucial to prevent complications like heart attack.

Types of Angina

  1. Stable Angina
    • Triggered by physical exertion or emotional stress.
    • Symptoms improve with rest or medication (e.g., nitroglycerin).
  2. Unstable Angina
    • Occurs unpredictably, even at rest.
    • A medical emergency requiring immediate attention as it can lead to a heart attack.
  3. Variant (Prinzmetal’s) Angina
    • Caused by spasms in coronary arteries.
    • Often occurs at rest, typically at night or early morning.
  4. Microvascular Angina
    • Affects the small coronary arteries rather than the main ones.
    • Symptoms may last longer and are not always relieved by nitroglycerin.

Causes of Angina

  • Coronary Artery Disease (CAD): Narrowing or blockage of coronary arteries by plaque buildup (atherosclerosis).
  • Coronary Artery Spasm: Temporary tightening of blood vessels.
  • Other Contributing Factors:
    • High blood pressure.
    • High cholesterol levels.
    • Diabetes.
    • Smoking.
    • Obesity and physical inactivity.

Symptoms of Angina

  1. Classic Symptoms:
    • Chest pain or discomfort (pressure, squeezing, or fullness).
    • Pain spreading to shoulders, arms, neck, or jaw.
  2. Other Symptoms:
    • Shortness of breath.
    • Nausea or vomiting.
    • Fatigue or dizziness.
    • Sweating.
  3. Triggers:
    • Physical exertion.
    • Emotional stress.
    • Cold weather.
    • Heavy meals.

Complications of Angina

  • Heart Attack: Prolonged lack of blood flow can lead to myocardial infarction.
  • Arrhythmias: Irregular heart rhythms due to insufficient oxygen.
  • Heart Failure: Chronic angina can weaken the heart over time.

Diagnosis of Angina

  1. Medical History and Physical Examination
    • Assessing risk factors like family history, lifestyle, and underlying conditions.
  2. Diagnostic Tests:
    • Electrocardiogram (ECG): Identifies changes in heart rhythm.
    • Stress Test: Monitors heart performance under physical or pharmacological stress.
    • Echocardiogram: Evaluates heart structure and blood flow.
    • Coronary Angiography: Visualizes blood flow in coronary arteries.
    • Blood Tests: Measure cardiac enzymes to rule out heart attack.

Treatment Options for Angina

1. Medications

Nitrates

  • Examples: Nitroglycerin, Isosorbide Mononitrate.
  • Relax and widen blood vessels to improve blood flow.

Beta-Blockers

  • Examples: Metoprolol, Atenolol.
  • Reduce heart rate and oxygen demand of the heart.

Calcium Channel Blockers

  • Examples: Amlodipine, Diltiazem.
  • Relax blood vessels and improve oxygen supply to the heart.

Antiplatelets

  • Examples: Aspirin, Clopidogrel.
  • Prevent blood clots in coronary arteries.

Statins

  • Examples: Atorvastatin, Simvastatin.
  • Lower cholesterol levels and stabilize plaques.

Ranolazine

  • Reduces chest pain without affecting heart rate or blood pressure.

2. Procedures and Surgery

  1. Angioplasty and Stenting
    • A catheter is used to open blocked arteries, and a stent is placed to keep them open.
  2. Coronary Artery Bypass Grafting (CABG)
    • Bypasses blocked coronary arteries using grafts from other parts of the body.

3. Lifestyle Changes

  • Diet: Adopt a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins.
  • Exercise: Engage in regular, moderate physical activity approved by your doctor.
  • Smoking Cessation: Reduces the risk of CAD progression.
  • Stress Management: Practice relaxation techniques like yoga or meditation.
  • Weight Management: Maintain a healthy weight to reduce strain on the heart.

Monitoring Parameters

  • Frequency and intensity of angina episodes.
  • Blood pressure and heart rate.
  • Lipid profile (LDL, HDL, triglycerides).
  • Regular follow-up with a healthcare provider to evaluate treatment effectiveness.

Patient Counseling Points

  • Take medications as prescribed, and carry nitroglycerin at all times for quick relief.
  • Recognize early warning signs of a heart attack and seek emergency care if necessary.
  • Follow lifestyle modifications to reduce angina episodes and improve heart health.
  • Limit physical activity during angina episodes and resume only when cleared by your doctor.

Use in Children

  • Rare, typically linked to congenital heart defects or Kawasaki disease.

Use in Pregnancy

  • Angina during pregnancy is rare; treatment focuses on safe medications like beta-blockers or nitrates.

Use in Elderly

  • Monitor closely for medication side effects, as the elderly are more prone to complications.

FAQs About Angina

Q1: What is angina?

  • Angina is chest pain caused by reduced blood flow to the heart muscles, often due to coronary artery disease.

Q2: What triggers angina?

  • Physical exertion, emotional stress, heavy meals, or cold weather can trigger angina.

Q3: How is angina treated?

  • Treatment includes medications, lifestyle changes, and procedures like angioplasty or bypass surgery.

Q4: Is angina a heart attack?

  • No, but it signals reduced blood flow to the heart and increases the risk of a heart attack.

Q5: Can angina go away on its own?

  • Stable angina often improves with rest or nitroglycerin, but unstable angina requires immediate medical attention.

Q6: How is angina diagnosed?

  • Through a combination of medical history, ECG, stress test, and imaging like angiography.

Q7: Can angina be cured?

  • While it cannot always be cured, angina can be managed effectively with treatment and lifestyle changes.

Q8: What is the difference between stable and unstable angina?

  • Stable angina occurs during exertion and improves with rest, while unstable angina occurs unpredictably and is more severe.

Q9: Can I exercise with angina?

  • Yes, but consult your doctor for a safe exercise plan tailored to your condition.

Q10: Does angina always cause chest pain?

  • No, some people experience atypical symptoms like fatigue, shortness of breath, or nausea.

Q11: What should I do if I have an angina episode?

  • Rest immediately and take nitroglycerin if prescribed. Seek medical help if symptoms persist.

Q12: Is angina dangerous?

  • Angina indicates an increased risk of heart attack, making proper management essential.

Q13: Can stress cause angina?

  • Yes, emotional stress can trigger angina by increasing heart rate and oxygen demand.

Q14: Are there foods to avoid with angina?

  • Limit saturated fats, trans fats, and high-sodium foods to prevent CAD progression.

Q15: Can angina occur at rest?

  • Yes, this is characteristic of unstable or variant angina, which requires urgent medical care.