Angina

What is angina?

Angina is chest pain that results when there is not enough blood and oxygen supply to the heart. It occurs when your coronary arteries become narrow over time resulting from a plaque build-up. Angina is not a disease but a symptom of coronary artery disease and is typically described as heaviness or tightness in the chest.

The condition is classified into stable, unstable and variant angina.

• Stable (or chronic) angina – occurs when the heart is working harder than usual for example during exercise. It has a regular and predictable pattern and symptoms can be relieved by rest and medication.
• Unstable angina – occurs when at rest and follows an irregular pattern. It is uncommon and more serious as it cannot be relieved by rest or medication and can signal a future heart attack. Unstable angina occurs suddenly and worsens over time.
• Variant angina (Prinzmetal) – occurs at rest without any underlying coronary artery disease. It is typically due to an abnormal narrowing or spasm of the blood vessels which reduces blood flow to the heart. It can often be relieved by medication.

What are the symptoms of angina?

The most common symptom of angina is pain or discomfort in the centre of your chest, generally describe as "heavy" and "tight" pain in the chest.

Other symptoms associated include:

• Pain in your arms, neck, jaw, shoulders and back and on top of chest pain
• Shortness of breath
• Nausea
• Fatigue
• Sweating
• Dizziness

It is vital to understand what type of chest discomfort you are experiencing and identify if it is new or changing.

What causes angina?

Angina is usually the result of underlying coronary artery disease, although chest pain that mimics angina can be caused by other conditions that are not heart related.

The coronary arteries supply your heart with oxygen-rich blood. However, when too much cholesterol is present in the blood, it leads to a build-up of plaque (fatty material that accumulates in the wall of blood vessels).This causes a narrowing of the blood vessel and, if severe, can reduce blood flow through the artery. This may limit the amount of blood and, therefore, oxygen getting to you heart.

Stable angina is usually caused by physical exertion. The heart demands more blood when you are doing vigorous exercise, but it’s difficult for the heart to get enough blood when your arteries are narrowed. Other factors that can also narrow arteries and trigger angina include emotional stress, cold temperatures and smoking.

Unstable angina occurs when plaque in a blood vessel ruptures (lifts off the artery wall), which leads to the rapid formation of a clot that can stop any blood getting to your heart. If blood flow does not improve it will result in a heart attack.

Variant (Prinzmetal) angina, is caused by a spasm (constriction) in the coronary artery that temporarily narrows the artery and reduces blood flow to the heart. It can occur at rest and is often severe, but can be relieved with medications.

How is angina diagnosed?

It is important to correctly diagnose any chest pain you are experiencing as this can predict your likelihood of having a heart attack. Your doctor will start with a physical exam and discuss symptoms, risk factors and family medical history.

Your doctor may also perform one or more of the following tests to confirm whether you have angina:

• Electrocardiogram (ECG or EKG)
• Echocardiogram
• Stress test
• Nuclear stress test
• Chest X-ray
• Blood tests
• Coronary angiography
• CT scan

How is angina treated?

There are many ways to treat angina, including lifestyle changes, medications and medical procedures. Treatment will help reduce the incidence and severity of symptoms and will help lower your risk of heart attack and death.

However, if you have unstable angina or unusual angina pain, you will need immediate medical treatment.

Lifestyle Changes

• Quit smoking
• Weight management
• Manage diabetes
• Check cholesterol levels regularly
• Manage or avoid stress
• Eat a healthy diet and avoid trans fats and sugar

Medications

If lifestyle changes do not help your angina, your doctor may prescribe the following medications:

• Nitrates
• Aspirin
• Clot-preventing drugs/blood thinners
• Beta blockers
• Statins
• Calcium channel blockers
• Ranolazine (Ranexa)

Medical Procedures

• Percutaneous coronary intervention (PCI) - angioplasty and stenting
• Coronary artery bypass surgery

How can angina be prevented?

The following lifestyle habits can help prevent angina:

• Avoid smoking
• Eat a healthy diet
• Regular physical exercise starting with daily walking
• Maintain a healthy weight
• Reduce stress level
• Monitor and control conditions such as high blood pressure, high cholesterol and diabetes

Ask your doctor for a heart health check which looks at the key risk signs. Download our Heart Health Check Guide to take with you to your next doctor's appointment.

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