Angina

Overview

Angina (angina pectoris) is chest pain or discomfort that occurs when the heart muscle does not receive as much oxygen-rich blood as it needs. It is not a disease in itself but is generally considered a sign of narrowing or blockage in the coronary arteries that supply the heart.

The heart muscle requires a continuous supply of oxygen to pump blood to the body. When arteries narrow, blood flow may become insufficient, especially during exertion or stress; this can lead to "oxygen deprivation" of the heart muscle. This temporary deficiency can manifest as a feeling of tightness or heaviness behind the chest wall.

The primary goal of treatment is to reduce the heart's workload to improve blood flow and help limit the risk of this condition progressing to a more serious event like a heart attack.

Symptoms of angina

Although angina symptoms are typically described as discomfort felt in the chest area, the nature of the pain and the areas it radiates to can vary from person to person. This sensation usually starts during physical activity and may subside with rest.

• Pressure and tightness in the chest: Patients may often describe a sensation of a heavy weight on the chest or as if their chest is being squeezed in a vise; this can reflect the heart muscle being under strain.
• Radiation of pain: This discomfort originating from the heart may not stay in the chest; it can spread to the arms (especially the left arm), neck, jaw, shoulders, or back.
• Shortness of breath: When the heart muscle does not get enough oxygen, its pumping efficiency can drop, which may lead to the person becoming breathless even with small movements.
• Nausea and dizziness: The heart's oxygen deprivation can stimulate the autonomic nervous system, triggering sweating, nausea, or a sudden feeling of weakness.
• Indigestion-like pain: Some individuals may mistake the pain of angina for a burning or indigestion sensation under the breastbone; this can cause a delay in diagnosis.

When to see a doctor

If you feel a new pressure in your chest during physical activity and this sensation subsides with rest, you should definitely consult a cardiologist regarding the possibility of an underlying vascular blockage.

However, if you experience chest pain that starts at rest, lasts longer than 15 minutes, is very severe, or does not go away with rest, you should call emergency services immediately, as this may be a sign of a heart attack.

Causes of angina

The main cause of angina is damage or narrowing of the coronary arteries to the extent that it restricts blood flow to the heart. This can usually be associated with plaques that accumulate over many years, narrowing the diameter of the vessels.

• Coronary artery disease: Cholesterol and fat plaques (atherosclerosis) accumulating on the vessel walls can narrow the path for blood, which may impair the nourishment of the heart muscle.
• High blood pressure and diabetes: Uncontrolled blood pressure can wear down vessel walls, and high blood sugar can damage the structure of the vessels, accelerating the blockage process.
• Smoking: Chemicals in tobacco products can damage the inner lining of the vessels and increase the blood's tendency to clot, which may trigger angina attacks.
• Coronary spasm: Rarely, even if there is no blockage in the vessels, sudden contraction of the muscles in the vessel wall can temporarily stop blood flow and lead to pain.
• Severe anemia: Having fewer oxygen-carrying cells in the blood may cause the heart muscle to not receive the oxygen it needs, even if the vessels are open.

Diagnosis of angina

Angina is diagnosed through questioning the characteristics of the pain and combining medical tests that show how the heart functions. Your doctor performs a comprehensive evaluation to understand how risky the pain is.

• Electrocardiogram (ECG): By creating an electrical map of the heart, it can check for an impairment in the heart muscle's nourishment during or after pain.
• Stress test: Used to monitor whether the vessels can respond to the demand and whether the pain is triggered when the heart's workload is increased (such as on a treadmill).
• Echocardiography: With the help of ultrasound, heart muscle movements and valve structure are examined to detect areas where blood supply is impaired.
• Coronary angiography: This X-ray, taken by injecting contrast material into the vessels, is the most definitive method showing the exact location and degree of narrowing.

Treatment of angina

The treatment process aims to reduce the frequency of pain and increase the amount of blood supplying the heart. While lifestyle changes form the basis of treatment, medications and surgical procedures play a supportive role.

• Drug therapy: Nitrates can widen the vessels to increase blood flow; beta-blockers can help lower oxygen demand by slowing the heart rate.
• Angioplasty and stenting: The narrowed coronary vessel can be opened with the help of a small balloon, and a metal mesh (stent) placed inside can ensure the vessel stays open.
• Bypass surgery: If many vessels are blocked, a new path (bridge) can be created around the blockage using vessels taken from another part of the body.
• Lifestyle management: Quitting smoking, controlling cholesterol, and an appropriate diet can directly affect the success of treatment and the patient's lifespan.

Risks of angina

Angina should be considered the heart's cry for help. If left untreated, the progression of vascular blockage can lay the groundwork for damage that is difficult to reverse in the body.

• Heart attack (Myocardial infarction): The narrowing in the vessel turning into a full blockage can cause that region of the heart muscle to die, leading to permanent damage.
• Heart failure: The heart muscle constantly receiving insufficient blood may cause it to weaken over time and become unable to pump enough blood to the body.
• Rhythm disorders (Arrhythmia): Heart muscle cells with impaired nourishment may transmit electrical signals incorrectly, leading to life-threatening palpitations.

Prevention of angina

Angina can largely be prevented or its progression halted through habits aimed at protecting vascular health. Early precautions can help keep coronary arteries open for many years.

• Balanced nutrition: Eating a diet rich in vegetables and fruits, such as the Mediterranean diet, can slow down the formation of plaques on vessel walls.
• Regular physical activity: A doctor-approved exercise program can raise the angina threshold by strengthening the heart and increasing blood circulation.
• Management of chronic diseases: Keeping blood pressure and sugar levels within target ranges can minimize the risk of blockage by protecting the inner lining of the vessels.