Also known as angina pectoris; angina is basically chest pressure or pain that occurs when the heart muscle fails to get enough oxygen-rich blood. This pain can also occur in other parts of your body including the arms, shoulders, back, jaw and neck. Angina typically occurs in patients suffering from either atheroma or atherosclerosis. These conditions cause the coronary arteries to become narrow due to plaque buildup in the wall of these arteries, thereby restricting the flow of oxygen-rich blood to the heart muscle. It is important to note that angina is a symptom of an underlying heart condition, not a disease. With that in mind, here is some more information about this cardiac problem.
Types of Angina
The most common types of angina pain include stable, unstable, variant (prinzmetal’s) angina and microvascular angina.
Stable angina – Also known as “effort angina”, is the most common type of angina, with nearly 500,000 new cases being reported in the US annually, according to the Framingham Heart Study. Stable angina normally occurs when the heart is beating faster than normal due to physical exertion, hence the name “effort angina.” The pain/discomfort typically goes away once the heart rate returns to normal or after taking angina medicine. This means stable angina has a regular pattern and therefore it is easy to predict. Although stable angina is not a heart attack, it is a warning sign that a heart attack may happen in the future.
Unstable angina — This is a form of acute coronary syndrome. Unlike stable angina, unstable angina does not have a regular pattern. Additionally, it can occur with or without physical exertion, even when at rest. In fact, studies indicate that more than 60% of patients experience unstable angina pain when at rest. Occurring with a crescendo pattern (distinctively more severe or frequent than before), unstable angina is a medical emergency that requires medical attention, especially because it is a warning sign of an impending heart attack. Besides symptoms, stable and unstable forms of angina also differ in terms of the pathophysiology of the atherosclerosis.
Variant (prinzmetal’s) angina — This is a rare, but potentially deadly type of angina. It usually occurs when a patient is at rest, particularly between midnight and early morning, and the pain can be severe. Fortunately, angina medicine can ease the pain caused by variant angina.
Microvascular angina — This type of angina can be more severe and generally lasts longer than the other types of angina. Even worse, patients who suffer from microvascular angina do not respond to angina medicine.
As mentioned above, the main cause of angina pain is plaque buildup in the coronary arteries. Plaque buildup stiffens and narrows the coronary arteries, reducing the flow of oxygen-rich blood to the heart muscle. Moreover, plaque buildup increases the risk for blood clots forming in the coronary arteries. The problem with blood clots is they can block blood flow to the heart.
The common symptoms of angina pain include chest pain/discomfort, shortness of breath, weakness, sweating, indigestion and heartburn.
Some of the risk factors associated with angina include tobacco smoking, diabetes, hypertension, unhealthy cholesterol levels, obesity, metabolic syndrome, inactivity and age.
Physicians typically perform a physical exam to diagnose chest pain as unstable or stable angina. In addition to a physical exam, your physician may also recommend certain diagnostic tests and procedures to determine whether your angina is related to an underlying heart problem or not. Examples of such tests and procedures include the use of a Holter Monitor, stress testing, EKG (Electrocardiogram), chest X-ray, blood tests and coronary angiography.
The common treatment options for angina include balloon angioplasty, coronary bypass surgery and angina medicines such as nitroglycerin and beta blockers.