Types and Symptoms of Angina

Angina Overview

Angina is tightness, squeezing, pressure, or pain in the chest. It occurs when an area of the heart muscle receives less blood oxygen than usual. Angina is also known as angina pectoris.

Although angina is relatively common, it can still be hard to distinguish from other types of chest pain, such as the discomfort of indigestion. If you have unexplained chest pain, seek medical help right away.

Angina is not a disease but a symptom. It usually happens due to ischemia, when one or more of the coronary arteries becomes narrow or blocked. It is often a symptom of coronary heart disease (CHD).

Alone, angina is not life threatening, but it can resemble the symptoms of a heart attack, and it is a sign of heart disease.

Types of Anginas

Following are several types of anginas:

Stable Angina

Stable angina is the most common form of angina. It usually happens during activity (exertion) and goes away with rest or angina medication. For example, pain that comes on when you’re walking uphill or in the cold weather may be angina.

This type of angina occurs when the heart is working harder than usual, for instance, during exercise. It usually lasts around 5 minutes.

Stable angina pain is predictable and usually similar to previous episodes of chest pain. The chest pain typically lasts a short time.

It has a regular pattern, and a person may experience it for months or years. Rest or medication often relieves the symptoms.

Unstable Angina

Unstable angina does not follow a regular pattern and usually occurs during rest. It mostly results from atherosclerosis, which involves a blockage preventing blood from reaching the heart.

It’s typically severe and lasts longer than stable angina, maybe 20 minutes or longer. Rest and medication alone may not improve the symptoms.

Unstable angina can indicate the risk of a heart attack. Anyone with unexpected angina should receive emergency care.

If the blood flow doesn’t improve, the heart is starved of oxygen and a heart attack occurs. Unstable angina is dangerous and requires emergency treatment.

Microvascular Angina

Microvascular angina can occur with coronary microvascular disease (MVD). This affects the smallest coronary arteries.

As well as chest pain, a patient may experience the following:

• Fatigue and low energy
• Shortness of breath
• Sleep problems

Microvascular angina tends to be more persistent than stable angina. It often lasts longer than 10 minutes and sometimes longer than 30 minutes.

Refractory Angina

Refractory Angina: Angina episodes are frequent despite a combination of medications and lifestyle changes.

Variant Angina

Variant angina is rare. It is also known as Prinzmetal angina, and it can develop when the body is at rest, often around midnight or the early morning.

This type of angina is caused by a spasm in the heart’s arteries that temporarily reduces blood flow. Severe chest pain is the main symptom of variant angina. It most often occurs in cycles, typically at rest and overnight. The pain may be relieved by angina medication.

Variant angina happens when a spasm occurs in the coronary arteries. Possible triggers include exposure to cold, stress, medicines, smoking, or cocaine use. It is a chronic condition, but medication can help manage it.

Signs and Symptoms of Angina

Angina involves any of the following sensations in the chest:

• Burning or aching across the chest, usually starting behind the breastbone.
• Heaviness
• Pressure
• Squeezing
• Tightening

The pain often spreads to the neck, jaw, arms, shoulders, throat, back, or teeth.

Other possible symptoms include:

• Dizziness
•  Cramping
• Heartburn
• Indigestion
• Nausea
•  Sweating
• Shortness of breath
• Weakness

The duration of these symptoms depends on the type of angina. Anyone who experiences severe or persistent chest pain should call 911 or otherwise seek emergency care.

Angina in Women

Symptoms of angina in women can be different from the classic angina symptoms. These differences may lead to delays in seeking treatment. For example, chest pain is a common symptom in women with angina, but it may not be the only symptom or the most prevalent symptom for women. Women may also have symptoms such as:

• Abdominal Pain
• Discomfort in the neck, jaw, teeth or back
• Fatigue
• Nausea
• Shortness of breath
• Stabbing pain instead of chest pressure
• Vomiting

MVD affects females more often than males, and as a result, the American Heart Association (AHA) explains, females may experience different symptoms that accompany angina.

According to the AHA cardiovascular disease is the main cause of death among females in the United States and that it occurs in almost half of Black American females.

Causes of Angina

Angina usually results from underlying coronary artery disease. It is caused by reduced blood flow to the heart muscle. Blood carries oxygen, which the heart muscle needs to survive. When the heart muscle isn’t getting enough oxygen, it causes a condition called ischemia.

The most common cause of reduced blood flow to the heart muscle is coronary artery disease (CAD). Coronary arteries supply the heart with oxygen-rich blood. When cholesterol collects on the wall of an artery and forms hard plaques, this effectively narrows the arteries.

Heart (coronary) arteries can become narrowed by fatty deposits called plaques. This is called atherosclerosis. If plaques in a blood vessel rupture or a blood clot form’s, it can quickly block or reduce flow through a narrowed artery. This can suddenly and severely decrease blood flow to the heart muscle.

Other factors, including damage to the arteries and smoking, increase the risk of plaque buildup.

During times of low oxygen demand, when resting, for example the heart muscle may still be able to work on the reduced amount of blood flow without triggering angina symptoms. But when the demand for oxygen goes up, such as when exercising, angina can result.

If blood cannot carry oxygen to the heart, the heart muscle cannot work properly. This causes angina.

Diagnosis of Angina

To diagnose angina, your doctor will perform a physical exam and ask questions about your symptoms. You’ll also be asked about any risk factors, including whether you have a family history of heart disease.

Following tests are used to diagnose and confirm angina include:

• Blood Tests
• Chest X-Ray
• Electrocardiogram (ECG or EKG)
• Echocardiogram
• Magnetic Resonance Imaging (MRI)
• Nuclear Stress Test
• Stress Test
• Computerized Tomography (CT) Scan
• Coronary Angiography

 

Triggers of Angina

Angina results from a fall in the oxygen supply to the heart. For people with stable angina, the following may trigger an attack:

• Exposure to low temperatures
• Physical exertion
• Stress

Treatment of Angina

Treatment of angina aims to reduce pain, prevent symptoms, and prevent or lower the risk of a heart attack. A doctor may recommend medication, lifestyle changes, a surgical procedure, or a combination of the above.

Options for angina treatment include the following:

• Angioplasty and stenting
• Lifestyle changes
• Medications
• Open-heart surgery (coronary bypass surgery)

The goals of angina treatment are to reduce the frequency and severity of the symptoms and to lower the risk of a heart attack and death.

Angina patient will need immediate treatment if you have unstable angina or angina pain that’s different from what you usually have.

Lifestyle Changes

The following strategies can help:

• Getting regular exercise.
• Having a diet that is rich in fruits, vegetables, whole grains, low-fat or no-fat dairy products, and lean sources of protein.
• Losing weight.
• Managing and avoiding stress.
• Regularly checking cholesterol levels
• Getting rest when necessary
• Quitting smoking

Medications

Doctors often prescribe nitrates, such as nitroglycerin, for angina. Nitrates prevent or reduce the intensity of angina by relaxing and widening the blood vessels.

Other drug options include the following:

• Angiotensin covering enzyme inhibitors.
• Anticoagulants.
• Beta blockers.
• Calcium channel blockers.
• Clot preventive drugs.
• Oral antiplatelet medications.
• Ranolazine (Ranexa).
• Statins, which are cholesterol-lowering medicines.

Medications to manage high blood pressure (hypertension) may help manage angina. These aim to lower blood pressure and cholesterol levels, slow the heart rate, relax blood vessels, reduce strain on the heart, and prevent blood clots from forming.

Alternative Therapies

If medications do not help, other treatments include:

• Enhanced External Counter Pulsation Therapy: This involves wearing a device like a blood pressure cuff to improve oxygen flow to the heart.
• Spinal Cord Stimulators: These block the sensation of pain but do not directly improve heart health.
• Trans-myocardial Laser Therapy: This stimulates the growth of new blood vessels or otherwise enhances blood flow in the heart.

Surgical Procedures

If lifestyle changes, medications or other therapies don’t reduce angina pain, a catheter procedure or open-heart surgery may be needed.

Surgeries and procedures used to treat angina and coronary artery disease include the following:

• Angioplasty with Stenting: During an angioplasty, also called a percutaneous coronary intervention (PCI), a tiny balloon is inserted into the narrowed artery. The balloon is inflated to widen the artery, and then a small wire mesh coil (stent) is usually inserted to keep the artery open.Angioplasty with stenting improves blood flow in the heart, reducing or eliminating angina. Angioplasty with stenting may be a good treatment option for those with unstable angina or if lifestyle changes and medications don’t effectively treat chronic, stable angina.
• Open-heart Surgery: During coronary artery bypass surgery, a vein or artery from somewhere else in the body is used to bypass a blocked or narrowed heart artery. Bypass surgery increases blood flow to the heart. It’s a treatment option for both unstable angina and stable angina that has not responded to other treatments.

Risk Factors of Angina

Angina can develop as a result of:

• An age of over 45, for males, or 55, for females
• Being overweight or obesity
• Certain medical treatments and procedures
• Exposure to particle pollution, for example, at work
• Genetic factors
• High cholesterol levels
• Stress
•  Low physical activity
• Overuse of alcohol or recreational drugs
• Smoking
• Conditions such as heart disease, diabetes, low blood pressure, metabolic syndrome, and anemia 
• Unhealthful diet

Prevention of Angina

The following strategies can help prevent angina:

• Avoiding or quitting smoking.
• Getting regular exercise.
• Having a varied, nutritious, “heart-healthy” diet.
• Practicing ways to manage stress.

Patients should receive consistent, effective treatment for cardiovascular disease and other aspects of metabolic syndrome, such as high blood cholesterol, high blood pressure, diabetes, and obesity.

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