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Causes of Angina
Angina occurs when a diseased coronary artery can no longer deliver enough blood to a portion of the heart to satisfy its oxygen demands. Typically, angina occurs when the heart has an extra demand for oxygen–rich blood, especially during exercise. The pain results from insufficient blood and oxygen supplies to the heart (Ischemia). Other triggers can be emotional stress, extreme cold or hot temperatures, heavy meals, alcohol, and smoking.
Angina attacks in men usually occur after the age of 30 and are nearly always caused by Coronary Artery Disease (CAD). For women, angina tends to occur later in life. Other causes include Aortic stenosis, anemia, or hyperthyroidism, which are more often found among women than men.
Symptoms of Angina
Angina is a symptom of heart disease. Persons with angina have an increased risk of heart attack when compared to those who have no symptoms of heart disease. Angina tends to originate in the center of the chest, but the pain may spread to the left arm, neck, or jaw. Some persons have numbness or loss of sensation in the arms, shoulders, or wrists. An episode usually lasts no more than a few minutes, however, if the pain persists, it may indicate a sudden total blockage or an ensuing heart attack.
Patients may have one of several types of angina. For those with stable angina, the level of activity or stress that provokes an attack is usually predictable. Therefore, it’s important for patients to know the pattern of their attacks: what causes them, what the attacks feel like, how long they last, and whether medication relieves them. Sometimes, the pattern changes – attacks happen more often, last longer, or occur without exercise. This may indicate unstable angina, and patients should seek medical attention immediately if they notice a change in the patterns of their attacks.
Types of Angina
Variant Angina pectoris, or Prinzmetal’s angina, is a rare form of angina caused by Coronary spasm (Vasospasm). The spasm temporarily narrows the coronary artery and reduces blood flow to the heart. It may occur in patients who also have severe arteriosclerosis in at least one major vessel. Variant angina differs from Typical angina as it occurs during periods of rest. These attacks may be extremely painful, and patients find that the attacks occur more often between midnight and 8:00 a.m. Frequently, they occur at the same time each day.
Patients with Variant angina may be at a risk for heart attack, arrhythmia, and even sudden death. Those who survive a heart attack usually stabilize. Most patients find that the symptoms and cardiac events associated with Variant angina gradually disappear. Microvascular Angina is a recently discovered type of angina. Patients experience chest pain but have no apparent Coronary artery blockage. The pain results from poor function of distal, tiny blood vessels that nourishes the heart, arms, and legs. Generally, this type of angina is well tolerated, with very few long–term consequences.
Diagnosis of Angina
Physicians can usually diagnose Angina by recognizing the symptoms and the pattern in which they occur. Further diagnostic tests may include X–rays, an Electrocardiogram (ECG or EKG) at rest, and during and after exercise, a Nuclear Stress Test, and Coronary Angiography.
Variant angina can be diagnosed using a Holter monitor. Holter monitoring gets a continuous reading of a person’s heart rate and rhythm over a 24–hour period (or more). The patient wears a recording device (the Holter monitor), which is connected to disks on the patient’s chest. With certain types of monitors, patients can push a “Record” button to capture a rhythm when they feel symptoms of angina.
Treatment for Angina
Lifestyle changes and medication are the most common ways to control angina. In more severe cases, revascularization may be necessary.
Although angina may be brought on by exercise, this does not mean patients should stop exercising. Patients are encouraged to continue with an exercise program that has been approved by their physician. Risk factors for the underlying heart disease (usually Arteriosclerosis) should be controlled, including high blood pressure, cigarette smoking, high blood cholesterol, and excess weight. By eating healthy, not smoking, moderating alcohol consumption, and avoiding stress, patients with angina may live more comfortably and with fewer attacks.
Medication for Angina
Certain drugs may help prevent or relieve the symptoms of angina. The best known is Nitroglycerin, which, by lowering blood pressure, can help relax arteries and keep them dilated. “Nitro” works in a matter of seconds. The moment an attack occurs, patients are usually advised to sit or lie down and then dissolve a tablet under their tongue. If an activity (such as climbing the stairs) brings on angina, persons can take a tablet beforehand to prevent an attack.
Other drugs used to control Typical Angina and Microvascular Angina are Beta–blockers and Calcium channel blockers. These types of drugs reduce the oxygen need of the heart by reducing the heart rate or lowering blood pressure. They also reduce the likelihood of arrhythmia. Calcium channel blockers and Nitrates may also be used to prevent the spasms that cause Variant angina.
For patients with unstable angina, physicians normally prescribe bed rest and some type of Heparin.
Trans–catheter Interventional Procedures and Surgery
If Typical angina or Variant angina is caused by severe Coronary artery disease, then a Trans–Catheter Intervention (TCI) or Bypass surgery may be needed to improve the blood supply to the heart.