Managing Angina - Causes, Symptoms, Diagnosis, Prevention

Managing Angina

Dr.Atul Biniwale profile Authored by Dr.Atul Biniwale on 20 Oct 2014 - 13:02.

Angina or Angina Pectoris refers to the sensation of pain, heaviness and/ or tightness in the chest, which emerges from the heart due to insufficient supply of blood to the heart muscles. Declined blood supply to heart muscle leaves them deprived of the oxygen, glucose and other necessary blood components required for proper functioning of the heart.  The characteristic sign of angina should not be ignored as it is a symptom of coronary heart disease (CHD) which is a serious health concern. It may be sudden or may become significant progressively.

Types of angina:

Angina can be categorized as follows:

Stable angina: It is the common type that most patients experience. It develops and progresses with rigorous activity and often disappears in relaxed phase. This category is often characterized by the following features:

-       Predictable chest pain and discomfort

-       Short duration attack (less than 5 minutes)

Unstable angina: It is a dangerous form of angina that may bring medical emergency and inappropriate approach to manage the condition may lead to life threatening consequences like heart attack. Features of unstable angina are:

-       Severe and may last about half an hour

-       May occur even if you are resting

-       It is unpredictable and often comes without any sign

-       Difficult to tackle by resting or medications

-       May be a warning sign of heart attack

Prinzmetal's angina: It’s a rare buta severe condition that often occurs during resting state. It is believed to emerge as a consequence of spasm in the arteries that carries blood to the heart. It may be treated immediately by some medication.

Angina in women: Symptoms of angina in women often vary from the normal angina characteristics. Special features are :

  • Pain in the abdomen
  • Nausea
  • Weakness and feeling exhausted
  • Difficulty in breathing

As mentioned above the root cause of angina is insufficient blood flow to the heart muscle, which forces the heart to work harder with lesser energy causing pain and discomfort. The declined blood supply may be attributed to:

-       Coronary artery heart diseases

-       Blockage in the arteries that

-       Blood clots in the heart

-       Physical exertion

-       Excessive stress

-       Excessive eating

-       Smoking tobacco

-       Declined body temperature

-       Some rare causes may include various clinical conditions affecting heart like,

  • Pulmonary embolism (obstruction in the lung artery)
  • Cardiomyopathy (Enlargement of the heart)
  • Pericarditis (Inflammation of the protective layer of the heart)
  • Aortic stenosis (obstruction in the heart valve)

Common symptoms of Angina may include:

  • Pressure, discomfort and/ or pain in the chest
  • Feeling of heaviness in the chest or feeling of indigestion or burning
  • In addition to chest, pain may occur in neck, shoulder, and jaw
  • Difficulty in breathing
  • Extreme tiredness
  • Nausea
  • Excess sweating

When to see a doctor

If one is troubled by chest pain and some other above explained symptoms (without any known cause) it is time to see your doctor immediately.

The diagnosis of angina often involves physical examination, assessment of history and a series of several tests and procedures.

Physical exam –General check-up to know the symptoms and family or personal health history.

Electrocardiogram (ECG) – Is done to detect the abnormality in the heart with the help of graph produced by electrical impulses generated by the heart.

Cardiac stress test–To obtain the ECG while you are exercising as angina can be detected easily when the heart is working harder.

Echocardiogram–To obtain the clear images of the heart with the help of sound waves.

Nuclear stress test–To detect blood flow to the heart by injecting radioactive substance into the bloodat rest.

Radiographs –To detect signs of enlargement of the heart.

Blood examinations – To detect heart enzymes in the blood that indicates abnormal functioning of the heart.

Angiography–To obtain a series of images by injecting dye into the blood vessels.

CT scans of the heart–  To obtain clear scanning images of the heart

Cardiac MRI–  This is done to study in detail the heart structure and blood carrying vessels. 

Several factors may increase the risk of getting angina. These may include:

-       Tobacco intake, smoking or second hand smoke

-       Diabetes

-       High blood pressure, which progressively damages the arteries

-       High blood cholesterol

-       Family history of angina

-       Over 45  year in men and over 55 years in women

-       Inactivity and obesity

-       Frequent stress

Complications

Complications associated with angina may include:

-       Discomfort

-       Most severe complication is heart attack

The right approach to manage the angina may include various medications, surgical procedures, alternative approaches and some lifestyle interventions. Altogether, the approach aims to reduce the severity of the disease and prevent death.

Drugs and medications

Commonly prescribed medications may include:

Nitroglycerine tablets – Helps to increase the blood supply by widening the blood vessels.

Aspirin – It prevents blood from getting clogged and thus improves blood flow.

Blood thinners –Also called as anticoagulants, helps to prevent blood clotting. Ex. Prasugrel, and ticagrelor.

Other medications – May include beta blockers to decrease the blood pressure, statins to reduce blood cholesterol and prevent narrowing of the arteries, calcium channel blockers to improve blood flow to the heart and thus prevent angina attacks, and ranolazine may be given in combination or sometimes alone.

Surgical procedures:

When medications and lifestyle interventions fail to relieve the condition, any of the following suitable procedure can be chosen.

Percutaneous coronary intervention (PCI) and stenting – It is the procedure of widening the narrowed artery with the help of inflating balloon and stent. It is usually preferred to treat unstable angina and to treat stable angina if other treatment measure do not work.

Coronary artery bypass surgery–It is the procedure of bypassing the affected vessel with the help of normal blood vessel from other part of the body. It is a suitable option to treat both stable and unstable angina when all other measures do not work.

Alternative medicine

Herbal treatments: Herb called Hawthorn is found to improve the heart function and thus can be used to treat the angina. Also, L-carnitine (an amino acid) helps to manage the stable angina by improving cardiac functions.

Yogasanas and meditation: Several yoga postures help to improve the heart function and meditation helps to take the stress off.A fourteen day course of yoga is believed to offer relief from angina.

Acupuncture –   A Chinese therapy to relieve pain by pricking small needles at particular points on the body.

Cognitive behavioral therapy (CBT)It helps to learn coping techniques so that patients can improve overall quality of life.

Transcutaneous electronic nerve stimulation (TENS)  -  To relieve pain with the help of electric signals.

Enhanced external counterpulsation (EECP)  - To enhance the blood flow to the heart by wrapping the inflated cuff at specific areas of the body and matching them with the heart rhythm.

Lifestyle interventions:

Lifestyle changes are important for heart care and the angina management. Lifestyle changes alone can suffice to encounter the milder angina,butsevere form may need additional treatments like medications or surgery. Recommended lifestyle interventions may include:

-       Quit smoking or avoid second hand smoke

-       Maintain a healthy weight

-       Manage your diabetes and other heart diseases

-       Take sufficient rest

-       Avoid overexertion

-       Avoid stress

-       Eat healthy (talk to your dietician)

-       Exercise daily (chose a right form of exercise by talking to the experts)

Diet and nutrition recommendations

  • Include whole grains and lots of fresh vegetables and fruits in your diet
  • Include fish oil in your daily food
  • Consume nutrition supplements including Coenzyme Q10 (an antioxidant) and L-carnitine.
  • Include lean meat and fish in your diet
  • Restrict the intake of salt and sugar
  • Avoid foods rich in saturated fat
  • Stop smoking
  • Take care of your heart and sugar level
  • Eat well
  • Be relaxed
  • Maintain a healthy weight
  • Exercise daily
*Disclaimer This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.