Angina (also called angina pectoris) is chest pain that appears when the muscle cells of the heart don’t get enough blood to properly carry out their pumping function. The lack of blood supply is most likely to cause pain during physical activity, when the heart pumps fastest and needs the most oxygen. Stopping the activity normally relieves the pain. This may help to distinguish angina from other types of chest pain.
Causes of Angina
Fatty deposits in the arteries that feed the heart or sometimes because of other abnormalities that interfere with the flow of blood to the heart muscle are the main causes. Not everyone with coronary artery disease has angina.
Angina can also be caused by severe anemia - a condition in which the body has fewer red blood cells or less hemoglobin, which carries oxygen. Rarer causes of angina are severe high blood pressure, a narrowing of the aortic valve (aortic valve stenosis), leakage from the aortic valve, thickening of the walls of the ventricles. All of these factors make the heart work heart and increase its need for oxygen. Abnormalities of the aortic valve may also reduce the blood flow through the arteries of the heart. The openings for these arteries are just beyond the aorta.
Symptoms of Angina
Not everyone with ischemia will experience angina. This is referred to as “silent ischemia.” More commonly, however, people will experience chest pain. The pain of angina comes from the heart, but it’s not generally felt exactly over the heart. The most common focus of pain is under the sternum (breastbone), midway between the breasts or pectoral muscles.
Stay calm during an angina attack by remembering that angina is not a heart attack. The symptoms feel as if you’re having a heart attack, though, and this is what’s so unnerving. Angina causes chest pain, pressure and sometimes a burning sensation. You can even experience pain in your arm, jaw or neck. Get your thoughts under control immediately and remind yourself that you are not having a heart attack.
Treatment of Angina
There are three complementary approaches to treating angina. One is to reduce angina pain with medications. Another is to treat the narrowed arteries with operations such as coronary artery bypass graft surgery or angioplasty/stenting. The third is to eliminate the risk factors that are causing coronary artery disease, of which angina is a symptom.
Beta-blockers and some calcium channel blockers reduce the demands put on the heart by decreasing the heart rate and by lowering the blood pressure.
Nitrates, such as nitroglycerin*, help to open the coronary arteries which then supply more blood to the heart. A tablet or spray of fast-acting nitroglycerin, also called sublingual nitroglycerin, can be placed under the tongue to provide rapid relief of angina pain. Longer-acting nitrates can be given in tablet form from one to three times a day to help control and prevent angina attacks. Nitroglycerin is also available in patches and ointment that can be applied to the skin for continuous control. With longer-acting nitrates, most physicians advise an 8- to 12-hour period where no nitrates are used or taken, as continuous use causes the nitrates to be less effective at the same dose.
