Angina

Overview

Angina is chest pain or discomfort that occurs when your heart muscle does not get enough blood. It is not a condition but rather a symptom of coronary artery disease (CAD) the most common type of heart disease. It is estimated that one in four Canadians has some form of heart disease - a leading cause of death for both men and women.

Causes

Angina is caused by reduced blood flow to an area of the heart. This is most often due to coronary artery disease. Sometimes other types of heart disease or uncontrolled high blood pressure can cause angina.

In CAD the arteries that carry oxygen-rich blood to the heart muscle are narrowed due to the buildup of fatty deposits called plaque. This is atherosclerosis. Some plaque is hard and stable and leads to narrowed and hardened arteries. Other plaque is soft and is more likely to break open and cause blood clots. The buildup of plaque on the inner walls of the arteries can cause angina by narrowing the artery to the point where the flow of blood is greatly reduced or by forming blood clots that partially or totally block the artery.

Symptoms

The pain or discomfort of angina:

  • is often described as pressure squeezing burning or tightness in the chest
  • usually starts in the chest behind the breastbone
  • may also occur in the arms shoulders neck jaw throat or back
  • may feel like indigestion.

Symptoms such as nausea fatigue shortness of breath sweating light-headedness or weakness may also occur.

There are three types of angina and each has its own specific symptoms:

Stable Angina is the most common type. It occurs when the heart is working harder than usual. There is a regular pattern to stable angina and after several episodes you learn to predict when it will occur. The pain usually goes away in a few minutes when you rest or take your angina medicine. Having stable angina increases your risk of a future heart attack.

The pain or discomfort:

  • Occurs when the heart must work harder usually during physical exertion
  • Is expected and episodes of pain tend to be alike
  • Usually lasts a short time (5 minutes or less)
  • Is relieved by rest or angina medicine
  • May feel like gas or indigestion
  • May feel like chest pain that spreads to the arms back or other areas.

Unstable Angina is a very dangerous condition that requires emergency treatment. It is a sign that a heart attack could occur soon. Unlike stable angina it does not follow a pattern. It can occur without physical exertion and is not relieved by rest or medicine.

The pain or discomfort:
  • Often occurs at rest while sleeping at night or with little physical exertion
  • Is unexpected
  • Is more severe and lasts longer (as long as 30 minutes) than stable angina episodes
  • Is usually not relieved with rest or angina medicine
  • May get continuously worse
  • May signal that a heart attack will happen soon.

Variant Angina is rare. It usually occurs at rest. The pain can be severe and usually occurs between midnight and early morning. It is relieved by medication.

The pain or discomfort:

  • Usually occurs at rest and during the night or early morning hours
  • Tends to be severe
  • Is relieved by angina medicine.

Chest pain that lasts longer than a few minutes and is not relieved by rest or angina medicine may mean you are having-or are about to have-a heart attack. Get emergency help immediately.

Treatment

Treatment for angina includes lifestyle changes medication surgery and rehabilitation. The main goal is to reduce the frequency and severity of symptoms and to prevent or lower the risk of heart attack and death.

Medicines such as nitrates beta blockers and calcium channel blockers can help relieve angina. Taking low-dose aspirin every day reduces the chance of a second heart attack in people who have already had one. Among surgical options is angioplasty in which doctors insert a tiny balloon in an artery to push open blocked arteries around the heart. If this isn't possible or if your condition is more severe they may recommend bypass surgery.

Prevention

Change your lifestyle to avoid bringing on an episode of angina. If angina does come on

  • with exertion slow down or take rest breaks.
  • after a heavy meal avoid large meals and rich foods that leave you feeling stuffed.
  • with stress try to avoid situations that make you upset or stressed. Learn techniques to handle stress that can't be avoided.

Other changes that you need to make include:

  • Eat a healthy diet to prevent or reduce high blood pressure and high blood cholesterol and obesity. Follow Canada's Food Guide to Healthy Eating and ask your doctor or a nutritionist for advice
  • If you smoke quit and avoid exposure to second-hand smoke
  • Exercise as directed by your doctor.
  • Lose weight if you are overweight.
  • Control blood sugars if you have diabetes

Additional Resources:

Heart and Stroke Foundation