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Angina: Types, Symptoms, Causes And Treatment

Angina is not a disease, but a symptom of coronary artery disease. It is also known as angina pectoris and is a type of chest pain caused by reduced blood flow to the heart. It is often described as a heaviness, pressure or tightness in the chest. The heaviness experienced can extend to your arms, neck, jaw, back or stomach as well. The extent of pain differs in people, with some experiencing severe discomfort while others experiencing only a mild ache [1] .

Angina is common and can affect anyone. It is not life-threatening in most cases, however, it can be an indicator of heart diseases. An angina attack can last from 1 to fifteen minutes [2] .

Types Of Angina

The tight, chest pain is classified into three different types [3] .

  • Stable or chronic angina: It develops when your heart is working harder than the usual, such as while climbing stairs or while exercising. Due to its regular pattern, it can be predicted and similar to usual chest pain. It lasts for a short period of time, around five minutes or even less.
  • Unstable angina: It does not have a regular pattern and can occur even while you are resting. Unstable angina is not that common and develops unexpectedly. It is severe in nature and lasts for more than 30 minutes. It does not subside or get relieved with the use of medicine or proper rest and can be considered as an indicator of a heart attack.
  • Variant and microvascular angina: Also called Prinzmetal's angina, this type of angina is considered to be extremely rare and can occur at rest. Variant angina arises due to the abnormal narrowing or relaxation of the blood vessels which in turn reduces the blood flow to the heart and can be relieved by medicine.

Apart from these three, one of the other types of angina is - angina in women. The symptoms of this particular condition can vary from that of classic angina due to the differences in the symptoms.

Symptoms Of Angina

The signs include the following [4] , [5] :

  • Sweating
  • Indigestion
  • Heartburn
  • Shortness of breath
  • Weakness
  • Cramping
  • Nausea
  • Pain in your arms, neck, jaw, shoulder or back accompanying chest pain
  • Dizziness

Angina in women can develop the following symptoms [5] :

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

Causes Of Angina

Mostly, it is the result of underlying coronary artery disease; that is caused by reduced blood flow to the heart muscles. When your heart gets an only a limited amount of oxygen, it's proper functioning becomes hampered thereby resulting in the chest pain [6] .

Stable angina is usually caused by physical exertion. Apart from that, other factors such as emotional stress, cold temperatures, heavy meals and smoking also can narrow arteries and cause angina.

Unstable angina is caused by blood clots that block the blood vessels in your heart.

Variant angina is caused by a spasm in a coronary artery, causing the artery to temporarily narrow. The narrowing reduces blood flow to your heart, causing chest pain [7] , [8] .

Risk Factors Of Angina

The following factors can increase your risk of developing angina and coronary artery disease [9] .

  • High blood pressure
  • Diabetes
  • Tobacco use
  • High blood cholesterol or triglyceride levels
  • Older age
  • Family history of heart disease
  • Lack of exercise
  • Stress
  • Obesity
  • Metabolic syndrome

Complications Of Angina

The chest pain can hinder with your daily activities such as walking, exercising etc [10] .

  • Extreme pain beyond your chest to your shoulder, arm, back, or even to your teeth and jaw.
  • Increasing episodes of chest pain
  • Prolonged pain in the upper abdomen
  • A sense of fear

Diagnosis Of Angina

The doctor will begin with a physical examination and then will ask about your symptoms and family medical history.

The doctor will advise you to undergo one or more of the following tests to examine and understand the condition in more clarity [11] .

  • Electrocardiogram (EKG) will record the electrical activity of your heart and will detect if the heart has a lack of oxygen.
  • Coronary angiography will help understand the insides of the artery.
  • Stress test
  • Echocardiogram
  • Chest X-ray
  • Blood tests
  • Cardiac MRI
  • Nuclear stress test

Treatment For Angina

The medical care options for angina aims to manage the symptoms by focusing on reducing the pain, preventing the risk of heart attack and controlling the symptoms as well. Likewise, the treatment option depends on the damage caused to your heart [12] .

Medications such as beta blockers, calcium channel blockers, angiotensin-covering enzyme (ACE) inhibitors, oral anti-platelet medicines, anticoagulants, high blood pressure medicines are prescribed for treating angina. These medicines are prescribed for widening blood vessels, slowing the heart down, relaxing the blood vessels and preventing blood clots.

Apart from that, if the situation is comparatively severe, the doctor will advise for surgery. Procedures such as angioplasty, stenting and coronary artery bypass surgery are the surgical procedures involved in treating angina [13] .

Lifestyle Changes For Angina

If the angina is mild, the doctor will advise you to undergo certain changes in your daily schedules [14] .

  • Stop smoking and avoid any exposure to secondhand smoke.
  • If you are overweight, focus on weight-loss options.
  • Follow a healthy diet with limited amounts of saturated fat, lots of whole grains, and many fruits and vegetables.

  • Start an exercising plan.
  • Take proper medical check-ups.
  • Avoid large meals.
  • Avoid getting stressed by trying measures to relax.
  • Limit alcohol consumption.
View Article References
  1. [1] Braunwald, E. (1990). Unstable angina: a classification. InUnstable angina(pp. 103-111). Springer, Berlin, Heidelberg.
  2. [2] Campeau, L. (1976). Grading of angina pectoris.Circulation,54(3), 522-523.
  3. [3] Prinzmetal, M., Kennamer, R., Merliss, R., Wada, T., & Bor, N. (1959). Angina pectoris I. A variant form of angina pectoris: a preliminary report. The American journal of medicine,27(3), 375-388.
  4. [4] Buffon, A., Biasucci, L. M., Liuzzo, G., D'onofrio, G., Crea, F., & Maseri, A. (2002). Widespread coronary inflammation in unstable angina.New England Journal of Medicine,347(1), 5-12.
  5. [5] Tegn, N., Abdelnoor, M., Aaberge, L., Endresen, K., Smith, P., Aakhus, S., ... & Bendz, B. (2016). Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (After Eighty study): an open-label randomised controlled trial.The Lancet,387(10023), 1057-1065.
  6. [6] Salazar, C. A., Flores, J. E. B., Espinoza, L. E. V., Dolores, J. W. M., Rodriguez, D. E. R., & Munárriz, C. L. (2017). Ranolazine for stable angina pectoris.Cochrane Database of Systematic Reviews, (2).
  7. [7] Nakashima, T., Noguchi, T., Haruta, S., Yamamoto, Y., Oshima, S., Nakao, K., ... & Kawasaki, T. (2016). Prognostic impact of spontaneous coronary artery dissection in young female patients with acute myocardial infarction: a report from the angina pectoris–myocardial infarction multicenter investigators in Japan.International journal of cardiology,207, 341-348.
  8. [8] Fanaroff, A. C., Prather, K., Brucker, A., Wojdyla, D., Davidson-Ray, L., Mark, D. B., ... & Stone, G. W. (2019). Relationship Between Optimism and Outcomes in Patients With Chronic Angina Pectoris.The American journal of cardiology.
  9. [9] Pedersen, E. R., Tuseth, N., Eussen, S. J., Ueland, P. M., Strand, E., Svingen, G. F. T., ... & Nordrehaug, J. E. (2015). Associations of plasma kynurenines with risk of acute myocardial infarction in patients with stable angina pectoris.Arteriosclerosis, thrombosis, and vascular biology,35(2), 455-462.
  10. [10] 10. Authors/Task Force Members, Fox, K., Garcia, M. A. A., Ardissino, D., Buszman, P., Camici, P. G., ... & Lopez-Sendon, J. (2006). Guidelines on the management of stable angina pectoris: executive summary: the Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology.European heart journal,27(11), 1341-1381.
  11. [11] Parker, J. D., & Parker, J. O. (1998). Nitrate therapy for stable angina pectoris.New England Journal of Medicine,338(8), 520-531.
  12. [12] Grines, C. L., Watkins, M. W., Helmer, G., Penny, W., Brinker, J., Marmur, J. D., ... & Engler, R. L. (2002). Angiogenic Gene Therapy (AGENT) trial in patients with stable angina pectoris.Circulation,105(11), 1291-1297.
  13. [13] Shimada, Y. J., Tsugawa, Y., Iso, H., Brown, D. F., & Hasegawa, K. (2017). Association between bariatric surgery and rate of hospitalisations for stable angina pectoris in obese adults.Heart,103(13), 1009-1014.
  14. [14] Müller, I., Besta, F., Schulz, C., Massberg, S., Schönig, A., & Gawaz, M. (2003). Prevalence of clopidogrel non-responders among patients with stable angina pectoris scheduled for elective coronary stent placement.Thrombosis and haemostasis,89(05), 783-787.
Story first published: Friday, May 10, 2019, 10:46 [IST]
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