Angina

Angina refers to the pain or discomfort in the chest caused by reduced blood flow to the muscles. It is felt like a pressure or squeezing in the chest. The pain and discomfort often radiates to the jaw, shoulders, neck, or back. The pain may resolve within 15 minutes or persist for more than half an hour. 

It is a symptom of coronary heart disease and is often a serious health concern. The pain may be triggered by physical activity or stress. In many people, angina is misunderstood for indigestion and ignored. Medicines and lifestyle changes can control angina pectoris. 

Severe cases are treated with surgery or stent.

Chest pain and discomfort are the two main symptoms of angina. The pain is felt like a pressure or squeezing at the center of chest. The pain often radiates to jaw, shoulder, neck, and back. Other common symptoms include: 

• Nausea
• Fatigue
• Difficulty in breathing
• Perspiration
• Dizziness

Severity of chest pain varies from person to person and from time to time. Any change in the severity or duration of the pain should be bought to the attention of the healthcare provider as it may be a warning sign of a more serious problem. There are two types of angina – stable and unstable form. 

• Stable angina – this is the most common form of angina and is often triggered by physical activity or stress. The pain lasts for a few minutes, and usually resolves when the activity is stopped. The pain can be predicted and is similar to previous types of pain. 
• Unstable angina – this form of angina starts when the person is at rest or not active. It is characterized by a strong pain which lasts for a longer duration. Unstable angina has an unusual pattern and may recur. 

In women, the symptoms of angina may be slightly different. Symptoms like nausea, difficulty in breathing, fatigue, and abdominal pain may or may not be accompanied by chest pain. 

They may not feel the pressure in the chest, instead the discomfort is felt in the neck, jaw, or back. Pain, when present, may be severe and not like the usual pressure or squeezing in chest. 

Angina is caused by reduced blood flow to the heart due to several conditions. Coronary heart disease is one of the most common causes of reduction in blood flow. This is caused by atherosclerosis, a condition in which the blood vessels become narrow due to deposition of plaques. 

Blood clots in blood vessels also narrow down the blood vessel. 

The demand for oxygen increases with physical activity and thus heart needs more blood to get enough oxygen. When the blood vessels are narrowed, the amount of blood reaching heart muscles is less. This triggers angina. Other factors that increases the demand for oxygen include stress, cold temperature, heavy meals, and smoking. 

Spasms of coronary artery narrows the blood vessel, affecting the amount of blood flowing through it. This results in chest pain, a condition called variant angina. The pain is often severe and can happen even when the patient is at rest. 

The major risk factors for angina include 

• Hypertension
• Tobacco use
• High levels of blood cholesterol and triglyceride
• Diabetes
• Age
• Lack of physical activity
• Stress
• History of heart disease

Review of symptoms, medical history, and physical examination are the first steps in the diagnosis of angina. Confirmation of diagnosis is done through many tests like ECG, stress test, and echo cardiogram. ECG helps to examine the electrical activity in heart. 

Patterns of heartbeats indicate the reduction of blood flow. Stress test helps to diagnose working of heart during strenuous activity. Blood pressure and ECG are continuously monitored during the test. Abnormality or inability to take the test shows the abnormality in functioning of heart. 

An echocardiogram also helps to visualize the functioning of heart. Nuclear stress test is a technique used to measure the blood flow to heart muscle during rest and stress. In this procedure, a radioactive substance injected helps to trace the heart muscles. Light spots in the images of heart produced by the scanner indicates reduced blood flow. 

Chest X-ray is used if enlarged heart is suspected. Damaged heart releases specific enzymes which can be measured by a blood test. Coronary angiography is another test used to get an image of the coronary blood vessels. 

A dye injected into the blood stream helps to obtain detailed images of the blood vessels. Cardiac CT scan provides images of heart and blood vessel, showing narrowed arteries.

Coronary bypass surgery, stenting, angioplasty, medications, and lifestyle changes are the common treatment methods used for angina. These methods help to reduce the frequency and severity of angina. Treatment of angina is important to reduce the risk of heart attack. 

Medications – medications are often suggested when the symptoms cannot be controlled by lifestyle changes. Nitrates are used to widen the blood vessels, improving the flow of blood. Nitroglycerin tablets is an example of nitrate used to obtain immediate relief. 

Aspirin is a blood thinner and improves the flow of blood in vessel. They prevent blood clots and make it easier to flow. Clopidogrel, prasugrel, and ticagrelor are also clot-preventing drugs. Beta blockers block the effect of epinephrine and reduce blood pressure. They also help the blood vessels to relax and improve blood flow. 

Statins are used to prevent atherosclerosis, thus preventing blockage of blood vessels. Calcium channel blockers are also effective in relaxing and widen the blood vessels. 

Angioplasty – in this procedure a small balloon is inserted into the artery. The balloon is then inflated at the narrowed portion of the blood vessel. This helps to widen the artery. To keep the artery open a small wire mesh is inserted. 

This procedure is recommended mostly of unstable angina. 

Coronary artery bypass surgery – in this procedure a vein or artery is used to bypass the block in the artery. This method can be used for both stable and unstable angina. 

Lifestyle changes are the best way to prevent angina. This includes quitting smoking, controlling hypertension and high cholesterol levels, healthy diet, regular exercise, maintaining a healthy weight, and reducing stress are the best changes for avoiding angina.

A few alternative and homeopathic remedies exist for Angina.

Amyl nitrite is used in homeopathy for widening the blood vessels. Glonoine, Spigelia, Cimicifuga, and crataegus helps to control pain and chest discomfort. Garlic, lemon, basil, honey, onion, and citrus fruits are home remedies suggested for controlling angina. 

Supplements of coenzyme Q10, hawthorn, L-carnitine, and fish oil are considered to be helpful in controlling the symptoms.

Lifestyle changes are necessary in order to cope with Angina. This includes: 

• Quitting smoking
• Healthy diet
• Regular exercise
• Weight loss 
• Treat underlying diseases 
• Avoid large meals
• Manage stress

Heart attack is the most serious complication of angina.