Angina is chest pain—or a sensation of discomfort in the chest—due to an insufficient supply of blood to the heart. Officially known as "angina pectoris" (from Latin words meaning "strangle the chest"), it is most often the result of a narrowing of the arteries that supply the heart with blood (a condition known as coronary artery disease or coronary heart disease). It may also be caused by a disturbance in the heart's rhythm (known as an arrhythmia), diseases of the heart valves, or diseases of the heart muscle. But regardless of its cause, the presence of angina indicates that your heart's demand for oxygen isn't being fulfilled by your arteries' ability to supply it with oxygen-rich blood.
Angina does not itself damage your heart. It actually serves as an alarm bell—a signal of the presence of heart disease and/or the possibility of a heart attack (also known as a myocardial infarction). It is important to take this warning signal seriously.
Angina affects more than seven million people in the U.S., according to the National Institutes of Health. It has several variations, as follows:
- Stable angina is a chronic, long-term pattern of anginal pain that is brought on by exercise and that occurs very predictably over a period of months to years. The pain usually goes away if you rest or take your angina medication.
- Unstable angina does not follow a predictable pattern. The pain may be more severe than that of stable angina, and it can occur either with or without physical exertion. Unstable angina is more serious than stable angina and is often a signal of an imminent heart attack.
- Variant angina (also known as Prinzmetal's angina) is the result of a temporary and reversible spasm of your coronary arteries. The pain of variant angina can be severe and usually occurs when you're at rest.
- Microvascular angina is thought to be due to a condition known as coronary microvascular disease (MVD), which affects the tiniest vessels of the coronary artery system. The pain of microvascular angina is often more severe and longer-lasting than that of other forms of angina.
Symptoms of a disease are indications that can be detected by the patient, such as pain or fatigue (while signs are indications that can be detected by a doctor, such as the results of a blood test or an X-ray). The symptoms of angina can vary dramatically from person to person. Most patients describe angina as pressure or squeezing in the middle of their chest. Some describe it simply as mild discomfort near the center of their chest. Others say it feels like a vice is compressing their chest. Still others complain of an aching or burning sensation, similar to heartburn.
In some cases, anginal pain is accompanied by discomfort in the neck, jaw, shoulders and/or arms. Many patients also complain of other symptoms at the same time, such as shortness of breath, sweating, nausea and/or lightheadedness. Angina often, but not always, comes on with exercise or stress and recedes with rest and relaxation.
Your heart—a muscular organ that pumps, on average, five to six quarts of blood a minute—has a huge need for oxygen- and nutrient-rich blood. As blood is pumped out of the heart and into the aorta, some of it is channeled back to the heart itself, via the coronary arteries. These arteries, three separate vessels on the surface of the heart, branch out and penetrate the heart to supply it with oxygen and nutrients. When the workload of the heart increases with exertion and other stresses, so, too, does its need for oxygen. A healthy heart can handle this increased demand. But a heart that is diseased or that has a compromised blood supply cannot keep up with the increased demand. Angina occurs whenever the heart's demand for oxygen outstrips the supply.
The most common cause of angina is atherosclerosis in the arteries that supply your heart itself with blood; this is known as coronary artery disease or coronary heart disease. Atherosclerosis is the progressive buildup of plaque, or deposits of cholesterol, inflammatory cells and other substances on the arterial walls; this buildup occurs over a period of years or even decades. As a result, the arteries narrow, reducing their ability to carry blood. Moreover, atherosclerosis leads to a loss of the arteries' ability to dilate, or expand, in response to exercise; this process is sometimes called "hardening of the arteries." Researchers are still studying the exact mechanisms of atherosclerosis, but it is known to be linked to many factors, most notably smoking, diabetes, hypertension (high blood pressure), hyperlipidemia (high cholesterol), elevated levels of an amino acid called homocysteine and certain hereditary factors. Additional risk factors include obesity, physical inactivity and a stressful lifestyle.
Angina can also occur in individuals with diseases of the heart muscle (which are known as cardiomyopathies), diseases of the heart valves, or arrhythmias (disturbances of the heart's rhythm), as well as with certain noncardiac conditions, such as hyperthyroidism and severe anemia. Basically, any time the heart's need for oxygen and nutrients surpasses what the blood vessels can supply, angina develops.
A detailed medical history is an essential element of diagnosing angina. Your doctor will ask you to thoroughly describe your symptoms' character, location and pattern of occurrence. Your medical history also will help your doctor determine what treatment options may be most appropriate.
Often, diagnostic tests will also be necessary. They may include blood tests; an angiogram (also referred to as cardiac catheterization), which uses opaque dye to image your cardiovascular system; an electrocardiogram (also referred to as an ECG or EKG), which measures and records your heart's electrical activity; a stress test; an echocardiogram (an ultrasound image of your heart); or a CT scan of your heart. The results of the tests will help your doctor assess the extent of your coronary artery disease, including how many blood vessels are involved.
There are a variety of approaches to treating angina, including lifestyle changes (such as not smoking and staying active), medications (including some that improve the flow of blood to the heart), and surgical procedures (including the placement of a stent or a coronary artery bypass graft.
The ideal approach depends on a number of factors, including the extent and severity of your disease, your age, other diseases you may have, and your feelings about the different options. Most forms of angina can be treated in any of several ways. Each course has different risks and benefits and varying recovery times. Therefore, it is essential that you explore the options carefully with your cardiac surgeon and your cardiologist to find out what each option involves and to decide which one will work best for you.
Page reviewed on: Jun 26, 2015
Page reviewed by: Jock McCullough, MD
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