Angina: Everything you need to know

Angina is a medical condition that manifests as chest pain or discomfort due to reduced blood flow to the heart muscle. Distinguished consultant cardiologist Dr Andrew Vanezis provides a guide to the condition, giving essential information about angina, its causes, symptoms, and management strategies.

What is angina?

Angina, often referred to as angina pectoris, is a symptom of an underlying heart problem, typically coronary artery disease (CAD). Coronary arteries are blood vessels that supply oxygen-rich blood to the heart muscle. When these arteries are narrowed or blocked, the heart doesn't get enough oxygen, resulting in chest pain or discomfort.

What are the various types of angina?

There are several types of angina, each with distinct characteristics:

Stable angina: This is the most common type and occurs predictably during physical exertion or stress. It usually lasts a few minutes and is relieved by rest or medication.

Unstable angina: This is more serious and can occur suddenly and without warning, even at rest. It may last longer and be more severe, indicating a higher risk of a heart attack.

Variant (Prinzmetal’s) angina or Coronary Spasm: This rare type occurs at rest, often in younger individuals. It is caused by a spasm in a coronary artery, temporarily reducing blood flow to the heart.

Microvascular angina or Ischaemia with Non Obstructive Coronary Arteries (INOCA): In this condition, the obstruction to coronary blood flow occurs in the tiny arteries of the heart that cannot be seen either at coronary angiography or with CT scanning. The mainstay of treatment for this condition is lifestyle changes and tablet therapy.

Recognising the symptoms

Angina typically presents as a pressure, heaviness, or tightness in the chest. Some people describe it as a squeezing or burning sensation. The pain may also spread to the shoulders, arms, neck, jaw, or back. Other symptoms can include:

• Shortness of breath
• Nausea
• Fatigue
• Sweating
• Dizziness

Diagnosing angina

If you experience chest pain or other symptoms of angina, it's crucial to seek medical attention promptly. Your doctor may perform several tests to diagnose angina and its severity, including:

• Electrocardiogram (ECG): This test records the electrical activity of your heart and can detect abnormalities.
• CT coronary angiogram (CTCA): This is a specialised CT scan with enough detail to look for plaque build up and blockages in the coronary arteries in the heart and is usually a precursor to invasive angiography.
• Stress test: This involves exercising on a treadmill or stationary bike while your heart activity is monitored.
• Echocardiogram: This ultrasound test shows the heart's structure and function. It can also be performed with a stress component, either with a bike or a medication that stresses the heart.
• Cardiac MRI: A detailed scan of the muscle of heart that is often used with a stress component if other stress tests are deemed to be not suitable or if a higher level of detail is required.
• Coronary angiography: This imaging test uses dye and X-rays to visualise the coronary arteries.

How can angina be managed?

The management of angina focuses on relieving symptoms and preventing further complications. Treatment options include:

• Medications: Nitrates, beta-blockers, calcium channel blockers and other agents such as Ranolazine can help relax and widen blood vessels and reduce the work of the heart, improving blood flow to the heart. Aspirin and other antiplatelet medications reduce the risk of blood clots.
• Lifestyle changes: Adopting a heart-healthy lifestyle is crucial. This includes quitting smoking, eating a balanced diet, exercising regularly, and managing stress and keeping blood pressure and cholesterol levels well controlled.
• Medical procedures: In some cases, procedures like angioplasty (widening the arteries with a balloon) or coronary artery bypass grafting (CABG) may be necessary to restore proper blood flow to the heart. In patient with no options for angioplasty or CABG, a newer procedure called a coronary sinus reducer device (CSRD) is now also available.

When should I seek emergency help?

It's important to recognise when angina might indicate a more serious problem. Seek emergency medical help if you experience:

• New or worsening chest pain.
• Chest pain that doesn't go away with rest or medication.
• Chest pain accompanied by shortness of breath, sweating, nausea, or fainting.

Understanding angina and its implications is vital for managing the condition effectively. By staying informed and proactive, you can work with your cardiologist to ensure the best possible outcomes for your heart health.

If you are concerned about angina and would like to book a consultation with Dr Vanezis, simply visit his Top Doctors profile today.