All about angina

Angina, commonly referred to as angina pectoris, is a type of chest pain or discomfort resulting from the heart muscle not receiving sufficient oxygen-rich blood. It is a critical symptom of underlying heart disease, most frequently coronary artery disease (CAD), which is the leading cause of death worldwide. Grasping the nuances of angina is essential for managing and averting more severe cardiovascular conditions, such as heart attacks. In his latest online article, Dr Ricardo Petraco gives us his insights.

Types of angina:

Angina manifests in several forms, each with distinct characteristics and underlying causes:

Stable angina:

• Characteristics: This form of angina is predictable, typically occurring during physical exertion or stress.
• Duration: It usually lasts a few minutes and can be relieved by rest or nitro-glycerine (GTN) spray.
• Cause: It arises from atherosclerosis, where plaques build up on the artery walls, narrowing them and restricting blood flow.

Unstable angina:

• Characteristics: Unstable angina is unpredictable and can occur at rest, often presenting more severe symptoms.

• Duration: The pain lasts longer and is not easily relieved by rest or medication.
• Cause: Often a precursor to a heart attack, this type is caused by the rupture of plaques and the formation of blood clots that significantly reduce blood flow.

Microvascular angina:

• Characteristics: Caused by abnormalities in the tiny vessels of the heart, leading to prolonged and more unpredictable patterns of pain under stress and minimal activities.
• Duration: The pain may last longer than other types and can be more severe.
• Cause: The exact causes are less understood but involve the small arterial branches within the heart muscle.

Symptoms

Angina presents through various symptoms, including:

• Chest pain or discomfort: Often described as pressure, squeezing, or a feeling of fullness in the chest.

• Radiating pain: This discomfort can extend to the arms, neck, jaw, shoulder, or back.
• Shortness of breath: Frequently accompanies or precedes chest pain.
• Fatigue: An unusual tiredness, particularly prevalent in women.
• Nausea: A feeling of sickness, also more common in women.

Diagnosis

The diagnosis of angina involves several steps to understand and confirm the condition:

Medical history and physical exam: Initial assessments to evaluate symptoms and risk factors.

Electrocardiogram (ECG): Measures the heart's electrical activity to detect abnormalities.

Stress testing: Assesses heart function under physical exertion.

Imaging tests: Includes echocardiograms, CT scans, and MRIs to visualise the heart’s structure and function.

Coronary angiography: An invasive procedure using dye and X-rays to examine the coronary arteries.

Treatment

Treating angina typically involves a combination of lifestyle changes, medications, and medical procedures:

Lifestyle changes: 

• Dietary approach: Adopting a heart-friendly eating plan abundant in fruits, vegetables, whole grains, and lean protein sources. Avoidance of sugars and saturated fat.
• Exercise: Regular physical activity tailored to individual fitness levels.
• Smoking cessation: Quitting smoking to enhance overall cardiovascular health.
• Weight management: Maintaining a healthy weight to reduce the heart's strain.

Medications:

• Nitrates: Such as nitro-glycerine, to alleviate chest pain by dilating blood vessels.
• Beta-blockers: Reduce heart rate and the workload on the heart. 
• Calcium channel blockers: Aid in the relaxation and dilation of blood vessels.
• Antiplatelet agents: Such as aspirin, to prevent blood clots.
• Statins: Lower cholesterol levels and stabilise plaques.

Medical procedures:

Angioplasty and stenting: Opens narrowed arteries and places a stent to keep them open.

Coronary artery bypass grafting (CABG): Surgically creates a new path for blood to flow around blocked arteries.

Prevention

Preventing angina involves proactive steps to maintain heart health:

• Regular check-ups: Monitoring blood pressure, cholesterol levels, and overall heart health.
• Healthy lifestyle: Adopting and maintaining a heart-healthy lifestyle to prevent CAD.
• Medication adherence: Following prescribed treatments to manage existing conditions and prevent complications.

Dr Ricardo Petraco is an esteemed cardiologist. You can schedule an appointment with Dr Petraco on his Top Doctors profile.