What Is Angina?

The term “angina” usually refers to “angina pectoris,” or chest pain that occurs when the heart doesn’t get enough oxygen. This lack of oxygen is called myocardial ischemia. It is generally caused by a buildup of plaque that partially clogs the coronary arteries, reducing blood flow to the heart. The pain can be severe or mild, and often follows exertion or stress.

There are three types of angina:

• Stable angina – The most common type, it occurs when the heart is exerted and usually resolves quickly after resting or taking medication.
• Unstable angina – Unlike stable angina, this can occur without physical exertion and is not relieved with rest or medication. Emergency treatment is required.
• Variant angina (also known as Prinzmetal’s angina) – A rare condition, this usually occurs at rest, but is relieved by medication.

Diagnosis

Your physician may suspect angina if you have any or all of the following symptoms:

• A tightness or heaviness in the chest
• Difficulty breathing
• Pressure, squeezing or burning in the chest
• Discomfort that spreads to the arm, neck, jaw or back
• Numbness or tingling in the shoulders, arms or wrists

Not all chest pain or discomfort is angina. Similar symptoms may occur with other conditions, including indigestion, panic attack or heart attack.

Chest pain that lasts longer than a few minutes and is not relieved by rest or angina medicine may mean you are having a heart attack. Don't wait. Call 911 to get emergency help right away.

Your physician may recommend any or all of the following diagnostic tests:

• Blood tests
• Fasting lipoprotein profile checks the cholesterol level
• Fasting glucose test checks blood glucose level
• C-reactive protein (CRP) test can indicate an inflammation (a risk factor for coronary artery disease)
• Cardiac enzyme tests look for enzymes such as troponin, which is released with severe ischemia or injury.
• A routine check for low hemoglobin (the part of a red blood cell that carries oxygen throughout the body) can help rule out other possible causes for the chest pain.
• Electrocardiogram (EKG or ECG) – This test involves attaching (with adhesive material) small electrodes to the arm, leg and chest to measure the rate and regularity of a heartbeat and to check for heart muscle damage.
• Exercise stress test – The patient is asked to perform exercise, such as walking on a treadmill, and EKG and blood pressure readings are taken before, during and after exercise to measure changes in heartbeat and blood pressure.
• Cardiac catheterization  – A thin flexible tube (catheter) is passed through an artery in the groin or arm into the coronary arteries, to examine the coronary arteries and monitor blood flow.

Treatment

If angina is diagnosed, your doctor may give you medications including:

• Nitroglycerin – relaxes blood vessels, allowing more blood to flow to the heart
• Beta blocker – decreases the heart’s need for blood and oxygen by slowing the heart rate and lowering blood pressure; decreases abnormal heart rhythms
• Calcium channel blocker – relaxes blood vessels, allowing more blood to flow to the heart
• ACE inhibitor – reduces blood pressure, reducing strain on the heart

Your physician may also recommend lifestyle changes to reduce your chance of having angina attacks, including one or all of the following:

• Quitting smoking
• Losing weight
• Eating a heart-healthy diet to prevent or reduce high blood pressure and high cholesterol (medications may also be prescribed)
• Practicing relaxation and stress management techniques
• Avoiding extreme temperatures, which can bring on angina attacks
• Avoiding strenuous activities

MidMichigan offers cardiac rehabilitation services, including supervised, prescribed aerobic training on exercise machines, to help you safely build a stronger cardiovascular system.

If medicines and lifestyle changes do not control your angina, your physician may recommend additional measures, including surgery.