What is Angina?

Angina is the clinical term for chest pain or discomfort caused by an inadequate supply of blood to the heart. Angina can be a recurring problem or a sudden condition and can feel like a squeezing, heavy pressure or tightness in the chest, shoulders, neck, jaw or back. Angina is a symptom of coronary artery disease. 

Baptist Health is an accredited Chest Pain Center known for advanced, superior care for patients with heart disease and the diagnosis, management and treatment of angina. You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health. 

Symptoms

One of the primary signs of angina is chest pain or discomfort, which can also spread to the shoulders, arms, neck, back, jaw, and upper abdomen. In some cases, the pain may feel like gas or indigestion, and may also be described as an uncomfortable pressure, fullness, squeezing, tightness, burning or heavy weight. Other symptoms of angina can include: 

• Shortness of breath
• Lightheadedness, dizziness, or fainting
• Sweaty, cold, or pale skin
• Anxiousness
• Nausea or vomiting 

Angina is also sometimes associated with sleep problems, fatigue, and lack of energy.

Chest pain that lasts for more than a few minutes and isn’t relieved by rest may be a sign of a heart attack. Angina attack symptoms and heart attack symptoms can share some similarities. Call 9-1-1 for emergency help or angina emergency treatment. 

How Long Can an Angina Attack Last?

A typical stable angina attack will last 5 minutes or less, and the pain is usually predictable and manageable. Unstable angina attacks are not predictable, cause more severe pain and last longer. Microvascular angina attacks often last 10 to 30 minutes or more. 

Diagnosis

To diagnose angina, we ask questions about your medical history and do a physical exam. We then use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. Common diagnostic procedures can include:

Electrocardiogram (EKG): This test measures the electrical activity of the heart and can help determine if parts of the heart are enlarged, overworked or damaged. The heart’s electrical currents are detected by 12 to 15 electrodes that are attached to the arms, legs and chest via sticky tape.

Stress testing: This test is conducted during exercise. If a person can't exercise, medicine is given to increase heart rate. Used along with an EKG, the test can show changes to the heart’s rate, rhythm or electrical activity as well as blood pressure. Exercise makes the heart work hard and beat fast while heart tests are administered.

Chest X-ray: A common imaging test of the lungs, heart and aorta.

Echocardiogram: This ultrasound exam uses soundwaves to take moving pictures of the heart’s chambers and valves.

Coronary angiography: This procedure often is done with cardiac catheterization. During the procedure, dye that can be seen on an X-ray is injected into the heart chambers or coronary arteries. The dye lets a physician study blood flow through the heart and blood vessels to detect any blockages.

CT scan: X-rays and computers are used to create images of the aorta, heart and blood vessels. This provides a more detailed picture than an ultrasound.

Radionuclide imaging (thallium stress test): This non-invasive procedure can identify if there is severe heart damage. A radioactive isotope is injected into a vein and a special camera or scanner records how it travels through the heart. Any heart damage can be plotted, locating the damaged area of the heart. This procedure can be done with an electrocardiogram, during both rest an exercise.

Causes

Stable angina attacks are usually caused by partially blocked arteries, and triggered by physical exertion or mental or emotional stress. Other types of angina can be triggered by stress or physical exertion as well, but may also be triggered by a slowed heart rate resulting from lying down or sleeping, or seemingly have no trigger at all. Other causes of angina may include:

• Cocaine use
• Diabetes
• High blood pressure
• High cholesterol
• Obesity
• Sedentary lifestyle
• Smoking
• Stress
• Unhealthy diet

Risk Factors

Risk factors that could contribute to angina include: 

Family or personal history: Those with a family or personal history of certain types of heart disease, including coronary artery disease, heart failure and heart attack, are at greater risk for angina. 

Age: Men over 45 and women after 55 are at greater risk for angina. 

Metabolic syndrome: Sometimes known as insulin resistance syndrome, metabolic syndrome is caused by a group of risk factors that increase the risk of heart disease. 

How to Prevent Angina

While some risk factors like age and heredity cannot be controlled, there are ways you can help to prevent a heart disease and the symptoms of angina. Here are some tips on how to prevent angina attacks:

• Avoid use of tobacco and cocaine: Both have significant risk for causing heart attack.
• Watch what you eat: Eat healthy and avoid foods that are high in trans and saturated fats.
• Exercise and maintain a healthy weight: Staying active increases your heart health.
• Take your medications as prescribed: if you have high blood pressure, high cholesterol or diabetes, make sure you take your prescribed medications as directed.
• Get regular check-ups: if you are experiencing chest pain, fatigue, shortness of breath or other symptoms, get checked out right away. The earlier you’re diagnosed and treated, the better the outcome.
• Avoid stressors: Avoiding highly stressful situations or learning to manage them better can help prevent angina attacks. 

Prognosis

The prognosis for angina depends on the type and severity of the symptoms. Angina that causes mild to moderate discomfort or pain can usually be treated with medication and lifestyle changes. Angina that causes severe or crippling pain that comes without warning requires emergency treatment and is often a symptom of a more serious underlying condition.

Treatment

Your doctor may help you identify your angina triggers and discuss ways you might avoid them, and in many case prescribe medication to relieve symptoms and help prevent more serious complications. If your condition is severe, you begin to see new or worsening symptoms, or suffer from unstable angina, you should see a doctor right away and your doctor may recommend a surgical option.

Lifestyle Changes

Changes in diet and exercise, stopping smoking, reducing stress, and identifying and managing triggers can help reduce angina attacks.

Medication

Your doctor may prescribe nitroglycerin to relieve symptoms of stable angina, which happens when your heart works hard and needs more oxygen. Other medications may include aspirin, statins to lower cholesterol or vasodilators to lower blood pressure.

Procedures

Certain minimally invasive procedures may be recommended if angina is caused by a blocked or narrowed artery, including:

Angioplasty and stenting: During this procedure, a small catheter is placed in your arm or groin, and a thin tube is threaded through the blood vessel to your heart. This tube may first be used to inject dye to get a clearer picture of any plaque buildup or blockages. Once a buildup or blockage is identified, a wire with a tiny balloon attached is sent through the tube and into the blockage, where the balloon is inflated. This stretches the artery and pushes the plague to the side, helping restore blood flow. In many cases, a mesh tube or stent is then placed in the previously blocked area to ensure the artery stays open.

Surgery

If angina is a symptom of severe coronary artery disease, surgery may be recommended.

• Coronary artery bypass grafting (CABG): This surgery improves blood flow to your heart by creating a bypass around your narrowed coronary arteries using arteries or veins taken from other parts of your body. 

Recovery After Surgery

Depending on how your body heals, you will be in the hospital for four to seven days after a CABG procedure and recover well within six to 12 weeks. Your doctor will tell you when you may be physically active again and about what activities to avoid during recuperation. After heart surgery, you will be directed to do cardiac rehabilitation. This program provides an exercise regimen specifically designed to help you slowly strengthen your heart, and make other diet and lifestyle changes that will reduce your risk of heart attack, heart failure, and other complications.

Complications

Angina is often a sign of a more serious condition, and can lead to or be a symptom of the following: 

Heart failure: When the arteries that supply the heart with oxygen-rich blood from the lungs become so narrow and clogged the heart can’t pump enough blood to meet the body’s needs, it results in heart failure. 

Heart attack: If the plaque that has built up in the coronary arteries and is causing your angina ruptures and forms a clot that severely or completely restricts the blood supply to the heart, a heart attack occurs. 

Related Conditions

Angina is often a symptom of the following underlying conditions:

Arteriosclerosis: Arteriosclerosis occurs when arteries grow thick and stiff and restrict blood flow to organs and tissues in the body.

Coronary artery disease (CAD): CAD is the result of the buildup of plaque on the inner walls of the coronary arteries, causing them to harden and narrow.