Angina Pectoris (Chest Pain)
What is angina pectoris?
Angina is temporary pain or discomfort in the chest that occurs when not enough oxygen-carrying blood reaches your heart muscle. (The term "angina" means "pain," while "pectoris" refers to the chest.) Sometimes angina feels like heartburn, the similar sensations you may get after eating a heavy meal. But if you feel this pain regularly, it may be a symptom of heart disease.
What causes it?
Angina is most often a sign that you have heart disease, specifically a blockage of one or more of the main blood vessels supplying the heart muscle. In fact, angina is the most typical symptom of heart disease. In the United States, approximately 9.8 million people suffer from it. An angina attack occurs when the blocked vessel prevents adequate blood flow, or when there is spasm of the vessel leading to decreased blood flow to the heart muscle.
Does angina cause or worsen a heart condition?
Usually, angina does not cause any heart damage. Angina is more like a warning signal, and it can mean you're at greater risk of having a heart attack. Whether you're hiking uphill, having a heated argument with your partner, or digesting a five-course gourmet meal, angina is your heart's way of telling you that you're making it work too hard and that it is not getting enough blood and oxygen.
What are the symptoms of angina?
Although they vary from person to person, these are the typical symptoms:
- A sharp or dull pain, tightness, pressure, squeezing, or burning sensation in the chest
- Pain in your arms, neck, jaw, shoulder, or back accompanying chest discomfort (These symptoms often occur during physical exertion, emotional stress, or eating.)
- Tingling, aching, or numbness in the elbows, arms, or wrists (especially your left arm)
- Shortness of breath
How is angina diagnosed?
By your symptoms and a stress test, which usually means walking on a treadmill. You'll be hooked up to an electrocardiogram (EKG), which measures the electrical activity of the heart before, during, and after the stress test, and your blood pressure will be monitored throughout. Characteristic changes occur on the EKG if heart disease is present. But this test is meant for screening, and you may need other tests, such as a nuclear scan or an angiogram. In an angiogram, a dye is injected into your blood and an x-ray is taken of the heart and its blood vessels.
How is it treated?
Nitroglycerin placed under the tongue is the usual medication for an attack of angina: It helps dilate blood vessels so more blood can reach the heart. Nitroglycerin is also available in pill or patch form to prevent symptoms. (Anyone taking nitroglycerin should avoid using Viagra (sildenafil), as a serious drop in blood pressure could result.) After you've undergone a full evaluation, your physician may prescribe other medications, such as beta blockers and calcium channel blockers, that can help prevent angina as well. Your doctor may also want you to take aspirin regularly, which reduces the ability of blood to clot allowing it to flow more easily through narrowed arteries.
You may benefit from learning stress-reduction techniques such as meditation or relaxation exercises. Check your local community center for classes or workshop listings.
What should I do if I'm having an angina attack?
Most people who have been diagnosed with angina are prescribed nitroglycerin tablets. You should always have them on you or nearby. Keep them in several places at home and work. Sit down and rest, if you're not already sitting, and put one tablet under your tongue to dissolve. Nitroglycerin can cause dizziness, so it's important to take it sitting down and to get up slowly once you feel better. The American Heart Association recommends taking one nitroglycerin tablet. If the pain has not improved or has worsened after five minutes, you should immediately call 911 for an ambulance in case you are having a heart attack. Once you are in contact with emergency services, you may be instructed to repeat the dose of nitroglycerin up to two more times in five minute intervals.
How do I know whether I'm experiencing angina or a heart attack?
It's easy to mistake an angina attack for a heart attack. They both tend to start with chest pain. Both can be marked by pain, numbness, or tingling in the neck, shoulders, arms, and jaw. The difference is that with the most common form of angina, rest and medication relieve the symptoms in two or three minutes.
If you are having a heart attack, the pain will not go away, and it may become more intense. Although angina can cause chest pain and discomfort, heart attack pain is also generally more severe. Also, women often experience heart attacks differently than men and may have symptoms unrelated to chest pain such as shortness of breath, nausea, sweating, dizziness, or unusual fatigue. If you ever feel these symptoms or what could be described as "an elephant sitting on your chest", call 911: they are signs of a heart attack.
Does medication always help ease an angina attack?
It does if you have stable angina, the most common sort. If you've been diagnosed with unstable angina, symptoms of an angina attack will closely mimic those of a heart attack. Often, medication doesn't help unstable angina, and it lasts longer than a few minutes and occurs when you're not exerting yourself. You need to discuss with your doctor how to monitor your condition and when you should consider symptoms an emergency.
Knowing the pattern of your angina attacks should help you identify a true emergency, especially if there are changes in duration, cause, or intensity.
If I have angina, what do I have to do to take care of myself?
Your doctor will advise you on how much you can do based on the results of your tests. A supervised exercise program for heart patients can be extremely helpful, but you may need to modify your activities so you don't overtax yourself (see Exercise and Heart Disease). If a big, rich meal sets off an attack, try smaller portions. If walking quickly causes symptoms, slow down your gait. In very cold or windy weather you'll probably have to bundle up better and cover your head and face; your doctor may even tell you to put a nitroglycerin tablet under your tongue before stepping outside. And if you've had a heart attack already, your doctor may prescribe a low dose of aspirin every day to prevent another one.
If you have heart trouble, you'll be healthier if follow these guidelines:
- Control high blood pressure, diabetes, and high cholesterol levels.
- Maintain a low-fat, low-sodium diet.
- If you smoke, quit.
- Reduce or stop your alcohol consumption.
- If you're overweight, try to drop a few pounds.
- Exercise 30 minutes at least 5 days a week, unless your doctor forbids it.
Heart disease is generally treated with medication. In some cases, however, people have successfully reversed heart disease by exercising, following a strict, low-fat diet recommended by their doctors, and making other lifestyle changes.
American Heart Association 800-242-8721 http://www.americanheart.org
National Heart, Lung, and Blood Institute 800-575-9355 http://www.nih.gov/nhlbi
Angina, National Heart, Lung, Blood Institute.
Angina pectoris, American Heart Association.
Nitroglycerin Sublingual. Health for Life. Ohio State University Medical Center.
Heart Attack and Angina Statistics. American Heart Association.
American Heart Association. Heart Attack and Angina Statistics. http://www.americanheart.org/presenter.jhtml?identifier=4591
ACC/AHA Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction-Executive Summary. ACC/AHA Practice Guidelines. Circulation. 2004;110:588-636 Accessed 21 Nov 2008. http://circ.ahajournals.org/cgi/content/full/110/5/588
Mayo Clinic. Heart disease in women: Understand symptoms and risk factors. http://www.mayoclinic.com/health/heart-disease/hb00040
Mayo Clinic. Angina. http://www.mayoclinic.com/health/angina/DS00994
American Academy of Family Physicians. Angina and Heart Disease. http://familydoctor.org/online/famdocen/home/common/heartdisease/basics/233.html#ArticleParsysMiddleColumn0006