Angina

What is angina?

Angina is the chest pain, pressure, or feeling of tightness you feel when your heart does not get enough oxygen.

What causes angina?

Angina is caused by reduced blood flow and oxygen to the heart. The following conditions could lead to angina:

• Blockage: Atherosclerosis is when fatty deposits and other things build up in an artery and form plaque. This plaque buildup is what narrows or blocks your arteries. It is the most common cause of angina. Blood clots can form on the plaque and narrow the arteries even more.
  
  
• Spasm: Sometimes a coronary artery can spasm (suddenly tighten) and cause angina.
  
  
• Other causes: Heart valve disease, an enlarged heart, or very high blood pressure may cause angina. Inflammation, infection, anemia, and blood clots can also cause angina.

What increases my risk of angina?

The following things can increase your risk for atherosclerosis, angina, and other heart problems:

• You are over 55 years old.
  
  
• You have diabetes, high blood pressure, or high cholesterol.
  
  
• You are a smoker, or you have smoked in the past or been exposed to cigarette smoke on a regular basis.
  
  
• You do not get much exercise or you are overweight.
  
  
• You are a man or a menopausal woman.
  
  
• You are a woman who smokes and takes birth control pills.
  
  
• You have atherosclerosis (hardening of the arteries) in other areas of the body.
  
  
• You have used cocaine.
  
  
• You have a family history of heart problems.

What are the signs and symptoms of angina?

Angina is a feeling of pressure, tightness, or pain that usually happens in the center of your chest. Angina may also be felt in your neck, jaw, shoulder, back, or as pain or numbness in either arm. You may have discomfort that feels like heartburn. You may have shortness of breath, sweating, or feel fear or anxiety before or during an angina attack. There following are different types of angina:

• Stable angina: Stable angina is often triggered by exercise or physical work. It may be triggered by extreme temperatures, heavy meals, or getting upset. The pain often starts slowly and may last a few seconds to 30 minutes. Ten minutes of rest, or medicine (such as nitroglycerin) usually makes stable angina go away.
  
  
• Unstable angina: Unstable angina may be more painful and last longer than stable angina. Some people get unstable angina without ever having stable angina. The chest pain may be new, worse, or occur at rest. Unstable angina is serious.
  
  
• Prinzmetal's or variant angina: This type of angina is caused by a spasm of a coronary artery.
  
  
• Microvascular angina: This occurs without narrowing, blockage, or spasms of the coronary arteries. It may be caused by a problem with the small blood vessels that supply your heart with oxygen.
  
  
• Atypical angina: Women and people who have diabetes may not have typical chest pain when they have a heart problem. The discomfort may be in an unusual place, or there may not be pain at all. With atypical angina, your only symptoms may be shortness of breath or nausea.

How is angina diagnosed?

Sometimes it is hard to tell the difference between angina and a heart attack. Your caregiver will review your medical history and your symptoms. He may need to order several tests to make sure you are not having a heart attack or other heart problem. You may need the following:

• Electrocardiogram: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity and look for problems or damage in different areas of the heart.
  
  
• Exercise stress test: This test helps caregivers see the changes that take place in your heart during exercise. It checks for blockages in the arteries of your heart. An EKG is done while you ride an exercise bike or walk on a treadmill. Caregivers will ask you how you are feeling during the test. They want to know if you have chest pain or trouble breathing.
  
  
• Echocardiogram: This test is a type of ultrasound. Sound waves are used to show the structure, movement, and blood vessels of your heart.
  
  
• Cardiac catheterization: This procedure uses dye and a special x-ray to check the blood flow in your coronary arteries. This can help your caregiver decide how to treat your angina. Sometimes blockages can be treated during a cardiac catheterization.
  
  
• Blood tests: Your caregiver may look at blood tests to get information about your overall health. These may be used to see if there is damage to your heart.

How is angina treated?

Caregivers will work with you to decrease your chest pain and reduce your risk for a heart attack. Your treatment plan may include one or more of the following:

• Medicines:
  
  
  • Heart medicines: You may be treated with medicine that helps blood flow better through your heart. You may also need medicine so your heart does not work too hard. Some medicines may keep you from having spasms in your coronary arteries. Heart medicine may decrease how often you have angina, how long it lasts, and the amount of pain you have.
    
    
  • Nitroglycerin: This medicine opens the arteries to your heart so it gets more oxygen. Nitroglycerin can be given in an IV, by mouth, or put on your body as a patch or paste.
    
    
  • Antiplatelet medicine: Your caregiver may have you take aspirin or other medicines to prevent blood clots in your coronary arteries. These medicines may increase your risk of bleeding, including stomach bleeding. Ask your caregiver for more information on the risks of these medicines.
  
  
• Angioplasty and stenting: Angioplasty is when your caregiver inserts a small balloon into the arteries of the heart to push the fatty deposits against the artery wall. This makes more room for blood to flow. Sometimes a stent (mesh tube) is placed during angioplasty to keep your arteries open.
  
  
• Heart bypass surgery: You may need open-heart surgery to help your chest pain or to keep you from having a heart attack. A coronary artery bypass graft (CABG) can improve blood flow to the heart by sending blood around a blocked artery.

What are the risks of angina?

• If you are taking nitroglycerin medicine, you should not take certain drugs. Some drugs used to treat certain sexual or impotence problems may interact with nitroglycerin. Ask your caregiver if any of your medicines contain nitroglycerin.
  
  
• If you do not get treatment, your angina may get worse and further increase your risk of a heart attack and death.

Where can I get more information?

• American Heart Association
  7272 Greenville Avenue
  Dallas , TX 75231-4596
  Phone: 1- 800 - 242-8721
  Web Address: http://www.heart.org
  

• National Heart, Lung and Blood Institute
  Health Information Center
  P.O. Box 30105
  Bethesda , MD 20824-0105
  Phone: 1- 301 - 592-8573
  Web Address: http://www.nhlbi.nih.gov/health/infoctr/index.htm
  

When should I contact my caregiver?

Contact your caregiver if:

• Your skin is itchy or you get a rash.
  
  
• Your angina is happening more frequently, lasting longer, or causing worse pain.
  
  
• You are dizzy or nauseated after you take your medicine.
  
  
• You have trouble breathing while resting.
  
  
• You have new or worse swelling in your feet or ankles.
  
  
• You are bleeding from your gums or nose, or have blood in your urine or bowel movement.
  
  
• You have any questions or concerns about your condition or care.

When should I seek immediate care?

Seek care immediately or call 911 if:

• Call 911 or an ambulance if you have any signs of a heart attack:
  
  
  • Discomfort in the center of your chest that feels like squeezing, pressure, fullness, or pain, that lasts for more than a few minutes or keeps returning
    
    
  • Discomfort or pain in your back, neck, jaw, stomach, or one or both of your arms
    
    
  • Feeling sick to your stomach
    
    
  • Having trouble breathing
    
    
  • A sudden cold sweat, particularly in combination with chest discomfort or trouble breathing
    
    
  • Feeling very lightheaded or dizzy, particularly in combination with chest discomfort or trouble breathing
  
  
• You have chest pain that does not go away after you take medicine as directed.
  
  
• You lose feeling in your face, arms or legs, or suddenly feel weak.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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