Watch Out for Angina! Know the Symptoms, Triggers, and Treatment

Think of the heart as a muscle that works hard to pump blood throughout the body. If the blood vessels that supply blood to the heart become narrowed or blocked, the heart does not get enough oxygen. This lack of oxygen causes pain or discomfort in the chest, known as angina.

01 / Heart Disease

What Is Angina?

In simple terms, angina is a condition marked by pain or discomfort in the chest (usually left-sided chest pain) caused by a lack of adequate blood flow to the heart. This symptom often appears when the heart needs more oxygen, such as when a person is physically active or under emotional stress. Although angina is not a heart attack, it is a sign that there is a problem with heart health and should be taken seriously.

02 / Heart Disease

Types of Angina

Angina is divided into several types based on the pattern of symptoms and triggers. Here is an explanation of the types of angina that are commonly seen:

1. Stable Angina

Stable angina is chest pain that occurs predictably, usually during physical activity that increases the heart’s need for oxygen. The pain usually goes away after rest. It indicates a narrowing of the coronary arteries that is relatively constant and does not change suddenly.

• Triggers: Physical activity (such as brisk walking or climbing stairs), emotional stress, eating heavy meals, and exposure to cold air.
• Symptoms: Pain or pressure in the chest, often felt as tightness or heaviness. The pain can spread to the left arm, jaw, neck, or back.
• Characteristics: Chest pain appears consistently, in the same pattern, during certain activities and eases with rest. The intensity and type of pain tend to stay the same over time.
• When to seek medical help right away: Even though it is called “stable,” if there is a sudden change in the intensity or frequency of the pain, or if the chest pain does not go away after rest, contact medical services immediately.

2. Unstable Angina

Unstable angina is a much more serious condition. Chest pain can occur suddenly, even at rest, and it can be more intense and last longer. It signals unstable plaque in the coronary arteries, which carries a high risk of causing a heart attack.

• Triggers: It can occur spontaneously, without strenuous physical activity. Emotional stress can be a trigger, but it often appears without a clear trigger.
• Symptoms: Chest pain that is more frequent, longer lasting, and more intense than stable angina. It may be accompanied by shortness of breath, cold sweats, and nausea.
• Characteristics: Unpredictable chest pain, increasing pain intensity and duration, and pain that occurs at rest or with minimal activity.
• When to seek medical help right away: Unstable angina is a medical emergency. Call emergency services immediately or go to a hospital if you have chest pain that matches these characteristics.

3. Variant Angina (Prinzmetal’s Angina)

A relatively rare type of angina caused by a spasm (temporary narrowing) of the coronary arteries, rather than by plaque blockage.

• Triggers: It often occurs at night or at rest. The cause of the spasm is not always known, but several factors such as smoking and cocaine use can increase the risk.
• Symptoms: Sudden and severe chest pain, often similar to unstable angina.
• Characteristics: Chest pain that comes on suddenly, especially at night or at rest, and often responds to medications that widen the blood vessels (such as nitrates).
• When to seek medical help right away: Because the chest pain can be very severe and signals a coronary artery spasm, contact medical services immediately if you have symptoms that match the characteristics of Prinzmetal’s angina.

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Causes of Angina

The main cause of angina is narrowing of the coronary arteries due to atherosclerosis. Atherosclerosis is a condition in which fat, cholesterol, and other substances form plaque on the artery walls, reducing blood flow to the heart. This narrowing prevents the heart from getting enough oxygen, especially when it needs more oxygen, such as during physical activity or stress.

Narrowing of the coronary arteries can worsen angina, which ultimately increases the risk of a heart attack or other serious complications.

Risk Factors

Several risk factors can increase the likelihood of developing angina. These factors can speed up the narrowing of the blood vessels and increase the chance of angina symptoms appearing. Here are some of the main risk factors:

• Smoking: Smoking damages the lining of the blood vessels and increases the risk of plaque formation. The nicotine in cigarettes also narrows the blood vessels, worsening blood flow to the heart.
• High Blood Pressure (Hypertension): High blood pressure forces the heart to work harder, increasing its need for oxygen. This condition can also damage the artery walls, speeding up plaque formation.
• High Cholesterol: High cholesterol, especially LDL (“bad cholesterol”), is a main component of atherosclerotic plaque. High LDL cholesterol levels increase the risk of plaque buildup in the coronary arteries.
• Diabetes: Diabetes increases the risk of heart and blood vessel disease, including atherosclerosis. People with diabetes often have high blood sugar levels, which can damage the artery walls.
• Obesity: Obesity increases the risk of various chronic diseases, including heart disease. Excess weight can raise blood pressure, cholesterol levels, and blood sugar levels, all of which are risk factors for angina.
• Lack of Physical Activity: Not exercising enough can increase the risk of obesity, high blood pressure, and high cholesterol, all of which are risk factors for angina.
• Family History of Heart Disease: If you have a family history of coronary heart disease, your risk of angina is higher. Genetic factors play a role in determining a person’s susceptibility to atherosclerosis.
• Age: The risk of angina increases with age. The aging process can reduce the elasticity of the blood vessels and speed up plaque formation.

Managing these risk factors through a healthy lifestyle can help reduce the risk of developing angina. Consult your doctor for a risk evaluation and a suitable prevention plan.

04 / Heart Disease

Diagnosis of Angina

Diagnosing angina requires several methods to evaluate the condition of the heart and determine the cause of chest pain. Here are some diagnostic methods commonly used to diagnose angina:

1. Electrocardiogram (ECG)

An ECG is a simple, noninvasive test that records the heart’s electrical activity. Electrodes are placed on the skin of the chest to detect and record the heart’s electrical signals. An ECG can show changes in the heart that may indicate coronary heart disease, although it does not always detect narrowed arteries directly. An ECG can show wave changes that may indicate ischemia (lack of oxygen) in the heart muscle, which often occurs in angina.

2. Cardiac Stress Test

A cardiac stress test is done to assess how the heart responds to an increased need for oxygen. There are several types of cardiac stress tests, including:

• Treadmill Stress Test: The patient walks on a treadmill at increasing speed and incline while heart activity is monitored with an ECG. This test aims to see whether angina symptoms or ECG changes indicating ischemia appear when the heart is working harder.
• Stress Echocardiography: This test combines a stress test with a heart ultrasound (echocardiography). The heart ultrasound is done before and after the stress test to assess heart function and blood flow to the heart. This allows more detailed detection of areas of the heart that may be lacking oxygen.

Cardiac stress tests help identify narrowing of the coronary arteries that is significant enough to cause angina.

3. Coronary Angiography

Coronary angiography is an invasive procedure that provides detailed images of the coronary arteries. A thin, flexible catheter is inserted into an artery in the groin or wrist, then guided to the heart to inject a contrast dye. This contrast dye allows the doctor to see the coronary arteries on X-ray images and identify areas of narrowing or blockage. Coronary angiography is the gold standard for diagnosing and assessing the severity of coronary artery disease.

4. Blood Tests

Certain blood tests can help in diagnosing angina, although they are not the main tests. For example, measuring certain cardiac enzymes (such as troponin) can help detect heart muscle damage that may have occurred due to a heart attack. Cardiac enzyme tests are generally not used routinely to diagnose stable angina, but are more often used to assess the possibility of more serious heart damage.

The doctor will consider the patient’s medical history, symptoms, and the results of the tests above to make an accurate diagnosis of angina. The choice of diagnostic tests depends on the patient’s condition and the doctor’s suspicion of how severe the coronary heart disease is.

05 / Heart Disease

Treatment of Angina

Treating angina involves a comprehensive approach to managing symptoms and improving overall heart health. Here are some of the main aspects of angina treatment:

1. Lifestyle Changes

Lifestyle changes are an important pillar of angina treatment. By changing daily habits, patients can reduce the risk of a heart attack and improve their overall heart health. Recommended lifestyle changes include:

• Healthy Diet: Eating foods that are low in saturated fat, sugar, and salt, and eating more vegetables, fruits, and whole grains. A balanced diet can help control body weight and lower cholesterol levels.
• Regular Exercise: Regular physical activity, such as walking, running, or cycling, can improve heart health and reduce the risk of angina symptoms. Consult your doctor before starting an exercise program.
• Quitting Smoking: Smoking is one of the main risk factors for heart disease. Quitting smoking can improve blood flow and overall heart health.
• Stress Management: Managing stress through relaxation techniques, such as yoga, meditation, or breathing exercises, can help reduce angina symptoms and improve quality of life.

2. Medications

Several types of medication can help manage angina. Your doctor will determine the right type and dose of medication based on your condition. Some commonly used types of medication include:

• Nitrates: These medications widen the blood vessels, increase blood flow to the heart, and help relieve chest pain. Nitrates are usually given as medication taken by mouth or sprayed under the tongue during an angina attack.
• Beta-Blockers: These medications slow the heart rate and lower blood pressure, reducing the heart’s workload and need for oxygen.
• Calcium Channel Blockers: These medications also widen the blood vessels, increasing blood flow to the heart.
• Statins: Statins lower LDL cholesterol (“bad cholesterol”) levels in the blood, helping prevent and slow the progression of atherosclerosis.
• Antiplatelets: These medications prevent blood clots, reducing the risk of heart attack and stroke.

3. Medical Procedures

In some cases, medical procedures may be needed to treat significant narrowing of the coronary arteries. These procedures include:

• Angioplasty and Stent Placement: This procedure involves inserting a catheter into the blocked coronary artery. A small balloon at the tip of the catheter is then inflated to widen the artery. A stent, a small wire mesh tube, is often placed inside the artery to keep it open.
• Coronary Artery Bypass Surgery (CABG): In this procedure, a blood vessel from another part of the body is used to create a detour around the blocked coronary artery, increasing blood flow to the heart. CABG is usually recommended for severe coronary artery blockages that cannot be treated with angioplasty.

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Preventing Angina

Preventing angina focuses on modifying the risk factors that can be controlled to reduce the chance of atherosclerosis and narrowing of the coronary arteries. Here are some effective and practical steps to prevent angina:

• Healthy Eating Pattern: Eating healthy foods that are low in saturated fat and cholesterol can help keep your heart healthy. Focus on foods rich in fiber, such as fruits, vegetables, and whole grains. Reducing your intake of red meat and processed foods high in saturated fat is also strongly recommended.
• Regular and Measured Exercise: Regular physical activity helps improve heart health. It is recommended to exercise at least 150 minutes per week, which can include activities such as walking, running, cycling, or swimming. Exercise helps improve blood circulation and reduce stress.
• Maintaining an Ideal Body Weight: Maintaining a healthy body weight is very important for heart health. Being overweight or having obesity can increase the risk of high blood pressure and high cholesterol. By maintaining an ideal body weight, you can reduce your risk of angina.
• Managing Stress Effectively: Stress can have a negative impact on heart health. Managing stress with relaxation techniques such as yoga, meditation, or hobbies can help lower stress levels and improve mental health.
• Avoiding Smoking and Secondhand Smoke: Smoking is one of the main risk factors for heart disease. Quitting smoking and avoiding secondhand smoke improve not only heart health but also your overall health.
• Monitoring and Controlling Blood Pressure and Cholesterol: It is important to monitor your blood pressure and cholesterol levels regularly. If you have high blood pressure or high cholesterol, follow your doctor’s advice to get the right treatment and keep your levels within a healthy range.
• Having Regular Heart Checkups: Regular heart checkups can help detect problems earlier. Discuss with your doctor how often you should have a checkup based on your age and individual risk factors.

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Conclusion

Angina is a condition that shows the heart is not getting enough oxygen. Knowing the signs and symptoms of angina, such as chest pain and discomfort related to physical activity or stress, is an important step in dealing with heart health problems.

Early detection and proper treatment are very important to prevent serious complications such as a heart attack, heart failure, arrhythmia, and even sudden death. Do not ignore chest pain or other worrying symptoms. Consult a doctor promptly if you have symptoms that may indicate angina.

If you have symptoms of angina or have risk factors for heart disease, it is important to consult a doctor or visit Heartology Cardiovascular Hospital to get the proper evaluation and care.