Angina: Types, Symptoms and Risks

Angina is a type of chest pain caused by a reduced flow of blood to the heart, and is a symptom of coronary artery disease. It is also referred to as angina pectoris. Angina is common and is typically described as heaviness, tightness or pain in the chest. It can either be a recurrent pain that goes away with treatment or can be described as a new pain and needs to be checked by a cardiologist.

Types of Angina

The different types of angina depend on its cause and whether medicine or rest can ease symptoms. These can be as follows:

• Stable angina: This is the most common type of angina. It usually occurs during strenuous physical activity or due to exertion. Stable angina is also relatively predictable and is usually similar to previous chest pain episodes.
  
  

• Unstable angina: Unstable angina is a medical emergency as it is unpredictable and occurs at rest. This is a severe type of angina and lasts longer than stable angina.

If the blood flow does not improve, the heart will not get enough oxygen, causing a heart attack.

• Variant angina: Also known as Prinzmetal angina, this form of angina is not due to coronary artery disease. It is due to spasm in the arteries of the heart. Severe chest pain is the most common symptom of variant angina. It occurs in cycles, typically in a resting state and overnight.
  
  

• Refractory angina: Frequent angina episodes despite treatment with medicines and lifestyle modifications.

Angina Symptoms

The symptoms of angina include chest discomfort and pain. This may feel like:

• Squeezing

• Pressure

• Fullness

• Burning

Pain may also be felt in the jaw, neck, shoulders, arms or back.

Other symptoms of angina may include:

• Shortness of breath

• Sweating

• Nausea

• Fatigue

• Dizziness

Note: The type, duration and severity of angina can vary. New or varying symptoms may indicate unstable angina or heart attack. In addition, a worsening symptom of angina must be checked immediately.

Angina in Women

Angina symptoms in women are different from classic angina symptoms. These variations can cause delay in seeking treatment. Symptoms of angina in women include:

• Discomfort in the jaw, teeth, neck or back

• Nausea

• Shortness of breath

• Stabbing pain in the chest

• Pain in the stomach

Angina Causes

• Angina is caused by reduced flow of blood to the heart. When the heart muscle is devoid of oxygen, this condition is referred to as ischemia.
  
  

• The most common cause of reduced blood flow to the heart is CAD (Coronary Artery Disease). Fatty deposits, known as plaques narrow the arteries of the heart, called coronary arteries, causing a condition called atherosclerosis.
  
  

• Plaque in a blood vessel can rupture or cause a blood clot. These events can reduce blood flow through a narrowed artery, suddenly decreasing the flow of blood to the heart. This severely and suddenly decreases the blood flow to the heart.
  
  

• Also, note that the heart muscle may be able to function even during times of low oxygen without triggering symptoms of angina.

Angina Risk Factors

• Age: Angina is common in adults over the age of 60.
  
  

• Family history: A family history of heart disease may increase the risk of angina or heart attack.
  
  

• Tobacco use: Use of tobacco and a prolonged exposure to passive smoking damages the lining of arteries, leading to cholesterol build-up and reduced blood flow.
  
  

• Diabetes: Diabetes can increase the risk of coronary artery disease. CAD can cause angina.
  
  

• Hypertension: High blood pressure causes damage to the arteries, by speeding up hardening of arteries.
  
  

• High cholesterol: Excessive bad cholesterol, known as low density lipoprotein in the blood can cause the arteries to narrow. High levels of LDL increases the risk of heart attack and angina.
  
  

• Lack of physical activity: Lack of exercise can increase the risk of high blood pressure, cholesterol, type 2 diabetes and obesity.
  
  

• Mental stress: High stress levels and anger can raise blood pressure levels. Also, a rush of hormones during stress can worsen angina.
  
  

• Medications: Certain medicines can tighten blood vessels and trigger angina, such as migraine medications.

Angina Treatment

The goal of angina treatment is to improve flow of blood to the heart and reduce the risk of complications. Common angina treatment options may include:

• Antiplatelet drugs or anticoagulants (lowers the risk of blood clots)

• Blood pressure medications

• Medications for cholesterol

• Medications specifically used to treat angina

• Lifestyle modifications

• Coronary artery bypass grafting

• Stenting and coronary angioplasty

Even after treatment, some people may experience angina. EECP (Enhanced External Counterpulsation) is another treatment option for individuals with continued pain. This therapy works by applying pressure to the lower legs and improves blood flow to the heart.

Prevention of Angina

Angina can be prevented with the help of lifestyle changes that include

• Limiting alcohol

• Quitting smoking

• Eating a healthy diet

• Exercising regularly

• Maintaining a healthy weight

• Managing health conditions linked to heart disease

• Reducing stress

• Getting an adequate amount of sleep.

FAQs

1. What is the main cause of angina?

The main cause of angina is coronary heart disease. This condition occurs when fatty deposits called plaque narrow the arteries that supply blood to the heart muscle. This reduces the blood flow and causes angina symptoms.

2. What is the difference between heart attack and angina?

The key difference between angina and heart attack is that angina is the result of narrowed coronary arteries. Also, unlike a heart attack, angina does not lead to permanent heart damage.

3. Can ECG detect angina?

An ECG or electrocardiogram helps recognize the types of angina and other serious heart conditions. Certain patterns in the ECG can be a sign of unstable angina.

4. How to detect angina?

Some tests that are used to diagnose and confirm angina include:

• Electrocardiogram

• Echocardiogram

• Chest X-rays

• Blood tests

• Stress tests

• Nuclear stress test

• Magnetic Resonance Imaging (MRI) or Cardiac Computed Tomography

• Coronary angiogram