All About Angina

By PEGGY EGAN, Beth Israel Deaconess Medical Center Correspondent

The heart relies on a steady flow of blood to supply the body’s other organs with the oxygen and nutrients they need to function well. When the heart itself does not get the amount of blood it needs, you may feel pain or pressure in the chest called angina. “Angina is a symptom that results from a mismatch between how much oxygen-rich blood the heart needs and how much it receives,” says Eli Gelfand, MD, FACC, director of outpatient cardiology at the Beth Israel Deaconess Medical Center CardioVascular Institute. “In some people, the body responds with pain or pressure that is felt in the chest, arm or jaw. Others may feel sudden unusual fatigue, nausea, vomiting and even tooth pain. Women and those with diabetes are particularly prone to having these less-typical symptoms.”

The most common cause of angina is coronary artery disease, a condition in which there is a blockage in one or more of the arteries that impedes the amount of blood that gets to the heart. Angina can also result from temporary narrowing, or “spasm” of the coronary arteries. “If you have chest pain or pressure you haven’t felt before, particularly if you are older, are a smoker, or have diabetes, high blood pressure or high cholesterol, consult your physician,” Dr. Gelfand notes. “If the sensation doesn’t pass quickly, or goes away and comes back, consider it an emergency and call 911.”

In non-emergency situations, a visit to your primary care physician is a good first step in determining whether you have angina and what is causing it. He or she will complete a physical exam, order appropriate blood tests, perform an electrocardiogram, and often arrange for a cardiac stress test. Sometimes a referral to a cardiologist is warranted for further consultation, testing and treatment.

Angina is typically classified as stable or unstable. Unstable angina requires immediate medical treatment, as it frequently indicates a blood clot in an artery and may progress to a full-blown myocardial infarction, commonly known as a heart attack. Stable angina, once properly diagnosed, is generally manageable at home under the care of a doctor.

After being diagnosed, Dr. Gelfand recommends writing down a list of questions to discuss with your physician, such as:

  • What caused my angina?
  • Do I have narrowed heart arteries?
  • Is my angina reversible?
  • What lifestyle changes can I implement to help myself?
  • What medicines will help me manage my symptoms?
  • Is it safe for me to exercise? When can I start and how much exercise is healthy for me?
  • Would a supervised exercise program be right for me?
  • Do I need other tests?
  • Are there procedures that will help my symptoms?

A treatment plan to manage angina may include lifestyle modifications to reduce risk factors such as smoking, high blood pressure and high cholesterol; changing your diet to a heart-healthy one; taking a daily low-dose aspirin to reduce heart attack risk; developing an individualized exercise plan; taking medications to reduce cholesterol and control blood pressure and heart rate; and taking nitroglycerin when symptoms are present. Angina may also be alleviated with procedures or surgery to widen narrowed arteries.

Individuals who experience stable angina will get to know its pattern over time, which is also helpful in managing symptoms. It is more likely to happen under circumstances that require the heart to work harder, such as physical exertion or emotional stress. “If someone who likes to walk always experiences angina pain halfway up a certain hill, he or she can take note of that and take a nitroglycerin at the bottom of the hill,” says Dr. Gelfand. “It can be taken in an anticipatory fashion.”

Dr. Gelfand notes the importance of a close working relationship with your cardiologist when managing stable angina. “Although angina is considered a chronic condition, in the vast majority of cases the symptoms are very manageable and the overall prognosis is excellent,” he says.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor. Posted August 2016

 

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