Having Angina Pectoris? It could be a sign of impending Heart Attack

Angina Pectoris - Symptoms, Causes, Diagnosis, Treatment

Overview

The heart works non-stop throughout the day, pumping around 2,000 gallons of blood all over the body without a second of rest. As a matter of fact, over the average lifetime, the heart beats around 2.5 billion times, helping circulate approximately 50-65 million gallons of blood. The blood circulated by the heart helps in carrying several vital nutrients as well as oxygen to the various blood vessels, tissues, and organs in the body.  Essentially, the heart is undoubtedly, the most valuable organ in the body which makes it extremely important that it gets treated like the precious commodity it is.

Angina pectoris -- or simply angina -- occurs when the heart muscle (myocardium) fails to receive a sufficient supply of blood required to carry out the given level of work (insufficient blood supply can be better described as ischemia). Angina is derived from the Latin phrase that literally translates to “strangling in the chest” which is why when an individual suffers from an angina attack, he experiences a feeling of squeezing accompanied by a pressing pain in the chest region. The pain can also be felt in the arm, shoulder, neck, back, or jaw regions as well. Although it's temporary in nature and lasts only for a few minutes, angina is a symptom of coronary heart disease which is why it should be taken as seriously as possible. Coronary artery disease can occur due to the narrowing of the coronary arteries that supply blood and oxygen to the heart muscle. If left untreated, angina could lead to greater implications such as a heart attack, cardiac arrest, or even death. It’s therefore recommended that an individual should seek immediate medical attention if they experience any chest pain or discomfort.

Here are some damning statistics related to heart diseases and angina pectoris in the UK (Source: Heart UK)

  • Approximately 2 million men and 900,000 women live with chronic angina.
  • Every year, nearly 20,000 new cases of angina along with 25,000 new cases of heart failure are diagnosed.
  • Coronary Heart Disease is responsible for the maximum number of deaths in the UK. Annually in the UK, nearly 73,000 people fall victim to coronary heart disease, approximately 40,000 people die from a stroke, 160,000 people die from various heart and circulatory diseases and 42,000 people died prematurely as a result of cardiovascular disease. As a matter of fact, Coronary Heart Disease is responsible for causing over 23,000 premature deaths in the UK.
  • Every year, approximately 1 million men and nearly 500,000 women live with the after effects of a suffering a heart attack.

Types of Angina

Angina can be further classified into three types:

  1. Stable Angina – Stable Angina usually has a set pattern and there’s no immediate danger to the patient as it may resemble a case of gas or indigestion. Considered to be the most common type of Angina, stable angina is usually associated with exertion and the accompanying discomfort is temporary that lasts for anywhere under 5 minutes. People with stable angina are aware of when it’s about to happen as its triggers before indulging in intense physical activity, anxiety and even emotional stress. This pain can be relieved within a few minutes by ceasing the current activity, taking appropriate rest and/or by taking the prescribed cardiac medications such as nitroglycerin. It's possible to have this kind of angina for a long time.
     
  2. Unstable Angina – Unlike stable angina, unstable angina is not as common as it does not follow a regular pattern. It doesn’t occur because of a specific reason which is why it’s considered to be a more serious version of Angina. Moreover, it can even happen while resting as rest and medication have little effect in relieving the person. Unstable angina may be the first indicator of a heart attack and usually strikes during periods of rest after a few minutes of moderate activity while lasting longer as well. It also exhibits symptoms which are more acute and serious in nature.
     
  3. Variant and microvascular angina

Variant or Prinzmetal's angina and microvascular angina are two other variants of angina which are rarer vis-à-vis the previous two types. Variant  Angina occurs spontaneously and is caused due to a transient coronary spasm which results in the narrowing of the coronary artery temporarily which, in turn, causes a shortage of blood supply to the heart. It happens almost exclusively when a person is at rest and unlike unstable angina, doesn’t seem to occur after a period of physical exertion or emotional stress, either. Variant angina attacks can prove to be very discomforting and painful and tends to occur usually between 12 PM and 8 AM. However, it can be relieved by certain types of medications.

A recently discovered type of angina, Microvascular angina can cause the individual to experience chest pain even if there is no apparent blockage present in the coronary artery. Research has uncovered that this pain is as a result of a fault in the functioning of tiny blood vessels responsible for providing nourishment to the heart, arms, and legs. Microvascular angina can also be treated with the help of the same medications used for treating angina pectoris.

How does one differentiate between angina and a heart attack?

Heart attacks and angina work on the same premise – they are caused due to a lack of oxygen being supplied to the heart muscle owing to a reduction or blockage in the flow of blood in the coronary arteries. Here's the primary difference though – while in case of angina, the lack of oxygen supply is temporary which doesn't result in permanent heart damage, in case of a heart attack, however, the lack of oxygen extends for a longer duration of time which can cause permanent damage to the heart. In the case of stable angina, the problem is noticeable only when the heart is working harder than usual and as a result, is in need of an extra supply of oxygen. For instance, while working out or exercising. In the case of unstable angina, however, there might a cloth which may be partially blocking the coronary artery or in some cases, permanently blocking it for a short duration.

Symptoms of Chronic Angina

Angina symptoms may resemble other medical conditions or problems and every patient may experience symptoms differently. Patients can suffer from the following symptoms including:

  • A feeling of numbness and pain in the front of the chest
  • A loss of feeling in the arms, shoulders, or wrists.
  • A sense of discomfort accompanied by pain radiating in the jaw, neck, arms, upper abdomen, shoulder or back
  • A pain quite similar to indigestion or heartburn
  • Shortness of breath
  • Sudden weakness
  • A fast or irregular heartbeat.
  • Fatigue, tiredness, and nausea/vomiting accompanied by bouts of dizziness
  • A feeling of burning or intense pain across the chest
  • Strange pains which develop while bending or eating food.

Upon noticing any of the above-mentioned symptoms, it's vital that one visits their nearest health care professional as soon as possible. In addition, it needs to be mentioned that the duration and the severity of angina may vary depending on the type of angina. It's imperative that an individual learns to recognize the warning signs as it could either be indicative of angina or a heart attack. To that end, it’s crucial that the affected individual gets it checked out immediately to avoid further the onset of further complications.

Causes of Angina

Angina is usually caused because the arteries in the heart have narrowed which, in turn, results in the blood supply getting restricted to the heart and surrounding areas. Angina might not happen while resting (depending on the type). However, any sort of physical activity or exertion causes the heart to work harder which results in the heart needing an increased supply of blood and oxygen. When the blood is unable to pass through the narrowed coronary arteries, the heart responds by letting out a sharp pain which can be experienced near the chest region.

Spasm of the coronary arteries – characterized by a sudden tightening of the muscles within the arteries of the heart – can also be a cause of angina.

Risk Factors

Owing to the fact that angina is predominantly caused by coronary artery diseases, most of the risk factors tend to be similar in nature. They are as follows:

  • Genetics – a family history of coronary heart disease
  • Hypertension
  • High cholesterol or Hypercholesterolemia
  • Diabetes
  • Smoking
  • Lack of physical activity
  • Excessive alcohol consumption
  • Obesity
  • Sleep deprivation
  • Metabolic syndrome
  • Age (In case of men over 45 years and women over 55 years, the risk is greater)
  • Stress and anxiety
  • Low levels of high-density lipoprotein cholesterol
  • Elevated c-reactive protein levels – especially in the case of women
  • A history of preeclampsia or toxaemia – in case of women
  • Pregnancy-related diabetes

It also helps to pay attention to what event or activity triggers angina symptoms. Some common triggers to look out for and avoid if possible are listed as below:

  • Temperature fluctuations – Extremely hot or cold temperatures
  • Consuming large portions of food and heavy meals
  • Certain types of physical activity/exertions
  • Emotional stress
  • Consumption of alcohol – excessive or otherwise
  • Any form of tobacco consumption
  • Smoking

Diagnosis

Angina can be easily diagnosed by a health care professional by going in for a physical examination. To understand the nature of the symptoms, the physician might ask a few questions pertaining to the exact symptoms experienced, nature of the uneasiness, risk factors as well as family history. Once the initial diagnosis is finished, the doctor might order the following tests to get a better understanding of the severity of angina:

  • Electrocardiogram (ECG) – ECG is used to monitor patterns of the electrical activity present in the heart. This helps in revealing if there are any heart abnormalities such as arrhythmias, heart muscle damage, or to check for ischemia (reduction of oxygen and blood) to the heart.
  • Blood tests to check for the presence of high levels of cardiac enzymes. These enzymes act as a precursor to any damage in the heart.
  • Chest x-rays help in revealing if there are any other conditions present which are causing angina symptoms. It can also help in checking if the heart is enlarged or not.
  • Echocardiogram: makes use of high-frequency sound waves, generated by a transducer, to create moving images of the heart. Further, the motion of the walls of the heart is evaluated which helps in identifying & monitoring any angina-related problems
  • CT scans of the chest: A chest CT differs from a chest x-ray as its more precise as it combines special x-ray equipment with sophisticated technology to create several images of the chest and heart. This helps in identifying various other causes of chest pain as well including aortic disease or blood clots in the blood vessels of the lungs
  • Cardiac catheterization is an invasive imaging test which involves the insertion of a long thin tube into an artery located in the arm, groin, or leg. This tube is then guided towards the heart into the coronary arteries where a dye or contrast material is injected. Images are then captured via x-rays which helps in determining which arteries are blocked and how the heart is functioning.
  • Coronary computed tomography (CT) angiography: This test is used to evaluate the coronary arteries in a bid to determine the extent to which the arteries have narrowed. Unlike a cardiac catheterization, this technique doesn’t require the need for an invasive catheter as the dye or contrast material can be injected with the aid of a small line inserted in the vein of the arm– similar to the ones used to draw blood.
  • Magnetic resonance imaging (MRI): involves the use of high-tech machines to assess the function of the heart. It captures a bunch of detailed images of the heart to check for enlargement of the heart is enlarged or to analyse if the coronary arteries are narrowed. 
  • A nuclear stress test can be used to analyse whether the flow of blood to the heart is normal or not with the help of radioactive tracer. This tracer captures the heart’s activity levels while the patient is at rest and also in motion to determine the stress levels caused to the heart.

Treatment and Prevention

Treatment involves medications, surgical procedures and/or lifestyle changes. Medications involve the use of nitrates which work by widening the blood vessels thus helping increase the flow of blood to the heart muscle. Other medications include statins, beta-blockers to lower heart rate, calcium channel blockers to increase blood flow and even aspirin to get relief from the pain.

In certain cases, where the patient develops a serious case of angina putting him/her at a higher risk for a heart attack, doctors might recommend surgery. Some of the procedures include:

Angioplasty: involves the use of a tiny balloon and vascular stents to open the blockage in the coronary arteries in order to improve blood flow to the heart and ease chest pain.

Coronary artery bypass graft surgery (CABG): This surgery involves the use of arteries from elsewhere in the body (legs) in order to increase blood flow to the heart. A blood vessel is grafted onto the blocked artery region to bypass or divert the blocked coronary artery of the heart.

Transmyocardial revascularization (TMR): in case of patients who aren’t eligible for angioplasty or a coronary artery bypass graft surgery, trans myocardial revascularization is the recommended procedure. TMR involves the use of a laser to create tiny little holes in the heart, which helps in relieving the pain in the chest region.

Self-management

The more one finds about the heart the more power the individual has to remain healthy and in top shape. Today, the world over, heart disease is the leading cause of death.  Lifestyle factors and certain vices including smoking, excessive alcohol consumption can lead to severe damage to the blood vessels and heart.

Learning to live a healthier lifestyle is far easier when one makes it a point to take preventive measures instead of opting for wholesale changes. Keeping the heart healthy may seem like a daunting task; but with a little bit of effort, the heart’s health can be improved.

  1. Get Enough Sleep

It cannot be stressed enough how important sleep is as it helps regenerate the body while stabilizing energy and appetite levels the next day.  It is vital to get at least 7 – 8 hours of sleep on a daily basis as it has the ability to heal and repair the heart and blood vessels while also helping optimize mental and physical energy levels. More than just sleeping for 8 hours a day, try to make sure that you sleep and wake up at the same time regularly at least 6 days a week. Regardless of age, weight, smoking and exercise habits, people who don’t get adequate sleep are at risk of contracting cardiovascular and coronary heart diseases including angina. Getting enough good quality sleep will go a long way in stabilizing your short and long-term health, keeping the biological clock of the body well balanced and in lowering the risk of these conditions

  1. Eat Well

Green leafy vegetables, fruits, beans, high-fibre grains, fish, bread, and olive oil form an integral part of your daily diet. These heart-healthy foods are ideal not only for weight control but also in helping you lower your risk for illnesses, such as obesity, high cholesterol, high blood pressure, heart disease and diabetes. Maintaining a healthy weight can also help in feeling a lot more energetic. Additionally, make sure to give enough time to rest and digest right after meals. Eat a low-fat diet and avoid certain foods such as unhealthy fats, sugars, and salts if they trigger chest pain. Last but not least, one should look at consuming smaller meals and portions more often during the day instead of two or three large meals.

  1. Get Ample Exercise

Getting regular exercise is the key to keeping the heart healthy as it helps in making the muscles in the heart more efficient which, in turn. helps in pumping blood to other parts of the body more effectively. Regular exercise also reduces the risk of developing diabetes by over 50 percent and is the key to keep the body balanced and healthy. Physical activity can also help in allowing a better flow of blood to the small blood vessels around the heart. Incorporating small changes in the daily routine – like taking the stairs instead of using the elevator, taking the dog out for walks, riding a bicycle around the neighbourhood – or anything that helps in maintaining a healthy weight and keeping oneself physically active should be undertaken. If a certain activity causes angina, make sure to stop and rest. Be active at a level that does not lead to symptoms showing up.

  1. Keep Stress at bay

It is important to consciously make an attempt to lower stress levels as unnecessary stress can damage the heart. Try doing things that help in maintaining a happy and positive frame of mind. Due to taxing working hours and other worries, stress has become a part and parcel of our lifestyle. But with a few controlled efforts, stress levels can be reduced drastically. Breathing deeply, undertaking meditation, doing yoga has been proven to help decrease stress hormones.

  1. Cut alcohol and caffeine consumption

Anything in excess is bad and alcohol and coffee are no different.  Excessive consumption of alcohol and caffeine can cause blood pressure to shoot up and in turn, increase the risk of having a heart attack or a stroke.

  1. Quit Smoking

Smoking has been recognized as the leading cause of heart attacks as well as heart diseases. Every cigarette smoked increases the likelihood of getting diagnosed with heart disease. As a matter of fact, smokers are 2-4 times more likely to get heart disease. One should avoid/quit smoking and avoid second-hand smoke as well because inhaling second-hand smoke can cause lung cancer and heart diseases. Quitting smoking can quickly reduce the risk of a heart attack almost immediately as it instantly lowers the blood pressure and heart rate.

The Bottom Line

Angina should not be taken lightly. It can lead to a gamut of health issues if corrective and preventive steps are not undertaken on time. By making a few lifestyle modifications and being self-aware can go a long way in keeping angina at bay.