This overview is a sample of the type of information available to you at Griffin Hospital's Community Health Resource Center. It is not intended to replace your physician's instructions in the management of your health problems, but to better inform you about a particular illness and alert you to the availability of other materials. If you have a question about any piece of information presented in theses fact sheets, please call your physician, or stop by the Community Health Resource Center at your convenience.
Angina (also called angina pectoris) is pain caused by the heart not getting enough oxygen. Angina pain is commonly described as a tightness, burning, or aching across the chest. Since the heart has no pain-sensitive nerves in it, a shortage of oxygen is felt instead in nearby areas of the body. Angina pain may radiate to the left shoulder or arm. It can also feel like heartburn or indigestion. In women, angina is often experienced as stomach or upper back pain, and can include nausea, shortness of breath, and sweating.
Angina is a sign that the heart needs to rest. Angina usually occurs during periods of activity, stress or emotional upset, all of which cause the heart to pump harder and to require more oxygen. Angina can also occur during rest.
The most common cause of angina is atherosclerosis or coronary artery disease, where plaque forms on the walls of the coronary arteries. The plaque consists of deposits of cholesterol and other fats which narrow or partially block the arteries, allowing less oxygen to reach the heart.
Angina can also be due to stenosis (narrowing) of the coronary arteries, or a temporary spasm in the coronary arteries which causes the artery to squeeze shut, temporarily cutting off the heart's blood supply.
Angina is most common in men ages 50 and over, and in women ages 60 and over.
People with coronary artery disease get angina. Risk factors that increase your chances of developing coronary artery disease are cigarette smoking, high blood pressure, a diet high in cholesterol, an inactive lifestyle, diabetes, and a family history of heart disease.
The most commonly reported symptoms of angina in men are a tightness, squeezing, or pressure in the chest area. The pain often is felt in the left shoulder or arm, and can spread to the jaw, teeth, and earlobes. Sometimes there is pain between the shoulder blades. It is not unusual to have indigestion, nausea, shortness of breath, or sweating along with the other symptoms.
Although some women experience the same symptoms as men, more common symptoms reported by women are pain or burning in the stomach or upper back, sweating, nausea, and difficulty breathing, or a feeling of gasping for air.
If untreated, episodes of angina usually last about 3 minutes. Any pain that lasts longer than 10 to 15 minutes or does not respond to medication needs a doctor's immediate attention. Because symptoms can vary, any unusual pain in the neck, stomach, jaw, or arms that is frightening and lasts more than a few minutes should be reported to your physician.
If angina is suspected, your physician will want to assess your risk factors and will also want to know where and when the pain occurs and whether or not resting brings relief. The doctor may order an electrocardiogram (EKG), a test which measures the heart's electrical activity. Lab tests and x-rays may be done. You may be given a dose of nitroglycerin under your tongue. This medicine relieves symptoms of angina but not those of other disorders that cause chest pain.
If your doctor feels you may be at risk for a heart attack, further tests may be done. The best test is a treadmill test (monitoring your heart's activity when you are exercising). Depending on your history, your physician may order a stress echocardiogram (an x-ray of the heart while it is beating during exercise and rest), or a thallium stress test (examining your coronary arteries after dye is injected into your vein).
Other tests that may be done for additional information include holter monitoring (monitoring your heart for 24-48 hours continuously as you go about your normal activities), or a cardiac catherization (a tube is threaded into your coronary arteries to see if there are any blockages).
Angina is often treated by a combination of medication and rest designed to improve or enhance the blood flow to the heart. Medications can be taken regularly or on an as needed basis. It is important to carry your medications with you at all times.
One medication which is commonly used for angina is nitroglycerin. When you experience angina, you should place a pill under your tongue for the quickest absorption into your blood. Within a minute or two, the pain should subside or disappear. You can repeat this if needed. If you have taken more than three pills without getting relief, most doctors advise you to get medical help. Nitroglycerin opens the blood vessels, allowing more blood flow to the heart. Some individuals take nitroglycerin before exercise, heavy eating, or stressful situations to prevent angina.
Medications called beta blockers are often given for long-term treatment of angina. These drugs reduce the heart's demand for oxygen by slowing the heart rate and reducing the force of its contractions. The heart is able to rest and the oxygen supply it receives is sufficient.
Calcium channel blockers are medications that help the walls of the arteries to relax, allowing blood to flow more freely to the heart. Aspirin and heparin are also commonly prescribed for their blood thinning effect.
If your angina is unstable – if the medications do not control your pain, if your heart is not able to pump effectively, and/or if your heart is at risk of being damaged – surgery may be considered. Two types of procedures are commonly done. Angioplasty is less complex and less invasive; however, its effects do not last as long as the bypass surgery.
Angioplasty is a procedure in which a balloon is inserted into the coronary artery and inflated at the site of the blockage. This opens the blockage and the balloon is removed. Angioplasty is performed under local anesthesia and requires only a few days in the hospital but may have to be repeated every few years to keep the artery open. Mild or moderate angina often can be treated with medication or angioplasty.
For more severe cases, coronary artery bypass surgery may be considered. In this
operation, a vein from the leg or an artery from the chest is used to bypass the blockage of the coronary arteries to improve the blood supply to the heart. Recovery can take up to three months.
WHAT YOU CAN DO
It is important for you to follow up with your doctor for close monitoring of your heart and how you are responding to your medications. If you smoke, try to quit. Smoking causes plaque to build up faster in the arteries and causes blood to clot more rapidly. A low-fat diet can help to reduce your cholesterol level and your weight. Smoking, excess weight, high blood pressure, and stress can place an added strain on the heart.
Limit alcohol and caffeine in your diet. Studies have shown that a low-fat low cholesterol diet combined with regular exercise (20 minutes 3 times a week) can reverse plaque build-up in the coronary arteries. A modest exercise program or regular activity is beneficial to keep your heart healthy.
COPING
The diagnosis of any illness can cause stress. Feelings of depression, guilt and resentment are common. If often helps to seek the company of others in similar situations. Support groups are available for people with a wide variety of conditions, and it can be a tremendous comfort to know other people are going through experiences like your own. Professional counseling also may help, as can talking openly with your family and friends.
It takes patience and perseverance to make the lifestyle changes that may be necessary. Ask your doctor if you need help to quit smoking, lose weight, or relax. Resources are available through community organizations, health plans, and hospitals. A positive attitude, information, and sharing your feelings can help in your healing process.
Please note that this information is intended to give you a general overview of the topic. It is not intended to replace advice or instruction of a health professional. We recommend that you consult your physician, nurse, or qualified health professional regarding the information in this publication. © 1994 Planetree, Inc. Reproduction of this material in any form is limited to license agreement.
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