Angina by Rosalyn Carson-DeWitt, MD

En Español (Spanish Version) More InDepth Information on This Condition

Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention

What is Angina Pectoris?

Definition

Angina is a pain or discomfort in the chest. It often has a squeezing or pressure-like feel. This discomfort can also be felt in the shoulders, arms, neck, jaws, or back. Anginal pain usually lasts for no more than 2-10 minutes. It is relieved by rest or nitroglycerin .

Types of angina include:

• Stable angina—has a predictable pattern. You generally know what brings it on and relieves it. You may also know what the intensity will be.
• Unstable angina—is more unpredictable or severe. Chest pain may occur while resting or even sleeping (nocturnal angina). The discomfort may last longer and be more intense than that of stable angina.
  • Unstable angina may be a sign that you are about to have a heart attack . It should be treated as an emergency.
• Variant or prinzmetal's angina—occurs when you are at rest. It most often occurs in the middle of the night. It can be quite severe.

Risk Factors

Symptoms

• Pressure or squeezing chest pain
  • Some people do not experience the pain as severe
  • Elderly people, women, and people with diabetes more likely to have atypical or subtle symptoms
  • Some people have silent ischemia and experience no symptoms of chest pain
  • Chest pain of any kind deserves a medical evaluation to determine its cause
  • Chest pain or discomfort is the hallmark symptom of angina

The likelihood of a heart attack is increased when chest discomfort is severe, lasts more than 15 minutes, and is accompanied by other symptoms such as:

• Pain in the shoulder(s) or arm(s), or into the jaw
• Weakness
• Sweating
• Nausea
• Shortness of breath

Diagnosis

Tests will be done right away to see if you are having an episode of angina or a heart attack. If you have a stable pattern of angina, other tests may be done to determine the extent of your disease. The test results will help to create a treatment plan.

The doctor will ask about your symptoms and medical history. A physical exam will be done.

Treatment

Treatments for angina include:

Medications

• Nitroglycerin—usually given during an attack of angina as a tablet that dissolves under the tongue or as a spray
  • Longer-lasting types may be used to prevent angina before an activity. May be given as pills, or applied as patches or ointments.
• Blood thinners—a small, daily dose of aspirin has been shown to decrease the risk of heart attack
  • Some may benefit from the addition of warfarin (eg coumadin). There is an increased risk of bleeding with this drug.
  • Talk to your doctor before taking aspirin daily or warfarin.
• Beta-blockers and calcium-channel blockers—may reduce the occurrence of angina
• Cholesterol-lowering medications—may prevent the progression of CAD; may even improve existing CAD
• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)—lower blood pressure and decrease the workload on the heart

Surgery

Prevention

If you already have angina, you can prevent an onset by being aware of what starts it.

If you don't have angina, preventing the development of CAD may reduce your chance of getting the condition.