Angina pectoris is a type of chest pain caused when the heart muscle does not get enough blood and oxygen. This usually happens because the blood vessels supplying the heart become narrowed or blocked. The pain often feels like pressure or tightness in the chest and can spread to the arm, neck or jaw.
What it means (simple definition)
Angina pectoris is chest pain due to poor blood supply to the heart muscle. Narrowed heart arteries reduce blood flow, especially when the heart needs more oxygen during activity, stress or heavy meals.
Types of angina
- Stable angina: Occurs during exertion (walking fast, climbing stairs). Improves with rest. Caused by significant narrowing of coronary arteries.
- Unstable angina: Occurs even at rest, more severe and unpredictable. Often due to sudden plaque rupture or clot formation. Needs emergency care.
- Variant (Prinzmetal’s) angina: Caused by sudden spasm of coronary arteries. Can happen at rest, often at night. Responds well to vasodilators.
- Nocturnal angina: Occurs during sleep; related to heart’s increased oxygen needs at night.
Epidemiology
Angina affects over 110 million people worldwide. It is slightly more common in men than women and increases with age.
Why angina happens (etiology)
Angina occurs when the heart muscle does not receive enough oxygen-rich blood. The most common cause is coronary artery disease, where fatty plaques narrow the arteries. Symptoms usually appear when the heart needs more oxygen, such as during exercise or stress.
Triggers
- Physical activity or exertion
- Emotional stress
- Cold weather
- Heavy meals
- Smoking
- Plaque rupture or blood clots (unstable angina)
- Coronary artery spasm (variant angina)
Symptoms
- Chest pain or tightness (squeezing or pressure-like feeling)
- Pain spreading to neck, jaw, shoulder or arms
- Shortness of breath
- Dizziness, sweating or nausea
- Fatigue or anxiety
- Variant angina may present as night-time pain lasting up to 30 minutes
Diagnosis (simple explanation)
- ECG: Shows electrical changes when blood flow is reduced.
- Stress test: Records heart activity while walking on a treadmill or after giving stress-inducing medicines.
- Echocardiogram: Ultrasound to assess heart muscle movement.
- Nuclear scan: Shows blood flow to different parts of the heart.
- Blood tests: To rule out heart attack (enzyme elevation).
- Angiography: Injects dye into heart vessels to find blockages.
- CT/MRI: Advanced imaging to look at coronary arteries.
Treatment overview
Treatment aims to relieve chest pain, prevent future attacks, and reduce the risk of heart attack. It includes lifestyle changes, medicines and, in severe cases, procedures like angioplasty.
Non-pharmacological therapy
- Quit smoking and avoid second-hand smoke
- Healthy diet: low saturated fat, more fruits and vegetables
- Regular light exercise as advised
- Control diabetes, high BP and high cholesterol
- Avoid heavy meals
- Manage stress and sleep well
- Limit alcohol intake
Pharmacological therapy (anti-anginal drugs explained)
- Nitrates (e.g., nitroglycerin): Quickly relax and widen blood vessels, improving blood flow to the heart. Used for immediate relief or prevention before exertion.
- Aspirin: Prevents clot formation by reducing the stickiness of platelets. Helps prevent heart attacks.
- Clopidogrel / Ticagrelor: Used when aspirin cannot be taken or when additional clot prevention is needed.
- Beta blockers: Slow the heart rate and reduce its workload, decreasing oxygen demand. Helpful in long-term control.
- Calcium channel blockers: Relax blood vessels and improve blood flow. Useful especially in variant angina.
- Statins: Lower cholesterol and stabilize plaques, preventing artery narrowing.
- ACE inhibitors / ARBs: Lower blood pressure, improve blood flow and protect the heart, especially in patients with diabetes or kidney disease.
- Ranolazine: Used as add-on therapy when symptoms persist despite standard drugs.
Medical procedures (when medicines are not enough)
- Angioplasty with stent: A balloon is used to widen the blocked artery and a stent keeps it open.
- Bypass surgery: A blood vessel from another part of the body is used to create a new path for blood flow.
- External counterpulsation (ECP): Noninvasive therapy that improves heart blood flow for resistant angina.
Key counselling points
- Carry nitroglycerin if prescribed and use it during chest pain.
- Avoid triggers like heavy meals, smoking and cold environments.
- Take medicines regularly; do not stop without consulting your doctor.
- Report symptoms that last longer than 5 minutes or worsen over time.
- Seek emergency care if chest pain is severe, new or does not respond to nitroglycerin.
Detailed Notes:
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