At Inventional Cardiac Consultants patient education is very important to us. It allows our health professionals and others impart information to our patients and their caregivers that will alter their health behaviors or improve their health status.

Angina Pectoris

Angina (an-JI-nuh or AN-juh-nuh) is chest pain or discomfort that occurs if an area of your heart muscle doesn't get enough oxygen-rich blood.

Angina may feel like pressure or squeezing in your chest. The pain also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.

Angina isn't a disease; it's a symptom of an underlying heart problem. Angina usually is a symptom of coronary heart disease (CHD).

CHD is the most common type of heart disease in adults. It occurs if a waxy substance called plaque (plak) builds up on the inner walls of your coronary arteries. These arteries carry oxygen-rich blood to your heart.

Plaque narrows and stiffens the coronary arteries. This reduces the flow of oxygen-rich blood to the heart muscle, causing chest pain. Plaque buildup also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow, which can cause a heart attack.

The major types of angina are stable, unstable, variant (Prinzmetal's), and microvascular. Knowing how the types differ is important. This is because they have different symptoms and require different treatments.

  1. Stable Angina
    Stable angina is the most common type of angina. It occurs when the heart is working harder than usual. Stable angina has a regular pattern. (“Pattern” refers to how often the angina occurs, how severe it is, and what factors trigger it.)

    If you have stable angina, you can learn its pattern and predict when the pain will occur. The pain usually goes away a few minutes after you rest or take your angina medicine.

    Stable angina isn't a heart attack, but it suggests that a heart attack is more likely to happen in the future.
  2. Unstable Angina
    Unstable angina doesn't follow a pattern. It may occur more often and be more severe than stable angina. Unstable angina also can occur with or without physical exertion, and rest or medicine may not relieve the pain.

    Unstable angina is very dangerous and requires emergency treatment. This type of angina is a sign that a heart attack may happen soon.
  3. Variant (Prinzmetal's) Angina
    Variant angina is rare. A spasm in a coronary artery causes this type of angina. Variant angina usually occurs while you're at rest, and the pain can be severe. It usually happens between midnight and early morning. Medicine can relieve this type of angina.
  4. Microvascular Angina
    Microvascular angina can be more severe and last longer than other types of angina. Medicine may not relieve this type of angina.
Pain and discomfort are the main symptoms of angina. Angina often is described as pressure, squeezing, burning, or tightness in the chest. The pain or discomfort usually starts behind the breastbone.

Pain from angina also can occur in the arms, shoulders, neck, jaw, throat, or back. The pain may feel like indigestion. Some people say that angina pain is hard to describe or that they can't tell exactly where the pain is coming from.

Signs and symptoms such as nausea (feeling sick to your stomach), fatigue (tiredness), shortness of breath, sweating, light-headedness, and weakness also may occur.

Women are more likely to feel discomfort in the neck, jaw, throat, abdomen, or back. Shortness of breath is more common in older people and those who have diabetes. Weakness, dizziness, and confusion can mask the signs and symptoms of angina in elderly people.

Symptoms also vary based on the type of angina you have.

Because angina has so many possible symptoms and causes, all chest pain should be checked by a doctor. Chest pain that lasts longer than a few minutes and isn't relieved by rest or angina medicine may be a sign of a heart attack. Call 9–1–1 right away.

Stable Angina
The pain or discomfort:
  • Occurs when the heart must work harder, usually during physical exertion
  • Doesn't come as a surprise, and episodes of pain tend to be alike
  • Usually lasts a short time (5 minutes or less)
  • Is relieved by rest or medicine
  • May feel like gas or indigestion
  • May feel like chest pain that spreads to the arms, back, or other areas
Unstable Angina
The pain or discomfort:
  • Often occurs at rest, while sleeping at night, or with little physical exertion
  • Comes as a surprise
  • Is more severe and lasts longer than stable angina (as long as 30 minutes)
  • Usually isn’t relieved by rest or medicine
  • May get worse over time
  • May mean that a heart attack will happen soon
Variant Angina
The pain or discomfort:
  • Usually occurs at rest and during the night or early morning hours
  • Tends to be severe
  • Is relieved by medicine
Microvascular Angina
The pain or discomfort:
  • May be more severe and last longer than other types of angina pain
  • May occur with shortness of breath, sleep problems, fatigue, and lack of energy
  • Often is first noticed during routine daily activities and times of mental stress

Treatments for angina include lifestyle changes, medicines, medical procedures, cardiac rehabilitation (rehab), and other therapies. The main goals of treatment are to:

  • Reduce pain and discomfort and how often it occurs
  • Prevent or lower your risk for heart attack and death by treating your underlying heart condition
  • Lifestyle changes and medicines may be the only treatments needed if your symptoms are mild and aren't getting worse. If lifestyle changes and medicines don't control angina, you may need medical procedures or cardiac rehab.
Unstable angina is an emergency condition that requires treatment in a hospital.

Lifestyle Changes
Making lifestyle changes can help prevent episodes of angina. You can:
  • Slow down or take rest breaks if physical exertion triggers angina.
  • Avoid large meals and rich foods that leave you feeling stuffed if heavy meals trigger angina.
  • Try to avoid situations that make you upset or stressed if emotional stress triggers angina. Learn ways to handle stress that can't be avoided.
You also can make lifestyle changes that help lower your risk for coronary heart disease. One of the most important changes is to quit smoking. Smoking can damage and tighten blood vessels and raise your risk for CHD. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke.

If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.

Following a healthy diet is another important lifestyle change. A healthy diet can prevent or reduce high blood pressure and high blood cholesterol and help you maintain a healthy weight.

A healthy diet includes a variety of fruits and vegetables (including beans and peas). It also includes whole grains, lean meats, poultry without skin, seafood, and fat-free or low-fat milk and dairy products. A healthy diet also is low in sodium (salt), added sugars, solid fats, and refined grains.

Other important lifestyle changes include:
  • Being physically active.
  • Maintaining a healthy weight. If you’re overweight or obese, work with your doctor to create a reasonable weight-loss plan. Controlling your weight helps you control CHD risk factors.
  • Taking all medicines as your doctor prescribes, especially if you have diabetes.
Medicine
Nitrates are the medicines most commonly used to treat angina. They relax and widen blood vessels. This allows more blood to flow to the heart, while reducing the heart’s workload.

Nitroglycerin (NI-tro-GLIS-er-in) is the most commonly used nitrate for angina. Nitroglycerin that dissolves under your tongue or between your cheek and gum is used to relieve angina episodes.

Nitroglycerin pills and skin patches are used to prevent angina episodes. However, pills and skin patches act too slowly to relieve pain during an angina attack.

Other medicines also are used to treat angina, such as beta blockers, calcium channel blockers, ACE inhibitors, oral antiplatelet medicines, or anticoagulants (blood thinners). These medicines can help:

  • Lower blood pressure and cholesterol levels
  • Slow the heart rate
  • Relax blood vessels
  • Reduce strain on the heart
  • Prevent blood clots from forming
  • People who have stable angina may be advised to get annual flu shots.
Medical Procedures

If lifestyle changes and medicines don't control angina, you may need a medical procedure to treat the underlying heart disease. Both angioplasty (AN-jee-oh-plas-tee) and coronary artery bypass grafting (CABG) are commonly used to treat heart disease.

Angioplasty opens blocked or narrowed coronary arteries. During angioplasty, a thin tube with a balloon or other device on the end is threaded through a blood vessel to the narrowed or blocked coronary artery.

Once in place, the balloon is inflated to push the plaque outward against the wall of the artery. This widens the artery and restores blood flow.

Angioplasty can improve blood flow to your heart and relieve chest pain. A small mesh tube called a stent usually is placed in the artery to help keep it open after the procedure.

During CABG, healthy arteries or veins taken from other areas in your body are used to bypass (that is, go around) your narrowed coronary arteries. Bypass surgery can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack.

You will work with your doctor to decide which treatment is better for you.

Cardiac Rehabilitation
Your doctor may recommend cardiac rehab for angina or after angioplasty, CABG, or a heart attack. Cardiac rehab is a medically supervised program that can help improve the health and well-being of people who have heart problems.

The cardiac rehab team may include doctors, nurses, exercise specialists, physical and occupational therapists, dietitians or nutritionists, and psychologists or other mental health specialists.

Rehab has two parts:

Exercise training. This part helps you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your exercise plan will be based on your personal abilities, needs, and interests.

Education, counseling, and training. This part of rehab helps you understand your heart condition and find ways to reduce your risk for future heart problems. The rehab team will help you learn how to adjust to a new lifestyle and deal with your fears about the future.