Angina
Medical Author: John P. Cunha, DO, FACOEP
Medical Editors: Daniel
Kulick, MD, FACC, FSCAI and William C. Shiel, Jr., MD, FACP, FACR
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Angina: Don't Take It Lightly
Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD
 I'm a fan of "Pardon the Interruption", a talk show on ESPN, only because I
enjoy the wit, wisdom and camaraderie of the hosts, Tony Kornheiser and Michael
Wilbon. Unfortunately for me and more unfortunately for Mr. Wilbon, instead of
being in front of the camera, he was underneath one in a heart cath lab
undergoing an angioplasty to open a blocked blood vessel to his heart.
Heart disease remains the number one killer in the United States, and each
case is a potential failure because risk management wasn't aggressive enough.
There are five major risk factors for heart disease:
You can't do anything
about the genes you inherited, but the other four need life long vigilance to
minimize the risk of not only heart attack but also stroke and
peripheral vascular disease. All risk factors involve narrowing of the arteries that supply
blood to the body and the consequences that occur when organs don't get enough
blood and start to fail.
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Introduction to angina
Chest pain is a common symptom that is caused by many different conditions. Some causes require prompt medical attention, such as angina,
heart attack, or tearing of the aorta. Other causes of chest pain that may not require immediate medical intervention include spasm of the esophagus, gallbladder attack, or inflammation of the chest wall. An accurate diagnosis is important in providing proper treatment to patients with chest pain.
The diagnosis and treatment of angina is discussed below, as well as the diagnosis of other causes of chest pain that can mimic angina.
What is angina, and what are the symptoms of angina?
Angina (angina pectoris - Latin for squeezing of the chest) is chest discomfort
that occurs when there is a decreased blood oxygen supply to an area of the
heart muscle. In most cases, the lack of blood supply is due to a narrowing of
the coronary arteries as a result of arteriosclerosis.
Angina is usually felt as:
- pressure,
- heaviness,
- tightening,
- squeezing, or
- aching across the chest, particularly behind the breastbone.
This pain often radiates to the neck, jaw, arms, back, or even the teeth.
Patients may also suffer:
Angina usually occurs during exertion, severe
emotional stress, or after a heavy meal. During these periods, the heart muscle demands more blood oxygen than the narrowed coronary arteries can deliver. Angina typically lasts from 1 to 15 minutes and is relieved by rest or by placing a nitroglycerin tablet under the tongue. Nitroglycerin relaxes the blood vessels and lowers blood pressure. Both rest and nitroglycerin decrease the heart muscles demand for oxygen, thus relieving angina.
Angina is classified in one of two types: 1) stable angina or 2) unstable angina.
Stable angina
Stable angina is the most common type of angina, and what most people mean when
they refer to angina. People with stable angina have angina symptoms on a regular basis and the symptoms are somewhat predictable
(for example, walking up a flight of steps causes chest pain). For most patients, symptoms occur during exertion and commonly last less than five minutes. They are relieved by rest or medication, such as nitroglycerin under the tongue.
Unstable angina
Unstable angina is less common and more serious. The symptoms are more severe and less predictable than the pattern of stable angina. Moreover, the pains are more frequent, last longer, occur at rest, and are not relieved by nitroglycerin under the tongue (or the patient needs to use more nitroglycerin than usual). Unstable angina is not the same as a heart attack, but it warrants an immediate visit to your healthcare provider or hospital emergency department as further cardiac testing is urgently needed. Unstable angina is often a precursor to a heart attack.
Next: What causes angina? »
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