Angina

Overview

Angina (angina pectoris) is chest pain or discomfort caused by inadequate blood flow to the heart muscle. It can be a warning sign of a heart attack; however, it is not a heart attack — no permanent damage occurs in the heart tissue.

It is the most common symptom of coronary artery disease (CAD). Common in our country, it can be controlled with proper treatment.

Types of Angina

1. Stable angina:

• Most common
• Starts with exertion, stress
• Relieved with rest or nitroglycerin
• Lasts less than 5 minutes
• Predictable

2. Unstable angina:

• Dangerous, herald of heart attack
• Occurs at rest too
• Lasts longer
• Does not respond to nitroglycerin
• Requires emergency intervention

3. Prinzmetal (vasospastic) angina:

• Due to artery spasm
• In younger patients
• At rest (night-morning)
• Responds well to medications

4. Microvascular angina:

• Small vessel disease
• More common in women
• No vessel blockage seen on standard tests

Symptoms

• Pressure, tightness, heaviness in the chest
• Burning, crushing sensation (in the heart area)
• Radiating to the left arm, shoulder, jaw, back
• Shortness of breath
• Fatigue
• Nausea
• Dizziness
• Sweating
• Starts with exertion, relieved by rest

Atypical symptoms in women:

• Classic chest pain may be absent
• Jaw, back, abdominal pain
• Extreme fatigue
• Shortness of breath

Causes

Inadequate blood and oxygen supply to the heart:

• Coronary artery disease (most common)
• Artery spasm
• Aortic valve disease
• Hypertrophic cardiomyopathy
• Severe anemia
• Hyperthyroidism
• High blood pressure
• Severe arrhythmias

Triggers

• Physical exertion (climbing slopes, lifting heavy)
• Emotional stress, anger
• Cold weather
• Heavy meals
• Smoking
• Sexual activity

Risk Factors

Non-modifiable:

• Age (men 45+, women 55+)
• Family history
• Sex

Modifiable:

• Smoking
• High blood pressure
• High cholesterol
• Diabetes
• Obesity
• Sedentary lifestyle
• Stress
• Unhealthy diet

When to See a Doctor

Emergency:

• Chest pain lasting more than 5 minutes
• Pain not relieved by rest or nitroglycerin
• New-onset chest pain
• Pain increasing in severity or frequency
• Atypical symptoms (especially in women)
• Pain occurring at rest

Scheduled visit:

• Chest pain with exertion
• First-time chest pain
• If diagnosed with angina and you notice changes
• Risk factors (smoking, blood pressure, cholesterol, family history)

Diagnosis and Treatment

Diagnosis:

• ECG
• Stress test
• Stress echocardiography
• Myocardial perfusion scintigraphy
• Coronary CT angiography
• Coronary angiography (definitive diagnosis)
• Blood tests (troponin, lipid profile)

Treatment:

1. Medication:

• Nitroglycerin (during attacks, sublingual)
• Beta blockers: Reduce heart rate and workload
• Calcium channel blockers
• Aspirin: Prevents clots
• Statins: Cholesterol
• ACE inhibitors
• Ranolazine (in resistant cases)

2. Interventional:

• Coronary angio + stent (PCI)
• Bypass surgery

3. Lifestyle changes (critical):

• Quit smoking
• Healthy diet (Mediterranean)
• Regular exercise (with doctor approval)
• Weight loss
• Stress management
• Blood pressure, cholesterol, sugar control

Prevention

• Quit smoking
• Keep blood pressure, cholesterol, sugar under control
• Maintain a healthy weight
• Regular exercise (150 min per week)
• Mediterranean diet
• Manage stress
• Limit alcohol
• 7-8 hours of sleep
• Annual health check-ups
• Early screening if family history
• If you have angina, always carry your nitroglycerin