Stable Angina (Angina Pectoris)

Angina pectoris gets its name from the nature of the pain: the Latin angere for choke describes the characteristic suffocating sensation and pectoral is for chest, where it is located.

Signs and Symptoms

• Heart pain (tight, band-like, crushing sensation, often sharp and suffocating, that usually is centered beneath the breast bone (sternum) and often spreads to the throat or to one arm or the other);
• Sensation of heaviness or tightness that is less than pain;
• Attacks generally brought on by exercise or emotional stress;
• Feelings of anxiety or of impending death.

The discomfort usually lasts for a minute or two; sometimes as long as 10 to 15 minutes. The pain may be severe and may be accompanied by a constricting feeling behind the breastbone (sternum) that may extend into the throat or down one arm or the other. It may also be a mild heaviness, tightness, or burning discomfort.

Angina usually is brought on by exertion such as heavy lifting, sexual activity, or strenuous exercise. It is relieved by rest. Extreme cold can cause it as can ingestion of a heavy meal or emotion such as extreme fear, anger, grief, or frustration.

Angina is the direct result of insufficient blood reaching your heart muscle (ischemia). When you exert yourself, your heart requires more oxygen to do the extra work. When the coronary arteries that serve your heart are narrow and unable to accommodate the increase in flow of blood demanded by the exercise, nerves in your heart transmit pain messages to your brain.

Angina is a symptom, not a disorder. It can be the result of arteries narrowed by a passing spasm. More likely, a limitation of blood flow is the result of atherosclerosis in which the arteries are narrowed by an accumulation of deposits or fatty plaque.

Thus, angina often is one of the warning signs of coronary artery disease. When the  attacks come frequently and are not linked to physical activity, they may be warning signs of an impending heart attack and require special treatment.

Angina is quite common. In men, it usually occurs after age 30; in women it tends to appear later. The cause in most cases is atherosclerosis.

Diagnosis:

Most often, the discomfort occurs after strenuous physical activity |or an emotional upset. However, it also can occur after mild exercise or even while you are asleep. The nature of the distress has been described as tight, band—like, crushing, burning, and, occasionally, sharp. Sometimes it is mistaken for indigestion. The duration of the pain is variable, up to a few minutes. lf the chest pain is prolonged beyond 5 to 10 minutes, the risk of damage to the heart muscle increases. The pain may also be "referred," a term used to describe pain impulses confused by your brain. It may feel as if your jaw, neck, or arms are in great pain when in fact it may be the pain of angina that is being perceived as stemming from one or more of these locations.

There is no specific laboratory test for the diagnosis of angina. Your physician may want to obtain an electrocardiogram to see if damage has occurred. He or she also may order blood tests to rule out heart damage. Exercise stress test and coronary angiography are other options for diagnosis.

In addition, your physician may want to obtain blood tests to make sure hyperthyroidism and anemia  are not present. Both of these disorders may force your heart to beat faster, use more oxygen, and, therefore, precipitate angina.

Should Angina Be Taken Seriously?

The decrease in blood flow to your heart is partial and temporary, so damage does not occur. This is in contrast to the blockage of a heart artery that results in permanent damage to a part of the heart muscle. However, Angina should be taken seriously, as progress of the disease will eventually damages your heart.

Treatment:

If you experience angina, try to stop the activity that precipitated the attack. This should lessen the load on your heart and reduce its need for oxygen. The distress should stop within a minute or two. If the discomfort does not cease within a few minutes or if the frequency or severity of the attacks increases, seek immediate medical attention.

If you smoke, stop. Lose the extra pounds if you are overweight. Eliminating obesity or smoking may decrease or even eliminate your symptoms.

Exercise: Having angina does not need to make you a sedentary person. In fact, exercise is a key part of dealing with your angina. The exercise must be compatible with the limitations imposed by your pain. Your own body and your physician will help you determine how much exercise is appropriate.

Medications:

The classic treatment for acute attacks of angina is the drug nitroglycerin. Nitroglycerin opens (dilates) the coronary arteries, allowing more blood to flow to the heart muscle. It is taken orally as a tablet, usually by letting it dissolve under your tongue. Recently, a form of nitroglycerin that is sprayed under the tongue has become available, in a remarkably short time, per haps a minute or less, the discomfort will ease.One side effect of nitroglycerin is that it causes headaches in some people. Usually the headaches are temporary and mild. If your physician prescribes nitroglycerin, keep your drug supply fresh because the tablet form of the drug loses potency in a matter of weeks. Also, keep the tablets out of direct sunlight which causes loss of potency.

Long-acting nitrates also may be helpful in decreasing the frequency of angina attacks.

Calcium channel blockers are drugs that interrupt the normal flow of calcium through channels in your heart muscle. This produces dilatation of the coronary and other arteries in your vascular system, which results in increased blood flow to the heart muscle. The work required of the heart is also decreased and its demands for oxygen are lessened. The calcium channel blockers also decrease blood pressure.

The beta-adrenergic blockers decrease heart rate and blood pressure. Both are useful in reducing the symptoms of angina. Your physician will select an appropriate medication for your particular symptoms.

Surgery: if the angina continues in spite of the use of medications or occurs more often or with greater intensity, your physician may consider coronary angioplasty  or coronary artery bypass surgery .