Angina pectoris, or simply angina, is a constant pain or irritation in the chest area. This comes about when some portion of the heart does not receive an adequate amount of blood. It is one of the usual indicators of coronary heart disease (CHD), when vessels that carry blood to the heart become narrowed and impeded attributed to atherosclerosis
Angina generally seems like a pressing or squeezing pain, felt in the chest under the breast bone, but in certain cases advancing up to the shoulders, arms, neck, jaws, or back.
Angina is often brought on by exertion. It arises when the heart’s need for oxygen increases outside of the oxygen offered from the blood nourishing the heart. Physical exertion is the most common cause for angina. Other causes can be emotional difficulties, extreme cold or heat, heavy meals, alcohol, and cigarette smoking.
Even so, angina is distinct from a heart attack. Angina pain means that some of the heart muscle in not getting sufficient blood for the short term, such as during exercise, when the heart has to work harder. The pain does NOT mean that the heart muscle is enduring irreparable, long-lasting damage. Episodes of angina don’t often result in long-lasting damage to heart muscle. It is generally relieved within a few minutes by resting or by taking prescribed angina medicine.
In contrast, a heart attack happens when the blood flow to a part of the heart is immediately and completely cut off. This brings about permanent damage to the heart muscle. Generally, the chest pain is more severe, lasts longer, and does not go away with rest or with medicine that was formerly highly effective. It may be complemented by indigestion, nausea, weakness, and sweating. Still, the indicators of a heart attack are assorted and may be substantially milder.
When a person has a repeating but stable pattern of angina, it does not mean that a heart attack is about to come about. Angina suggests that there is underlying coronary heart disease. Patients with angina are at an elevated risk of heart attack compared with those who have no symptoms of cardiovascular disease, but the episode of angina is not a signal that a heart attack is about to occur. On the flip side, when the pattern of angina changes–if episodes become more frequent, last much longer, or arise without exercise–the possibility of heart attack in up coming days or weeks is much greater.
A person who has angina should certainly know the pattern of his or her angina–what causes an angina attack, what it feels like, how long episodes usually last, and whether medication alleviates the attack. If the pattern changes dramatically or if the symptoms are those of a heart attack, one should get medical help rapidly, perhaps best done by looking for an evaluation at a neighborhood hospital emergency room.
Take note, however, that not all chest pain is angina, or related to the heart. If the pain lasts much less that 30 seconds or if it goes away during a deep breath, after drinking a glass of water, or by merely changing position, it almost certainly is NOT angina and should not cause headache. But extended pain, unrelieved by rest and followed by other discomforts may signal a heart attack.
Normally the doctor can establish angina by observing the symptoms and how they start. Nevertheless one or more diagnostic tests may be needed to exclude angina or to know the seriousness of the underlying coronary disease. These include the electrocardiogram (ECG) at rest, the stress test, and x- rays of the coronary arteries (coronary “arteriogram” or “angiogram”).
The ECG monitors electrical impulses of the heart. These may indicate that the heart muscle is not getting as much oxygen as it really needs (“ischemia”); they may also indicate abnormalities in heart rhythm or some of the other probable unusual features of the heart. To record the ECG, a technician positions a number of small contacts on the patient’s arms, legs, and across the chest to connect them to an ECG machine.
For many patients with angina, the ECG at rest is typical. This is not surprising because the symptoms of angina happen during stress. Therefore, the performance of the heart may be analyzed under stress, normally exercise. In the easiest stress test, the ECG is taken before, during, and after exercise to look for stress related abnormalities. Blood pressure is also measured during the stress test and symptoms are observed.
A more complicated stress test involves picturing the blood flow pattern in the heart muscle while in peak exercise and after rest. A tiny amount of a radioisotope, usually thallium, is injected into a vein at peak exercise and is consumed up by normal heart muscle. A radioactivity detector and computer record the pattern of radioactivity distribution to different parts of the heart muscle. Local distinctions in radioisotope concentration and in the rates at which the radioisotopes disappear are measures of unequal blood flow due to coronary artery narrowing, or due to breakdown of uptake in scarred heart muscle.
The most accurate way to evaluate the existence and intensity of coronary disease is a coronary angiogram, an x-ray of the coronary artery. A long slim versatile tube (a “catheter”) is threaded into an artery in the groin or forearm and advanced through the arterial system into one of the two major coronary arteries. A fluid that blocks x-rays (a “contrast medium” or “dye”) is injected. X-rays of its distribution show the coronary arteries and their narrowing.