Angina pectoris

<languages /><translate> Angina pectoris is pain experienced in the chest, arms, jaw or sometimes abdomen usually due to a lack of oxygen to the heart muscle.

Angina pectoris

Types of angina

There are many types of angina such as angina are stable, unstable, microvascular, and variant. The types vary based on their severity or cause.

Stable angina

Stable angina follows a pattern that has been consistent for at least 2 months. That means the following factors have not changed:

Unstable angina

• Unstable angina does not follow a pattern. It may be new or occur more often and be more severe than stable angina. Unstable angina can also occur with or without physical exertion. Rest or medicine may not relieve the pain.
• Unstable angina is a medical emergency, since it can progress to a heart attack. Medical attention may be needed right away to restore blood flow to the heart muscle.

Variant angina

Variant angina, also known as Prinzmetal’s angina, is rare. It occurs when a spasm—a sudden tightening of the muscles within the arteries of your heart—causes the angina rather than a blockage. This type of angina usually occurs while you are at rest, and the pain can be severe. It usually happens between midnight and early morning and in a pattern. Medicine can ease symptoms of variant angina. How long your angina events last

Angina

Causes of angina

Two types of ischemic heart disease can cause angina.

Coronary artery disease happens when plaque builds up inside the large arteries that supply blood to the heart. This is called atherosclerosis. Plaque narrows or blocks the arteries, reducing blood flow to the heart muscle. Sometimes plaque breaks open and causes blood clots to form. Blood clots can partially or totally block the coronary arteries.

Coronary microvascular disease affects the tiny arteries that branch off the larger coronary arteries. Reduced blood flow in these arteries causes microvascular angina. The arteries may be damaged and unable to expand as usual when the heart needs more oxygen-rich blood.

Coronary spasm

A spasm that tightens your coronary arteries can cause angina. Spasms can occur whether or not you have ischemic heart disease and can affect large or small coronary arteries. Damage to your heart’s arteries may cause them to narrow instead of widen when the heart needs more oxygen-rich blood.

Risk factors

Risk Factors- Angina

You may have an increased risk for angina because of your age, environment or occupation, family history and genetics, lifestyle, other medical conditions, race, or sex.

Signs, Symptoms, and Complications- Angina

Signs and symptoms vary based on the type of angina you have and on whether you are a man or a woman. Angina symptoms can differ in severity, location in the body, timing, and how much relief you may feel with rest or medicines. Since symptoms of angina and of heart attack can be the same, call 9-1-1 if you feel chest discomfort that does not go away with rest or medicine. Angina can also lead to a heart attack and other complications that can be life-threatening.

Symptoms of Angina

Pain and discomfort are the main symptoms of angina. Angina is often described as pressure, squeezing, burning, indigestion, or tightness in the chest. The pain or discomfort usually starts behind the breastbone. Some people say that angina pain is hard to describe or that they cannot tell exactly where the pain is coming from.

Other symptoms include:

• Fatigue
• Light-headedness or fainting
• Nausea, or feeling sick in the stomach
• Shortness of breath
• Sweating
• Weakness

Symptoms of angina can be different for women and men. Instead of chest pain, or in addition to it, women may feel pain in the neck, jaw, throat, abdomen, or back. Sometimes this pain is not recognized as a symptom of a heart condition. As a result, treatment for women can be delayed.

Because angina has so many possible symptoms and causes, all chest pain should be checked by a doctor.

Each type of angina has certain typical symptoms. Learn more about the symptoms that are characteristic of each type.

Stable angina

• Discomfort that feels like gas or indigestion
• Pain during physical exertion or mental stress
• Pain that spreads from your breastbone to your arms or back
• Pain that is relieved by medicines
• Pattern of symptoms that has not changed in the last 2 months
• Symptoms that go away within 5 minutes

Unstable angina

• Changes in your stable angina symptoms
• Pain that grows worse
• Pain that is not relieved by rest or medicines
• Pain that lasts longer than 20 minutes or goes away and then comes back
• Pain while you are resting or sleeping
• Severe pain
• Shortness of breath

Microvascular angina

• Pain after physical or emotional stress
• Pain that is not immediately relieved by medicines
• Pain that lasts a long time
• Pain that you feel while doing regular daily activities
• Severe pain
• Shortness of breath

Variant angina

• Cold sweats
• Fainting
• Numbness or weakness of the left shoulder and upper arm
• Pain that is relieved by medicines
• Pain that occurs during rest or while sleeping
• Pain that starts in the early morning hours
• Severe pain
• Vague pain with a feeling of pressure in the lower chest, perhaps spreading to the neck, jaw, or left shoulder

Diagnosis

Your doctor may diagnose angina based on your medical history, a physical exam, and diagnostic tests and procedures. These tests can help assess whether you need immediate treatment for a heart attack. Some of these tests may help rule out other conditions.

History and physical examination

Your doctor will want to learn about your signs and symptoms, risk factors, personal health history, and family health history to determine whether your chest pain is angina or is caused by something else. Other heart and blood vessel problems or problems with your chest muscles, lungs, or digestive system can cause chest pain.

Tell your doctor if you notice a pattern to your symptoms. Ask yourself these questions:

• How long does the pain or discomfort last?
• How often does the pain occur?
• How severe is the pain or discomfort?
• What brings on the pain or discomfort, and what makes it better?
• Where do you feel the pain or discomfort?
• What does the pain or discomfort feel like?

Treatment

Your doctor may have you undergo some of the following tests and procedures.

• Blood tests to check the level of cardiac troponins. Troponin levels can help doctors tell unstable angina from heart attacks. Your doctor may also check levels of certain fats, cholesterol, sugar, and proteins in your blood.
• Chest X-ray to look for lung disorders and other causes of chest pain not related to ischemic heart disease. A chest X-ray alone is not enough to diagnose angina or ischemic heart disease, but it can help rule out other causes.
• Computed tomography angiography to examine blood flow through the coronary arteries. This test can rapidly diagnose ischemic heart disease as the source of your chest pain and help your doctor decide whether a procedure to improve blood flow will benefit your future health.
• Coronary angiography with cardiac catheterization to see if ischemic heart disease is the cause of your chest pain. This test lets your doctor study the flow of blood through your heart and blood vessels to confirm whether plaque buildup is the problem. The results of the scan can also help your doctor assess whether unstable angina might be relieved by surgery or other procedures.
• Echocardiogram to assess the strength of your heart beating, to help the doctor determine your risk of future heart problems.
• Electrocardiogram (EKG) to check for the possibility of a heart attack. Certain EKG patterns are associated with variant angina and unstable angina. These patterns may indicate serious ischemic heart disease or prior heart damage as a cause of angina. However, some people who have angina have normal EKGs.
• Hyperventilation testing to diagnose variant angina. Rapid breathing under controlled conditions with careful medical monitoring may bring on EKG changes that help your doctor diagnose variant angina.
• Magnetic resonance imaging or other noninvasive tests to check for problems with the heart’s movement or with blood flow in the heart’s small blood vessels.
• Provocation tests to diagnose variant angina. Your doctor may give you a medicine such as acetylcholine during coronary angiography to see if the coronary arteries start to spasm.
• Stress testing to assess your heart’s function during exercise. A stress test can show possible signs and symptoms of ischemic heart disease causing your angina. Stress testing in the early morning can help diagnose variant angina. Stress echocardiography tests can help your doctor diagnose the cause of your angina.

Complications

Angina is not a heart attack, but it suggests that a heart attack or other life-threatening complications are more likely to happen in the future.

The following are other possible complications of angina:

• Arrhythmia
• Cardiomyopathy
• Sudden cardiac arrest

Classification	ICD-10: I20 ICD-9-CM: 413 MeSH: D000787 DiseasesDB: 8695
External resources	MedlinePlus: 000198 eMedicine: med/133

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