Angina pectoris is discomfort or pain in the chest that occurs during effort or emotion. The heart receives too little oxygen at that moment. An attack of angina pectoris usually disappears after a few minutes of rest and is usually harmless. Prolonged lack of oxygen, however, can lead to a heart attack. Angina pectoris belongs, as well as heart attack, to the coronary artery diseases.
Angina pectoris is caused by a narrowing in one of the coronary arteries. Such a narrowing may result from atherosclerosis. When someone has a narrowed coronary artery, the heart receives less oxygen and nutrients and that is mainly a problem when the heart needs a lot of oxygen, for example during exercise, strong emotions, after a heavy meal or when a person switches from a hot to a cold environment.
The main risk factors that increase the chance of getting angina pectoris are:
- High blood pressure.
- High cholesterol.
- Unsufficient exercise.
Angina pectoris is not the same as a heart attack. Angina pectoris is in fact a temporary lack of oxygen in the heart and doesn't cause permanent damage. But it’s a warning that the blood supply to the heart is not entirely healthy. In case of a heart attack, the coronary artery is fully blocked and part of the heart receives no more blood at all. Then that portion of the heart dies.
Angina pectoris usually occurs during physical exertion or in other situations in which the heart needs more oxygen than normal. The main symptom of angina pectoris is a crushing chest pain. This pain can radiate to the left arm or to the jaw. Sometimes, the pain also radiates to the back, shoulder blades or right arm. Other signs and symptoms are:
- An oppressive or restless feeling.
- A burning sensation (this is sometimes confused with stomach problems).
- A feeling of numbness in the shoulder, arm or wrist.
- Heavy sweating.
An attack of angina pectoris usually lasts between one and fifteen minutes. At rest, the symptoms disappear again.
When angina pectoris is presumed, the doctor will do a physical examination, a medical history and probably a blood test and make an electrocardiogram (ECG). The doctor will also order a stress test, in which the patient undertakes efforts on a bicycle or treadmill, in order to determine whether the symptoms occur in this situation. According to the results, the doctor will decide about the best treatment.
- Usually, medication is prescribed. The most commonly used drugs for angina pectoris are nitrates, beta blockers, calcium antagonists and anticoagulants. These drugs generally make the blood vessels wider, the heart rate lower or the blood thinner.
- With angina pectoris, it is important to adopt a healthy lifestyle. This means: no smoking, regular exercise and a healthy and varied diet.
- When medicines and a healthier lifestyle do not help, it may be necessary that the patient should have percutaneous angioplasty. A kind of little balloon is inflated in the narrowing in the coronary artery, causing the artery to be stretched and more blood can flow through again. A stent may also be placed in the narrowing of the coronary artery. This is a kind of metal ballpoint spring, which ensures that the artery remains open after the procedure.
- Furthermore, heart surgery can be done to create a bypass. Bypass is another word for diversion. A surgeon will attach a new piece of vein to the coronary artery. This allows the blood to flow around the narrowing in the artery, through the new piece of vein.
The prospects depend on the stage of the heart disease. In case of a mild angina pectoris, the prospects are good. However, the patient has to change lifestyle and it's important to follow the recommendations of the doctor. Most people have no more symptoms after treatment has been started. Maybe there are only restrictions on exertion. If the arteries are severely affected, the prospects are less good.
- Quit smoking is very important. Smoking is harmful to blood vessels.
- Exercise is good for the heart and blood vessels. Make sure to leave enough ‘breath’ during the effort to be able to talk. Take a rest as soon as problems are encountered, do not force.
- Eat healthy, avoid heavy meals.
- Drink little or no alcohol.
- Try to lose weight in case of overweight. Obesity is an extra burden on the heart.
- Tackle the causes of stress. There are several ways to deal with stress.
- Be sure to always have a tablet isosorbide dinitrate or nitroglycerine spray for under the tongue at hand. These drugs dilate the blood vessels and relieve the symptoms of a sudden attack of angina pectoris.