Angina

Download this Patient Note in PDF format

VOL 109 / NO 2 / FEBRUARY 2001 / POSTGRADUATE MEDICINE

Angina is not a disease but a symptom of heart trouble--a pain, pressure, or discomfort in the chest usually warning you that your heart is not receiving enough oxygen.

What does angina feel like?
Angina is a squeezing or crushing pain in the chest, although it is sometimes described as pressure, tightness, or burning. It has been likened to a vise around or a heavy weight on the chest. Occasionally the pain or discomfort is felt in the neck, arm (especially the left), jaw, lower teeth, back, or upper abdomen. The pain may be accompanied by shortness of breath, nausea, sweating, or dizziness. Sharp chest pain that lasts less than a minute is usually not angina.

When is angina most likely to occur?
Usually angina occurs when blood vessels that carry oxygen to the heart become narrowed or develop spasm, limiting the supply of oxygen to the heart, but other factors may play a role. It is felt most often during exertion, such as walking, climbing stairs, carrying a heavy load, or performing any activity that increases the oxygen demand on your heart. Sometimes, little or no exertion is needed to provoke an attack, such as after meals, when exposed to cold winds, or during excitement or stress.

When should you see your doctor?
Angina rarely lasts longer than 3 to 5 minutes. It is relieved by rest but can recur several times within a short period. Pain or discomfort that lasts longer than this may signal a heart attack. Rather than take chances, seek medical attention immediately.

How is angina treated?
Angina can be treated with drugs that affect the supply of blood to the heart muscle or medications that lower the heart's workload.

Drugs called coronary vasodilators help the blood vessels relax and open up to allow greater blood flow. More oxygen and other nutrients can then reach the heart muscle. Nitroglycerin is the vasodilator used most often. Medicines called beta blockers or calcium channel blockers also help relieve angina. Aspirin and cholesterol-lowering medicines can help prevent recurrence of heart problems.

When pain is clearly caused by heart disease and medication doesn't work, a procedure called angioplasty is sometimes needed. A tiny balloon is inflated in the blood vessel to open blocked areas. A small mesh tube called a stent may be inserted into the vessel to keep it open.

Bypass surgery is sometimes used to treat heart pain. Veins or arteries from the legs are sewn into the arteries of the heart to carry blood around a blockage. A bypass is usually done when angioplasty isn't possible or when the results are likely to be better than with a balloon or stent.

Pay attention to chest pain
Heart disease often can be managed through proper treatment, lifestyle changes, and exercise. Your doctor will guide you, but you need to be alert to changes that might be clues to the need to adjust your treatment plan. If you have any unusual chest pain that lasts more than a few minutes or that doesn't go away with rest or after taking nitroglycerin, go to the nearest emergency department right away.

Lowering your risk of heart disease
Here are some of the things you can do to reduce your chance of having a heart attack.

• If you smoke, quit.
• If you are overweight, trim down.
• If you have high blood pressure or diabetes, follow the program prescribed to bring it under control.
• Eat a healthful diet and avoid fatty foods, especially those high in saturated fats, such as butter, ice cream, fried foods, and fatty meats.
• Develop a reasonable and realistic exercise program.
• Get regular medical checkups, including cholesterol tests.
• Follow the medication and exercise plan developed for you.

What does angina feel like?

Angina is pain usually caused by blockages in coronary arteries. Symptoms may include:

• Chest pain or pressure under the breastbone in the middle of the chest or slightly to the left
• Pain that travels to the shoulder, arm, jaw, neck, back, or other areas
• Tightness, squeezing, crushing, burning, choking, or aching sensations
• Discomfort that mimics gas pains or indigestion
• Chest pain that occurs after activity or exertion or that is related to stress
• Episodes of pain that are of short duration, usually 1 to 15 minutes

When is chest pain an emergency?

Go to your nearest hospital immediately if you have chest pain or discomfort that:

• Is very bad, gets worse, and lasts longer than 20 minutes
• Is associated with weakness, feeling sick to your stomach, or fainting
• Does not go away when you take three nitroglycerin tablets 5 minutes apart
• Is worse than any pain you have had before

Call 911 immediately if you think you may be having a heart attack. If an ambulance is not available quickly, have someone drive you to the nearest hospital. Do not drive yourself.

This information is not a substitute for medical treatment.

Please send technical questions related to the Web site to Ann Harste