*** IMPORTANT ***

• If you are worried that you may be having a heart attack, call 9-1-1 immediately or go to the closest Emergency Department.

• Symptoms of a heart attack include: Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back. Nausea, indigestion, heartburn or abdominal pain. Shortness of breath. Cold sweat. Fatigue. Lightheadedness or sudden dizziness.

• Do NOT waste valuable time by going to your family doctor’s office.

• TIME IS CRUCIAL. Too often, patients waste valuable time by waiting to book an appointment with their family doctor, or walking in to their family doctor’s office. Instead, go to the ER directly!

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What is Angina:

Angina is a type of chest pain caused by reduced blood flow to the heart. 

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What causes Angina:

Angina is caused by reduced blood flow to your heart muscle. Your blood carries oxygen, which your heart muscle needs to survive. When your heart muscle isn't getting enough oxygen, it causes a condition called ischemia.

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The most common cause of reduced blood flow to your heart muscle is coronary artery disease (CAD). Your heart (coronary) arteries can become narrowed by fatty deposits called plaques. This is called atherosclerosis.

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During times of low oxygen demand — when you're resting, for example — your heart muscle may be able to get by on the reduced amount of blood flow without triggering angina symptoms. But when you increase the demand for oxygen, such as when you exercise, this can cause angina.

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Types of Angina:

• Stable angina. 

  • Stable angina is usually triggered by physical exertion. When you climb stairs, exercise or walk, your heart demands more blood, but it's harder for the muscle to get enough blood when your arteries are narrowed. Besides physical activity, other factors such as emotional stress, cold temperatures, heavy meals and smoking also can narrow arteries and trigger angina.

• Unstable angina. 

  • If fatty deposits (plaques) in a blood vessel rupture or a blood clot forms, it can quickly block or reduce flow through a narrowed artery, suddenly and severely decreasing blood flow to your heart muscle. Unstable angina can also be caused by blood clots that block or partially block your heart's blood vessels.

    Unstable angina worsens and isn't relieved by rest or your usual medications. If the blood flow doesn't improve, your heart is deprived of oxygen and a heart attack occurs. Unstable angina is dangerous and requires emergency treatment.

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What are the symptoms of Angina:

• Chest pain or discomfort, possibly described as pressure, squeezing, burning or fullness

• Pain in your arms, neck, jaw, shoulder or back accompanying chest pain

• Nausea

• Fatigue

• Shortness of breath

• Sweating

• Dizziness

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These symptoms need to be evaluated immediately by a doctor who can determine whether you have stable angina, or unstable angina that may indicate a possible heart attack.

 

Stable angina is the most common form of angina. It usually happens when you exert yourself and goes away with rest. For example, pain that comes on when you're walking uphill or in the cold weather is often angina.

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What are the Characteristics of Stable Angina:

• Develops when your heart works harder, such as when you exercise or climb stairs

• Can usually be predicted and the pain is usually similar to previous types of chest pain you've had

• Lasts a short time, perhaps five minutes or less

• Disappears sooner if you rest or use your angina medication

The severity, duration and type of angina can vary. New or different symptoms may signal a more dangerous form of angina (unstable angina) or a heart attack.

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What are the Characteristics of Unstable Angina (A medical emergency):

• Occurs even at rest

• Is a change in your usual pattern of angina

• Is unexpected

• Is usually more severe and lasts longer than stable angina, maybe 30 minutes or longer

• May not disappear with rest or use of angina medication

• Might signal a heart attack

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Risk factors

The following risk factors increase your risk of coronary artery disease and angina:

• Tobacco use. 

  • Chewing tobacco, smoking and long-term exposure to secondhand smoke damage the interior walls of arteries. 

• Diabetes. 

  • Diabetes is the inability of your body to produce enough or respond to insulin properly. Insulin, a hormone secreted by your pancreas, allows your body to use glucose, which is a form of sugar from foods. Diabetes increases the risk of coronary artery disease, which leads to angina and heart attacks by speeding up atherosclerosis and increasing your cholesterol levels.

• High blood pressure. 

  • Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. Over time, high blood pressure damages arteries by accelerating hardening of the arteries.

• High blood cholesterol. 

  • Cholesterol is a major part of the deposits that can narrow arteries throughout your body, including those that supply your heart. A high level of  "bad" cholesterol known as low-density lipoprotein (LDL) cholesterol, increases your risk of angina and heart attacks. 

• Family history of heart disease. 

  • If a family member has coronary artery disease or has had a heart attack, you're at a greater risk of developing angina.

• Older age.

  •  Men older than 45 and women older than 55 have a greater risk than do younger adults.

• Lack of exercise. 

  • An inactive lifestyle contributes to high cholesterol, high blood pressure, type 2 diabetes and obesity. However, it is important to talk with your doctor before starting an exercise program.

• Obesity. 

  • Obesity raises the risk of angina and heart disease because it's associated with high blood cholesterol levels, high blood pressure and diabetes. Also, your heart has to work harder to supply blood to the excess tissue.

• Stress. Stress can increase your risk of angina and heart attacks. Too much stress, as well as anger, also can raise your blood pressure. Surges of hormones produced during stress can narrow your arteries and worsen angina.

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Treatment options:

Lifestyle: 

If your angina is mild, lifestyle changes may be all you need. Even if your angina is severe, making lifestyle changes can still help. Changes include:

• If you smoke, stop smoking. Avoid exposure to secondhand smoke.

• If you're overweight, talk to your doctor about weight-loss options.

• Eat a healthy diet with limited amounts of saturated fat, lots of whole grains, and many fruits and vegetables.

• Talk to your doctor about starting a safe exercise plan.

• Because angina is often brought on by exertion, it's helpful to pace yourself and take rest breaks.

• Treat diseases or conditions that can increase your risk of angina, such as diabetes, high blood pressure and high blood cholesterol.

• Avoiding stress is easier said than done, but try to find ways to relax. Talk with your doctor about stress-reduction techniques.

• Limit alcohol consumption to two drinks or fewer a day for men, and one drink a day or less for women.

 

Medications:

If lifestyle changes alone don't help your angina, you may need to take medications. These may include:

• Nitrates. 

  • Nitrates are often used to treat angina. Nitrates relax and widen your blood vessels, allowing more blood to flow to your heart muscle.

    You might take a nitrate when you have angina-related chest discomfort, before doing something that normally triggers angina (such as physical exertion) or on a long-term preventive basis. 

• Aspirin. 

  • Aspirin reduces the ability of your blood to clot, making it easier for blood to flow through narrowed heart arteries. Preventing blood clots can also reduce your risk of a heart attack. But don't start taking a daily aspirin without talking to your doctor first.

• Clot-preventing drugs.

  •  Certain medications such as clopidogrel (Plavix), and ticagrelor (Brilinta) can help prevent blood clots from forming by making your blood platelets less likely to stick together. One of these medications may be recommended if you can't take aspirin.

• Beta blockers. 

  • Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. As a result, the heart beats more slowly and with less force, thereby reducing blood pressure. Beta blockers also help blood vessels relax and open up to improve blood flow, thus reducing or preventing angina.

• Statins. 

  • Statins are drugs used to lower blood cholesterol. They work by blocking a substance your body needs to make cholesterol.

    They may also help your body reabsorb cholesterol that has accumulated in plaques in your artery walls, helping prevent further blockage in your blood vessels. Statins also have many other beneficial effects on your heart arteries.

• Calcium channel blockers. 

  • Calcium channel blockers, also called calcium antagonists, relax and widen blood vessels by affecting the muscle cells in the arterial walls. This increases blood flow in your heart, reducing or preventing angina.

• Blood pressure-lowering medications.

  •  If you have high blood pressure, diabetes, signs of heart failure or chronic kidney disease, your doctor will likely prescribe a medication to bring your blood pressure down. There are two main classes of drugs to treat blood pressure: angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs).

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Medical procedures and surgery:

Lifestyle changes and medications are frequently used to treat stable angina. But medical procedures such as angioplasty, stenting and coronary artery bypass surgery may also be used to treat angina.

• Angioplasty and stenting.

  •  During an angioplasty - percutaneous coronary intervention (PCI) — a tiny balloon is inserted into your narrowed artery. The balloon is inflated to widen the artery, and then a small wire mesh coil (stent) is usually inserted to keep the artery open.

    This procedure improves blood flow in your heart, reducing or eliminating angina. Angioplasty and stenting is a good treatment option if you have unstable angina or if lifestyle changes and medications don't effectively treat your chronic, stable angina.

• Coronary artery bypass surgery.

  •  During coronary artery bypass surgery, a vein or artery from somewhere else in your body is used to bypass a blocked or narrowed heart artery. Bypass surgery increases blood flow to your heart and reduces or eliminates angina. It's a treatment option for both unstable angina as well as stable angina that has not responded to other treatments.

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