Vital Finds: Understanding Angina

Angina is not a death sentence; it is an alarm. While your doctor may prescribe drugs, you should not underestimate how much lifestyle changes can improve your cardiac health.

By Jon W. Wahrenberger, MD, FACC

Angina, also called pectoris, is a pain or a sense of discomfort in the chest arising from the heart. Most often caused by an inadequate supply of oxygen to the heart arteries, angina may also be because by heart valve disease, cardiac rhythm disturbances and diseases of the muscular portion of the heart.

Symptoms can vary dramatically from person to person. Typically, angina is described as a pressure of squeezing sensation in the center of the chest, sometimes accompanied by discomfort in the neck, jaw, shoulders and arms. Others say it feels like a vice is compressing their chest or that they feel an aching or burning sensation.

Still others complain of pain in areas outside of the chest. Often, there are other symptoms at the same time, such as shortness of breath, sweating, nausea and lightheadedness. Angina typically comes on with exercise or stress, and recedes with rest and relaxation. While angina itself does not lead to permanent damage of the heart muscle, it does suggest the presence of heart disease, which can lead to heart attack and death. Angina may occur in one of a number of patterns. Among them:

Chronic stable angina – is characterized by a long term pattern of exercise induced angina occurring very predictably over months and years.

Unstable angina – occurs at rest. The term may also refer to a sudden worsening of the symptoms in a person who had been experiencing stable angina. Unstable angina often is seen days, hours or weeks before a heart attack.

Variant angina - a unique form that results not from progressive narrowing of the heart arteries or other underlying heart disease, but from a transient and reversible spasm of the heart arteries. Variant angina tends to occur without any particular pattern and is not linked to exercise or exertion.

Microvascular angina – is a form of angina in which the patient has symptoms virtually identical to those of stable angina yet appears to have normal coronary arteries. The coronary arteries inability to dilate during exercise is thought to cause microvascular angina. There is much debate in the medical community about microvascular angina, which is dubbed Syndrome X. some doctors question whether the syndrome exist at all.

Causes of Angina

In the Unites States and Europe, the most common cause of angina is atherosclerosis. Atherosclerosis is a process in which cholesterol, inflammatory cells and other substances are deposited in the arterial wall over a period of years or even decades. As a result, the arteries grow narrower, reducing their ability to carry blood. Moreover, atherosclerosis leads to a loss of arteries normal dilating capacity in response to exercise.

Difference Between Angina and a Heart Attack

Although the pain of a heart attack may be similar to the discomfort of angina, the two are different in many regards. Angina is a symptom resulting from a transient lack of oxygen to the heart. Once the demand for oxygen subsides, so do the symptoms of angina. No permanent damage is done to the heart.

During a heart attack or myocardial infarction, there is a loss of blood flow to one or more of the coronary arteries. If the blood is cut off for more than 30 minutes, it is increasingly likely that permanent damage will be done to the heart muscle. In some instances, significant portions of the heart muscle will actually turn to scar tissue. Many people who have had heart attacks say they had angina before the attack. Others say they never experienced any cardiac pain until they had a heart attack.

Lifestyle Changes with Angina

Angina is not a death sentence; it is an alarm. While your doctor may prescribe drugs, you should not underestimate how much lifestyle changes can improve your cardiac health.

Stay Active

Even people with coronary artery disease can benefit from starting an exercise program. Aim for at least 20 to 30 minutes of moderate activity daily, or at least several times a week. Rapid walking, bicycling or swimming are all beneficial.

Because exercise may induce angina, you may need to modify the type of activity you choose and the way you approach it. Talk with your doctor about an ideal exercise program and determine a target heart rate.

Some medications, particularly beta blockers, will prevent your heart rate from increasing in a normal fashion. If you are taking such medications, your doctor will usually recommend a lower target heart rate. A quick formula for determining your maximum heart rate is to subtract your age from 220. A 50-yeal old would have a predicted maximum heart rate of 170 beats per minute. Thus, the target heart rate during exercise should be between 85 and 144 beats per minute.

Manage Stress

You may be upset to learn you have angina and coronary artery disease and understandably so. But do not let that worsen the situation. There is no reason to feel helpless or to give up. Learn about your disease and put that knowledge to work for you.

Eat Well

Diet is an important component of health, especially cardiac health. Keep in mind that animal products are the biggest sources of saturated fat and cholesterol, as much as possible substitute fruits, vegetables and grains. Think about the importance of your health and joy you get from a fit, well turned body. There may be some truth to the old axiom “we are what we eat.”

Control your Blood Pressure

Blood pressure is often called the “silent killer” since it rarely announces itself with symptoms, but silently causes the damage to various organs throughout the body. It is a potent risk factor for heart disease and angina. If you are already treated for high blood pressure, take your medications and make sure your condition is well controlled.