Unstable Angina

Angina, often referred to as angina pectoris or ischemic chest pain, occurs when a part of your heart doesn’t receive enough blood, leading to chest discomfort akin to a heart attack, marked by pressure or squeezing sensations. This condition is a symptom of heart disease, typically arising from arterial blockages or reduced blood flow to the heart’s oxygen-rich areas.

The discomfort associated with angina may radiate to the shoulders, arms, neck, throat, jaw, or back. Although angina usually subsides quickly, it can signify a serious underlying heart issue, necessitating prompt diagnosis and preventive measures against a potential heart attack.

Key points to remember:

Management of angina primarily involves medications and lifestyle adjustments. In severe cases, surgical intervention or the insertion of a stent—a small tube to prop open arteries—may be necessary.

Angina differs from a heart attack in the duration of the reduced blood flow to the heart. In a heart attack, this restriction persists longer, leading to permanent damage to a part of the heart muscle. Conversely, angina episodes involve brief reductions in blood flow, causing temporary discomfort without lasting harm.

Symptoms to watch out for:

• Chest pain, pressure, tightness, or squeezing
• Discomfort radiating to shoulders, arms, neck, jaw, or back
• Shortness of breath
• Dizziness
• Sweating
• Feeling full or achy in the chest
• Upset stomach or vomiting

Different types of angina:

• Stable angina: This is the most common type, triggered by physical activity or stress and usually subsides with rest.
• Unstable angina: This type can occur at rest or during minimal activity and requires immediate medical attention.
• Microvascular angina: This type is more common in women and causes prolonged chest pain.
• Prinzmetal’s angina: This rare type occurs at night and involves sudden tightening of the heart arteries.

What causes angina?

The main culprit is coronary artery disease, where plaque buildup narrows the arteries supplying blood to your heart. This restricts blood flow and oxygen delivery, leading to angina pain.

Risk factors

• Age
• Family history of heart disease
• High blood pressure
• High cholesterol
• Diabetes
• Obesity
• Smoking
• Lack of exercise
• Stress

Diagnosis and treatment:

Diagnosis of angina involves a thorough physical examination, symptom inquiry, assessment of risk factors, and possibly various tests:

• Electrocardiogram (EKG) to measure the heart’s electrical activity and rhythm.
• Stress test to evaluate heart function during physical exertion.
• Blood tests to detect heart damage markers and assess overall health.
• Imaging tests like chest X-rays, echocardiograms, CT scans, or MRI scans are used to visualize heart structures and blood flow.
• Invasive procedures such as cardiac catheterization or coronary angiography directly examine blood vessels and heart function.

Patients may ask their doctors about additional tests needed, the type of angina diagnosed, the presence of heart damage, recommended treatments, potential side effects of treatment, preventive measures against heart attacks, activity restrictions, and dietary modifications.

Treatment options may include:

• Medications like nitrates, calcium channel blockers, beta-blockers, blood thinners, antiplatelet drugs, and statins may alleviate symptoms and improve blood flow.
• Invasive procedures such as angioplasty with stenting or coronary artery bypass grafting (bypass surgery) may be necessary to reopen blocked arteries and restore blood flow.
• Enhanced external counterpulsation (EECP) is a non-invasive option involving the application of pressure cuffs on the legs to enhance blood flow to the heart, particularly beneficial for individuals who do not respond to other treatments or are not suitable candidates for invasive procedures.

EECP treatment typically spans 35 hours over 7 weeks, offering relief from angina symptoms and reducing the need for medication, thereby enhancing quality of life and physical activity tolerance.

Living with angina:

• Engage with support groups for insights and coping strategies.
• Adopt a heart-healthy lifestyle.
  • Eat a balanced diet rich in fruits, vegetables, whole grains, and lean protein.
  • Limit salt, fat, and sugar.
  • Be physically active, but listen to your body and stop if you experience pain.
  • Manage stress through meditation, deep breathing, or yoga.
  • Get regular checkups with your doctor.

When to seek immediate medical attention:

If you experience new or unusual chest pain, don’t hesitate to seek help. Early intervention can be life-saving during a heart attack.

Addressing common questions:

• Does angina mean a heart attack? Not necessarily. Angina can be a warning sign, but it doesn’t cause permanent damage like a heart attack. Seek a medical evaluation for chest pain.
• How do I relieve gas pain? Try a heating pad, over-the-counter gas medication, ginger, gentle massage, or light exercise.

Remember, angina is manageable with proper care. By working with your doctor and adopting a heart-healthy lifestyle, you can live a full and active life.