Angina – When the heart aches

Angina or angina pectoris is a type of chest pain, discomfort or tightness that occurs due to less blood reaching heart muscles. It is not a disease in itself but is a vital symptom of coronary artery disease, the commonest type of heart disease.

Pain of angina typically lasts from 1 to 15 minutes.

The condition is classified into stable, unstable and variant angina.

  • Stable (or chronic) angina strikes when the heart is working harder than usual, like during exercising. It has a regular pattern and symptoms are relieved by rest or medication
  • Unstable angina can occur even on rest and is considered more serious as it does not get relieved by rest or medicine. This variant can signal a future heart attack within hours or weeks
  • Variant (Prinzmetal’s) angina is rare and can occur without any underlying coronary artery disease and at rest. This angina occurs due to abnormal narrowing or spasm of the coronary blood vessels, reducing the flow of blood to the heart. It does get relieved by medicine

Causes of angina
Angina is caused when the heart comes under pressure, usually after exercise or emotional/mental stress. At such times, more blood flows towards the heart muscles and the thickened blood vessels couldn’t give way, which leads to angina.

Symptoms of angina
The chest pain of angina typically occurs behind the breastbone and is rather severe in intensity. Some other associated symptoms that may occur are

  • Nausea and sweating
  • Indigestion & heartburn
  • Pain radiating to teeth, jaw, arms or back
  • Difficulty inbreathing

Diagnosis and investigations for angina
A person experiencing angina should be thoroughly evaluated and examined by a cardiologist. Some important investigations done to reach the final diagnosis are,

ECG: This will demonstrate if the electrical conduction of the heart is interrupted, which may occur during a heart attack. As compared to an older ECG, it may show changes which may indicate heart problem.

Stress test: The person is asked to walk on a treadmill while his ECG and heart rate are monitored. The person with a heart problem or poor stamina may not be able to complete the stress test.

X ray chest: This is done to look for an enlarged heart and to check for any lung diseases.

Blood tests: Certain enzymes if elevated in blood signal a heart attack.

Cardiac CT scan: This helps in checking the heart’s status and narrowing or blocks in the coronary arteries.

Coronary angiography: This imaging test is done to assess the exact percentage of blockage and if possible, ballooning and placement of stent is done during the procedure.

Other conditions which can cause chest pain:

  • a blockage in a lung artery (Pulmonary embolism)
  • lung infection
  • tearing of aorta
  • narrowing of the heart’s aortic valve (Aortic stenosis)
  • heart muscle disease
  • inflammation in the tissues that surround the heart
  • a panic attack

All chest pain should be checked by a doctor.