Week Four - Angina

Angina is the pain experienced when coronary arteries become damaged, blocked or narrowed and aren’t able to bring enough oxygen-rich blood to the heart. People who have angina describe the pain as a squeezing, suffocating or burning. Usually, the pain will go away with rest or medication, but angina is an indication that the heart is struggling to meet the demands of the body. Angina is a warning to rest.

If you experience this kind of chest pain, see your healthcare provider to determine the cause, and get treatment if necessary.

Causes

Angina may occur during physical activity, exercise, stress, periods of extreme cold or hot temperatures, after heavy meals, while drinking alcohol, or smoking. It is most often caused by:

• Coronary artery disease (CAD) as a result of atherosclerosis (a build-up of fatty deposits that block the flow of blood through the coronary arteries).
• Coronary artery spasm where one of the blood vessels supplying the heart muscle vigorously contracts, causing blood flow to decrease or even stop, resulting in a heart attack.
• In some cases, angina can be caused by uncontrolled high blood pressure, or other heart conditions such as narrowing of one of the valves in the heart (aortic stenosis) or an enlarged heart (hypertrophic cardiomyopathy).

Sometimes, people can have chest pain that is the result of other health conditions such as lung, muscle, or bone problems.

Symptoms

Angina is usually a symptom of CAD and puts people at risk of having a heart attack. Symptoms of angina are often experienced after exertion or emotional stress and are relieved with rest or medication and may include the following:

• pain that starts in the centre of your chest, but spreads to the left arm, neck, back, throat or jaw
• tightness, pressure, squeezing and/or aching feeling in the chest or arm(s)
• feeling of moderate to severe indigestion that is persistent
• sharp, burning or cramping pain
• an ache starting in, or spreading to, the neck, jaw, throat, shoulder, back or arm(s)
• discomfort in the neck or upper back, particularly between the shoulder blades
• numbness or a loss of feeling in your arms, shoulders or wrists

If you experience one or more of these symptoms or notice any changes to angina, seek further medical assessment as soon as possible.

Treatment

If it appears that heart problems are the cause of chest pain, healthcare providers may prescribe medications such as:

• Aspirin as it hampers blood clotting thereby helping to maintain blood flow through narrowed heart arteries. When taken during a heart attack, aspirin can significantly decrease death rates; it is recommended for most people who have had a heart attack.
• Nitroglycerin medication is taken to treat angina by temporarily widening narrowed blood vessels, improving blood flow to and from the heart.
• Beta blockers are designed to help relax the heart muscle, slow the heart rate and decrease the blood pressure. This decreases the demand on the heart.
• Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers allow blood to flow from the heart more easily. These medications may be prescribed if you have previously experienced a moderate to severe heart attack which has resulted in a reduced heart pumping capacity and lower blood pressure.
• Calcium channel blocking medications are prescribed to relax the coronary arteries and prevent the spasms.

Prevention

It's never too late to take steps to prevent heart conditions even if there may already be a previous cardiac event or condition. Drug therapy has become an increasingly important part of reducing the risk of a second heart attack and helping a damaged heart function better. Lifestyle factors such as being smoke free, eating a healthy well-balanced diet and being physically active also play a critical role in heart attack prevention and recovery. Healthcare providers typically prescribe drug therapy for people who've had a heart attack or are at high risk of having one.

What is a Heart Attack and How is it Different From Angina?

Angina is not a heart attack – it is a warning signal noting an increased risk of a heart attack, cardiac arrest or sudden cardiac death. A heart attack occurs when the blood supply to the heart is slowed or stopped because of a blockage. In more than 90% of heart attacks, the blockage is due to a blood clot, although a blockage may also be caused by the narrowing of a coronary artery by years of plaque build-up, a condition known as atherosclerosis. A heart attack may also occur when a coronary artery temporarily contracts or goes into a severe spasm, effectively shutting off the flow of blood to the heart.