What is Angina?
Despite popular belief, angina is a symptom of coronary artery disease and not a disease in itself. It commonly presents as chest pain or a dull ache in the chest caused by reduced blood flow to the heart1. This is a result of the heart muscle not getting enough oxygen-rich blood to contract and carry out its job effectively. When oxygen demand is greater than the oxygen supply, this puts strain on the heart. This imbalance may occur during exertion (strenuous exercise). The dull ache and tightness of the chest are a result of this imbalance. This is angina in a nutshell. The medical term Angina Pectoris derives from the Latin word “Angerer'' which means to strangle and “Pectorus” which means chest. This translates as “the strangling of the chest”.
Angina is not considered to be life-threatening, it’s just your body’s way of warning you that something isn’t quite right with your heart and is often a sign of coronary heart disease.2
Angina can either be stable (Angina Pectoris) or unstable. These are the main types of angina and they usually present with different signs and symptoms.
Angina Pectoris, also known as stable angina, occurs during or after a person carries out physical activity such as walking or performing strenuous activities such as gardening, running, etc. The symptoms usually last between 30 to 60 seconds and go away once the individual rests or seeks treatment.
Unstable angina occurs more frequently, and the symptoms tend to last longer than stable angina. It can occur at any time, even while at rest. It can also be a warning sign that a heart attack is imminent. Therefore, it is very important to act fast if you develop symptoms.
Other types of angina include microvascular angina and variant angina. These types are usually very rare.
Signs and Symptoms
The intensity of the symptoms varies and usually depends on the type of angina; however, the most common sign is tightness or squeezing of the chest.
Other symptoms include:
- Dizziness
- Sweating
- Fatigue
- Shortness of breath
Pain can also be felt in the arm and the back of the neck. Not all chest pain is associated with angina. If you are experiencing chest pain, radiating to your arm and shoulders please seek medical attention immediately.
Causes and Risk Factors
One of the major causes of angina is coronary heart disease, also known as ischaemic heart disease. This occurs as a result of cholesterol or plaque build-up in the arteries associated with the heart muscles. These fatty deposits cause the walls of the arteries to narrow, thus reducing the amount of oxygen-rich blood flow to the heart. The medical term for this is atherosclerosis. Athero (Greek word) means gruel/paste, and sclerosis means hardening of tissue.3
As mentioned above, angina can occur following physical exertion, however stress (emotional and mental) can also be a trigger. Studies have shown that an increase in stress hormones may put you at a higher risk of developing cardiovascular disease and experiencing angina.12 Therefore, it is very important to manage your stress levels.
In addition, patients with high cholesterol levels are at a greater risk of developing angina pectoris as increased levels of cholesterol eventually build up in the arteries4.
People with angina are more likely to have other disorders such as hypertension, congestive heart failure; as well as diabetes and Chronic Obstructive Pulmonary disease (COPD).4
Age and Angina
Angina is more prevalent in individuals aged over 55 years. It is very rare to develop angina under 45 years. However, it is not impossible and can actually occur at a younger age. Age is said to be an independent risk factor for developing angina. The older you become, the more at risk you are of developing cardiovascular diseases.6
Can you develop angina in your 40s? The answer is yes. If you are 40 and above with risk factors such as diabetes, hypertension, and high cholesterol, then you are likely to develop angina. According to the American Heart Association, between the ages of 40-59 years, there is a 40% incidence rate of developing cardiovascular diseases such as atherosclerosis, heart attack and stroke, with the rate increasing to 75% (60 -79 years) and 86% for those above 80.7
It is implied that women are more likely to develop angina at an older age than men and their symptoms are often atypical, which means they are more likely to be wrongly diagnosed5. In addition, men aged 40 and above with low testosterone levels were at a higher risk of developing cardiovascular diseases and more likely to develop angina symptoms.
Diagnosis
Your doctor will usually assess your symptoms together with your medical history and risk factors to perform a diagnosis. Furthermore, a range of tests can be used to aid diagnosis of angina, such as:
- Electrocardiogram (ECG): Traces your heart to detect any abnormalities in your heart’s rhythm, rate, and electrical activity.
- CT Angiography: Assesses the presence of any structural abnormalities in the heart.
- Coronary Angiogram: A special type of X-ray which enables your doctor to see your coronary arteries (vessels that transport blood to your heart) through use of a special dye. The dye shows how well blood is flowing through your arteries and will usually indicate any narrowings.9
- Cardiac Magnetic Resonance Imaging (MRI) scan: A machine that uses magnetic waves to show detailed images of your heart.
- Blood Tests: Your doctor may also carry out some blood tests to diagnose signs of unstable angina.
Management and Treatment
As Angina is a symptom and not a condition, its management involves providing symptom relief following an attack. The most common immediate relief for angina pain is a sublingual nitroglycerin spray or tablet, which your doctor will prescribe. The pain should generally subside once this has been administered.10 You may also be prescribed medications that help lower your risk of experiencing a heart attack or stroke such as Aspirin, Statins (help lower cholesterol levels), and Ranolazine (anti-angina medication).
Depending on the severity of your symptoms, you may also be offered treatments such as coronary angioplasty or surgery. Coronary angioplasty involves a special type of balloon which is gently inflated inside the coronary artery to widen the artery and improve blood flow.11 Many people have found their angina symptoms to improve following angioplasty; however, some do face complications depending on their overall health and heart condition.11 In some cases, you might have a stainless-steel mesh known as a stent inserted into your artery which also promotes better blood flow. Surgery for relief of angina symptoms is generally a Coronary Bypass also known as CABG. A surgeon will use a blood vessel from either your chest, leg, or arm to bypass a narrowed artery, essentially diverting away the blood from entering the clogged artery.
Prevention
So, you know the saying…Prevention is better than cure…Well, the same applies to angina. There are various things you can do to lower your chances of developing angina. Lifestyle changes such as adopting a low-fat diet, regular exercise, joining smoking cessation and weight loss programs (if required) can reduce your chances of developing angina.6
Your doctor will assess your predispositions and will recommend you to adopt some changes to reduce your risks of developing angina. If you are a smoker, your doctor will talk to you about the cessation programs you can join to help you stop smoking. You may also benefit from adopting a healthy diet which limits your intake of saturated fats, trans fat, salt, sugar, and alcohol. Diets rich in vitamins, such as fruit, vegetables, and lean meat, can also reduce your risk of getting angina.
Stress is also a key risk factor associated with angina.12 Avoiding stress is not always easy; however, try to find ways to help alleviate stress, such as focusing on your breathing or meditating. Speak to your doctor for more advice.
When to See a Doctor
Speak to your doctor as soon as you notice the chest pain. Keep a journal to note down every time you experience an episode. Jot down the intensity of the chest pain and what triggered it, for example, what you were doing when it happened. Note how long it lasted and whether it went away once you rested. This will make it easier for your doctor to perform the diagnosis. It’s also helpful for you to recognise your symptoms and act quickly once you notice any significant changes.
Summary
Angina is a symptom that is associated with coronary artery disease. It acts as a warning sign from your body to let you know that there is a problem with your heart. In severe cases, especially with unstable angina. it may be an indicator of an imminent heart attack. It can manifest as central chest pain, which includes tightness in the chest. You may also experience dizziness, sweating and shortness of breath. Although it is not a condition, it is still important to recognise the signs and seek medical help as soon as you experience the pain. Adopting a healthy lifestyle and performing regular exercise can help reduce your risk of developing angina.
References
- Angina - Causes, symptoms & treatments [Internet]. Bhf.org.uk. 2022 [cited 26 July 2022]. Available from: https://www.bhf.org.uk/informationsupport/conditions/angina
- Angina [Internet]. nhs.uk. 2022 [cited 26 July 2022]. Available from: https://www.nhs.uk/conditions/angina/
- Adebayo O, Moshood Adeoye A. Atherosclerosis: A Journey around the Terminology. Atherosclerosis, Arteriosclerosis and Arteriolosclerosis. 2020;.
- Scirica B. Chronic Angina: Definition, Prevalence, and Implications for Quality of Life. Reviews in Cardiovascular Medicine. 2009;10(S1):3-10.
- Rodgers J, Jones J, Bolleddu S, Vanthenapalli S, Rodgers L, Shah K et al. Cardiovascular Risks Associated with Gender and Aging. Journal of Cardiovascular Development and Disease. 2019;6(2):19.
- Shao C, Wang J, Tian J, Tang Y. Coronary Artery Disease: From Mechanism to Clinical Practice. Advances in Experimental Medicine and Biology. 2020;:1-36.
- Angina in Women Can Be Different Than Men [Internet]. www.heart.org. 2022 [cited 26 July 2022]. Available from: https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain/angina-in-women-can-be-different-than-men
- Angina (Chest Pain) [Internet]. www.heart.org. 2022 [cited 26 July 2022]. Available from: https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain
- Coronary angiogram [Internet]. Bhf.org.uk. 2022 [cited 26 July 2022]. Available from: https://www.bhf.org.uk/informationsupport/tests/angiogram
- Medicines for heart conditions [Internet]. Bhf.org.uk. 2022 [cited 26 July 2022]. Available from: https://www.bhf.org.uk/informationsupport/treatments/medication
- Kloner R, Chaitman B. Angina and Its Management. Journal of Cardiovascular Pharmacology and Therapeutics. 2016;22(3):199-209.
- Yaribeygi H, Sahraei H. Physiological/Neurophysiological Mechanisms Involved in the Formation of Stress Responses. Neurophysiology. 2018;50(2):131-139.