Introduction to Angina
Angina refers to a set of symptoms that may occur as a result of restricted or reduced blood flow to the muscles in the heart. The blood circulating within the body to the organs is rich in oxygen and nutrients.
When muscles do not receive these nutrients (mainly oxygen), they will malfunction and could result in muscle tissue death. In such cases, a heart attack may occur.
A heart attack is when your heart stops working due to the lack of oxygen reaching the heart muscles. The reason why blood flow is restricted, in such cases, is mainly due to the deposition of fats within the blood vessels. These buildups act as obstructions and can increase blood pressure.
Some of the most commonly experienced symptoms include chest pain and shortness of breath. Chest pain can be experienced as a feeling of tightness, heaviness or dullness. This pain may also be experienced in your back, neck, arms or jaw. The pain can also be described as a stabbing pain or that similar to indigestion. Sometimes you may also experience nausea and abdominal pain. It can be coupled with dizziness, feeling lightheaded, discomfort, anxiety, sweating and/or feeling sick.
Types and Triggers
There are different types of angina associated with varied triggers. It is necessary to understand this to avoid situations that may lead to such events.
Stable angina can develop over a period of time, rather than being spontaneous. They may follow a specific pattern, such as experiencing symptoms in stressful situations or due to physical exertion. The symptoms of stable angina are temporary and last only for a few minutes. These symptoms can improve upon resting and via medication.
One of the main triggers of stable angina is physical activity. Physical exertion puts excess pressure on your heart to pump blood. When blood vessels are blocked, blood does not reach the organs effectively, causing angina.
Unstable angina refers to the chest pain that occurs when you are resting or due to stress or exertion. It is a more severe form of angina as opposed to stable angina. It is an emergency, and requires immediate medical assistance, as leaving it unchecked, could cause heart attacks, irregular heartbeat and/or heart failure.
Microvascular angina is chest pain caused by issues in the smaller blood vessels within the body. These are responsible for bringing oxygen to the heart. When the heart lacks a sufficient amount of oxygen, the muscles can get damaged. This leads to heart attacks. Microvascular angina can be eased with changes in your lifestyle habits and proper medication. It is mainly brought about by physical exertion.
The treatments for angina can help reduce and ease the symptoms and even stop them. Bringing healthy lifestyle changes can greatly help along the treatment.
Medication may also be prescribed to prevent angina attacks. In case of any other underlying conditions, such as coronary heart disease, medications may be prescribed to treat those conditions as well. Quick-relief treatments are suitable for those with stable angina. Those who suffer from unstable angina will be prescribed more medications to prevent blood clot formation. This reduces the risk of developing heart attacks.
If medications fail to work, surgery can be recommended.
Glyceryl Trinitrate (GTN), or Nitroglycerine in the USA, can be prescribed to those who experience symptoms of angina. GTN can be available in the form of tablets or sprays and also available in the form of ointments or patches. However, the sprays and tablets can provide faster action on the symptoms of chest pain, whereas the ointments and patches are applied to prevent attacks.
What is it/how it works
The GTN spray and tablets provide fast relief by dissolving within the body. GTN works by widening or dilating the blood vessels. Individuals that suffer from angina have narrow blood vessels. By opening them up, blood can flow more freely and at ease to the organs that need it, especially the heart. This means that more oxygen can be incorporated towards the heart, reducing the amount of pressure exerted on the heart.
How and when to take it
The type and amount of GTN used should be as recommended by the doctors. It is important to always follow the instructions provided with the medications.
- The GTN spray is available in the form of a mouth spray. The spray can be taken below the tongue. One to two sprays are sufficient. It can be taken during an attack or before activities that might trigger an attack. If up to two sprays do not provide relief after five minutes, the final third dose may be taken.
- The GTN tablets can be taken by putting them under the tongue. It should be kept there until it is completely dissolved, after which it is advisable to wait for five minutes before ingesting the second dose if the pain still has not stopped. After the second dose, waiting for five minutes is imperative. After this, if the pain continues, you may take the third and final dose.
- The GTN patches can be applied in the morning and taken off at night, with eight to twelve hours in between using a new patch. It can be placed on your arm. The patch contains medication that is absorbed by the skin.
- The GTN ointments can be applied to the chest, arms or thighs. The amount is usually prescribed by your doctor. It should be pressed gently into the area, using a paper measure provided in the packet. The ointment can be applied every three to four hours or as recommended to you.
Some of the side effects of using GTN can include:
- Lightheadedness or dizziness
- Blurred vision
- Flushing or skin reactions
If any of these side effects are bothersome, or if you experience any symptoms outside of this scope, speak to your doctors to get more advice and clarity on your situation.
Research shows that antiplatelets are an effective drug used to treat angina. Antiplatelet treatment involves the administration of drugs that can help reduce the formation of blood clots.
Clots, if present, can increase the symptoms of angina by narrowing the blood vessels. The most common type of antiplatelet drug is aspirin. ADP (Adenosine diphosphate) receptor inhibitors can also be prescribed to those who have experienced heart attacks or strokes in the recent past. Some medications, like glycoprotein IIB/IIA, can also be prescribed intravenously. This is mainly done in a clinical setting, i.e., at the hospital. The medications that are prescribed are of varying strengths and types. As a result, the amount that needs to be administered varies. It is advisable to consult your doctor for more information on this type of therapy.
Beta-blockers can be used to reduce the speed at which the heart muscles work. This can reduce the pressure exerted on them and regulate the heartbeat. They can also reduce blood pressure. By reducing the speed at which the heart muscles work, they reduce the amount of oxygen required by the heart. Therefore, beta-blockers help reduce the frequency of angina attacks.
Research shows that ACE inhibitors can be particularly useful in managing angina. They can be especially useful as preventive medicines for patients with diabetes who suffer from angina. ACE inhibitors can reduce the activity of angiotensin converting enzyme (ACE). This enzyme controls the activity of other hormones responsible for or associated with blood pressure regulation. ACE inhibitors reduce the activity of this enzyme which leads to the widening of the blood vessels. It also allows the heart to relax.
Living With Angina
A diagnosis of angina can be scary and worrisome; however, it can motivate you to make the changes necessary to lead a healthier lifestyle. It is important to consult specialists to develop a plan.
- Nutritionists can help you with a balanced diet to reduce the foods that can increase your cholesterol levels and are bad for your heart.
- Physical activity, after consultation with a physical trainer, can be useful. Physical exertion can cause angina; however, the right amount of exercise done the right way can be beneficial.
- Meditation and mindfulness can also help deal with stress and emotionally difficult situations, which could be triggers of angina.
- Quitting smoking can also be extremely beneficial to reduce blood pressure and blood clot formation.
- If you drink, make sure you are drinking within the recommended guidelines, as alcohol can also contribute to angina.
In addition to this, your doctors will help you prepare a medication routine. This can include medicines to treat underlying conditions causing angina, such as coronary heart disease. GTN sprays and tablets can be used to treat angina immediately. These formulations contain the GTN medicine, dilating blood vessels and reducing the severity of chest pain. GTN patches and ointments can help prevent future angina and heart attacks. Beta-blockers, antiplatelet therapy, and ACE inhibitors may also be prescribed, depending on your condition. These together can ease your symptoms, reduce the pressure on the heart, and prevent angina attacks.
- Briasoulis, A., Tousoulis, D., Bakogiannis, C., Papageorgiou, N., Androulakis, E., Latsios, G., Chatzis, G., Chrysohoou, C., Vogiatzi, G., & Stefanadis, C. (2013). Novel anti-platelet agents for the treatment of stable angina pectoris. Current pharmaceutical design, 19(9), 1581–1586.
- Uzokov, J., & Alyavi, A. (2017). Treatment of stable angina pectoris: focus on the role of calcium antagonists and ACE inhibitors. Escardio.org. Retrieved 11 February 2022, from https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Treatment-of-stable-angina-pectoris-focus-on-the-role-of-calcium-antagonists-and-ACE-inhibitors.