Until recently, angina was primarily seen in older adults but it is now becoming more common in the younger generation. This is because a variety of modifiable concerns are involved among young individuals leading them towards cardiovascular health risks.
Angina, often known as chest pain, is not a disease and is typically a non-life-threatening condition. However, it may be a warning indicator of an underlying serious heart issue such as a heart attack or stroke.
What is Angina?
Angina, also called Angina pectoris, plainly means strangling of the chest. This is a type of chest pain that is caused by restricted blood flow and oxygen supply to the heart muscles. Angina pain is often described as a tight, dull, or heavy squeezing discomfort, sometimes like a sharp stabbing pain in the chest.
Although angina is relatively typical, it can still be tricky to differentiate it from other types of chest pain, such as indigestion discomfort.
There are several types of angina that are categorized by the cause of pain, and whether rest or medication may relieve the symptoms.
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- Stable Angina: This is the most common type and usually occurs when a patient has more or equal to 70% stenosis, which is a narrowing of the blood vessel due to plaque build-up. At rest, the narrow opening of an artery might be enough to supply blood to the muscles. However, during an activity (physical or emotional exertion), the heart can demand a more oxygen-rich supply, which takes a total toll on the cardiac muscle. During such events, people with stable angina experience chest pain, which usually goes away with rest and medication.
- Unstable angina: Unlike stable angina, this type often occurs at rest or worsens when less physical effort is made. It's typically intense, lasts longer than stable angina, and does not go away with medication or with rest. If left untreated, this might lead to a heart attack. Unstable angina requires immediate emergency treatment.
- Variant angina: Variant angina or Prinzmetal angina, is caused by a spasm in the arteries that temporarily decreases blood flow. It most often occurs periodically with severe chest discomfort, sometimes at rest or during sleep.
- Refractory angina: This is a chronic condition caused when there’s an insufficient blood supply to the heart muscles due to more than 75% narrowing. In this case, chest pains are frequent and cannot be controlled by a combination of medical therapies and lifestyle changes.
- Microvascular angina: This type of angina is distinguished by the absence of visible coronary artery blockages. It is more common in women and can usually be treated with medications.
Signs and Symptoms
Chest discomfort is the most common symptom; however, it affects each individual differently it may feel similar to:
- Burning.
- Squeezing.
- Stabbing pain.
- Heavy or dull.
Other signs and symptoms include:
- Dizziness.
- Pain in the throat, jaw, arms, shoulder, or even at back.
- Fatigue.
- Nausea.
- Unusual sweating.
- Shortness of breath.
- Abdominal pain.
Causes and Risk Factors
Heart muscles need oxygen to survive. During angina, the blood flow to the heart is reduced, which causes the heart muscles to suffocate due to insufficient oxygen supply, a condition known as ischemia. The most common cause of restricted blood flow is coronary artery disease (CAD). In this, the tiny vessels of the heart called coronary arteries narrow due to a fatty accumulation called plaque, which makes blood vessels become stiff and thick, medically known as arteriosclerosis. If plaque cracks open, it can form a blood clot, further narrowing the vessel and causing more blockage, which can trigger angina symptoms.
The following are the primary risk factors for angina that might be linked to any form of cardiac health problem:
- High cholesterol level or an excess of bad cholesterol
- High blood pressure damages the arteries over time and can trigger the hardening of vessels.
- Smoking or long-term exposure to second-hand smoke can cause damage to the arteries.
- Diabetes can speed up arteriosclerosis, leading to angina and heart attacks.
- Family history of cardiovascular diseases.
- Obesity
- Sedentary lifestyle
- Ageing.
- Unhealthy diet.
Complications
Individuals suffering from angina are at a high risk of cardiac arrest or heart failure if the pain is not treated promptly. Any type of angina felt due to physical activity can dangerously lead to a heart attack if left untreated. Especially if someone experiences unstable angina or variant angina, which might cause cardiac complications, strict immediate changes in lifestyle and medical therapy are recommended to deter the chance of a heart attack.
Diagnosis
In addition to examining the complete medical history, the concerned doctors may conduct certain diagnostic tests according to the symptoms reported by the patient to confirm angina:
- Electrocardiogram (ECG)
- Echocardiogram.
- Stress Test with Exercise ECG.
- Chest X-rays.
- Blood Tests.
- Coronary angiography.
- Cardiac Computerized Tomography (CT) Scan.
- Cardiac MRI.
Treatment
Angina patients are often suggested different treatment options to reduce the severity of symptoms and minimize the risks of a heart attack such as:
- Lifestyle changes.
- Medications (Nitrates, aspirin, calcium channel blockers, clot-preventing drugs, and others)
- Surgical procedures such as Angioplasty with stenting and open-heart surgery.
- Therapies like a non-drug option called enhanced external counterpulsation (EECP) to reduce frequent or uncontrolled chest pain.
When to See a Doctor
It is best to contact a doctor when any symptoms of angina are initially suspected. In emergency situations, it is recommended to seek immediate medical attention if the angina pain radiates to the jaw, neck, or arms and it does not subside within a few minutes. If individuals experience chest pressure, numbness, and shortness of breath, then it might be a warning indication of a heart attack (myocardial infarction).
Do Young Adults Get Angina?
Although angina is considered a condition experienced by elderly people, however, because of various modifiable factors it is becoming more prominent among younger adults. A study was conducted, where a prevalence of 1% was found in people younger than 40 years of age and 5–10% among those less than 50 years of age for acute coronary syndrome in an emergency unit.1
Another study expressed concern that nearly 1 in 5 people younger than 40 years old are affected by heart attacks. Overall, the proportion of young adults with cardiac problems is increasing at a rate of 2% per year.2
Are There Angina Symptoms Specific to Young Adults?
Angina symptoms in young adults are often unexpected. However, there are a few general symptoms, which include:
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Causes of Angina in Young Adults
One of the possible indicators of angina in young adults is a family history of heart disease. Moreover, the major cause of chest pain is the increasing incidence of type 2 diabetes among young adults due to lifestyle choices, diet, and obesity. Diabetes can put someone more at risk of having heart disease.
Other key contributing factors to angina are hypertension, substance abuse, and smoking, especially those smoking e-cigarettes (vaping). A recent study indicated that 34% of vaping users are more prone to heart issues.3
Other research showed that a family history of heart attacks is linked with cardiac events at a young age. However, it is not the only contributing factor; most of them are related to unhealthy lifestyles.4,5
Other Heart Conditions in Young Adults
- Aortic Dissection.
- Arrhythmias.
- Pulmonary Embolism.
- Cardiomyopathy.
- Congenital heart defects.
- Mitral Valve Prolapse (Click-murmur syndrome)
- Myocarditis.
- Acute Pericarditis.
Other Causes of Chest Pain in Young Adults
e.g. Costochondritis, Anxiety
Costochondritis, an inflammation of the rib cartilages connected to the breastbone that often manifests as sharp pain, and panic attacks (anxiety), are the most prevalent causes of chest wall pain in young adults. A significant majority of adults with underlying anxiety experienced acute chest pain, which is often treated with a combination of psychological and medical treatment.
Furthermore, a lung infection, pulmonary embolism (restriction in a lung artery), and substance abuse are also common contributing risk factors for chest pain.1
Advice for Keeping Your Heart Healthy
Healthy lifestyle changes can prevent or delay angina pectoris. The following recommendations can help to maintain good heart health:
- Regular physical activity.
- Healthy diet.
- Maintaining a healthy weight.
- Avoid smoking and restrict exposure to second-hand smoking.
- Stress relief therapy.
- Managing other health conditions (blood pressure, diabetes)
Summary
Angina can be a serious issue for heart health. However, it is treatable. recognising the warning signs of chest pain promptly and following healthy life choices can help to prevent and manage cardiac problems.
References
- Chest pain in young adults | 2018-04-20 | ahc media - continuing… [Internet]. Relias Media | Online Continuing Medical Education | Relias Media - Continuing Medical Education Publishing. [cited 2022 Aug 10]. Available from: https://www.reliasmedia.com/articles/142570-chest-pain-in-young-adults
- Heart attacks increasingly common in young adults: Youngest heart attack survivors have same likelihood of dying as survivors 10+ years older; substance abuse may be contributing to trend [Internet]. ScienceDaily. [cited 2022 Aug 10]. Available from: https://www.sciencedaily.com/releases/2019/03/190307081026.htm
- E-cigarettes linked to heart attacks, coronary artery disease and depression: Data reveal toll of vaping; researchers say switching to e-cigarettes doesn’t eliminate health risks [Internet]. ScienceDaily. [cited 2022 Aug 10]. Available from: https://www.sciencedaily.com/releases/2019/03/190307103111.htm
- Heart attacks in young adults are related to unhealthy lifestyles, not just family history [Internet]. [cited 2022 Aug 10]. Available from: https://www.escardio.org/The-ESC/Press-Office/Press-releases/heart-attacks-in-young-adults-are-related-to-unhealthy-lifestyles-not-just-family-history, https://www.escardio.org/The-ESC/Press-Office/Press-releases/heart-attacks-in-young-adults-are-related-to-unhealthy-lifestyles-not-just-family-history
- Aggarwal A, Srivastava S, Velmurugan M. Newer perspectives of coronary artery disease in young. World Journal of Cardiology. 2016;8(12):728.