Angina Untreated: What happens?

Contents

Introduction

Angina Pectoris, more commonly referred to as Angina, is a cardiovascular condition that affects roughly 6.2%1 of the global population. Angina causes us to experience chest pain due to a lack of oxygenated blood reaching our cardiac muscles. In most cases, this is caused by atherosclerosis, the process in which plaque builds up within our arteries, narrowing them and restricting blood flow. While angina alone is not normally considered life-threatening, it is seen as a warning sign that some form of intervention is required to prevent more severe cardiovascular issues from occurring.  

Causes/Risk factors

In most cases, angina is caused by coronary artery disease (CAD). CAD is a condition in which plaque begins to build up within our coronary arteries, causing them to become narrower and restricting oxygenated blood flow to our heart. An individual’s lifestyle can greatly influence their risk of developing CAD and angina. Below are some of the most prominent risk factors in the development of angina.

Inactive lifestyle - The British Heart Foundation2 explains that spending large portions of our day inactive increases the rate at which plaque can build up within our arteries, therefore increasing the risk of developing CAD and angina.

Unhealthy Diet - Consistently consuming a diet high in saturated fats and sugary products has been shown3 to increase an individual’s risk of developing CAD and angina. A combination of high dietary fats and sugars increases our blood pressure and plaque build-up, both of which can damage and narrow our coronary arteries, increasing angina risk.

Age - Unfortunately as we age our arteries naturally become narrower and harder due to a lifetime of plaque build-up (the extent of which is highly dependent on how healthy of a lifestyle you have lived previously). Subsequently, it is well-established4 that our risk of angina increases greatly after the age of 60. 

Smoking - Research5 has found that the nicotine within cigarettes can cause significant damage to artery walls and blood vessels, making those who smoke significantly more prone to plaque build-up and restricted oxygenated blood flow, increasing angina risk.

Types of angina

Like many medical conditions, there are different types of angina pectoris. Angina is categorised by the trigger that causes the individual to experience chest pain. Below are the four main types of angina.

Stable angina

Stable angina is considered the most common type of angina. While the condition still requires medical attention, it isn’t considered an immediate threat to life and can normally be treated with medication and lifestyle changes. Stable angina pain is normally triggered by physical activity and other external factors. Pain commonly subsides once the individual rests.

Unstable angina 

Unstable angina is considered a medical emergency6 and requires immediate attention. Unstable angina is much harder to manage in comparison to stable angina and will almost always require medication and in some cases surgical intervention. Unlike stable angina, unstable angina pain may not subside with rest and can randomly occur without an obvious trigger.

Variant angina

Also referred to as coronary artery spasm, vasospastic angina and prinzmetal angina, variant angina is when our arteries become temporarily narrowed due to a spasm occurring within one of our coronary arteries. Subsequently, oxygenated blood flow to our cardiac muscles becomes temporarily restricted, causing us to experience angina pain.

Microvascular angina

Microvascular angina is a condition in which the microvessels responsible for allowing oxygenated blood to flow into our cardiac muscles are either unable to vasodilate (open) properly or go into spasm, causing them to become narrower. In both cases, oxygenated blood flow to our cardiac muscles is restricted, causing us to experience angina pain.

Symptoms

The symptoms an individual with angina experiences can differ greatly depending on the type of angina they have and the severity of their condition. If you suffer from any of the following symptoms regularly, ensure to visit your local GP immediately. Here are some of the most common symptoms associated with angina.

  • Chest pain caused by physical activity
  • Random chest pain that does not appear to have a trigger
  • Breathing difficulties
  • Feeling extremely fatigued
  • Indigestion like pain in your stomach
  • Regularly feeling nauseous

Treatment

The type of treatment angina patients will receive will depend highly on the type of angina they are diagnosed with and the severity of their condition. Medical professionals will likely utilise three main methods when treating those with angina: lifestyle changes, medication, or surgery.

Lifestyle Changes

Alongside medication, those with angina may be prescribed a set of lifestyle changes to help manage their condition. Clinical trials7 have shown that particularly in stable angina patients, following a set of prescribed lifestyle changes can significantly reduce the frequency and severity of an individual’s angina attacks. Lifestyle changes will most commonly consist of the following:

  • Increase in exercise participation
  • Decrease in sedentary behaviours.
  • Consumption of a healthier and balanced diet
  • Decreased alcohol consumption
  • Stress management
  • Quitting smoking or any drug usage

Medication

Whilst lifestyle changes can be extremely effective, most of those diagnosed with angina will require several forms of medication. Below are some of the medications commonly prescribed to those diagnosed with angina.

Glyceryl Trinitrate (GTN) - A type of medication that helps stop/reduce the amount of pain experienced once an angina attack has begun. Can be prescribed in both tablet and spray form.

Aspirin - Help reduce the rate at which blood clots, preventing arteries from becoming narrowed further as a result of blood clotting.

Nitrates - Nitrates help our blood vessels relax, allowing them to become wider and increase blood flow to the heart.

Beta-Blockers - Help ensure the heart beats slowly and with less force by reducing the effects hormones such as adrenaline have on our heart.  

Surgery

In more severe cases, surgery may be required to prevent heart attacks, strokes and other severe health problems from occurring. There are two main types of surgery performed on those with angina.

  • Coronary Angioplasty and Stent Insertion- A small tube referred to as a stent is placed within the narrowed section of an artery, helping widen it and increase blood flow.
  • Coronary Artery Bypass Graft- Blood is redirected around the blocked or narrowed part of an artery using a blood vessel taken from another part of the body.

What if left untreated

Unfortunately, all four types of angina can lead to more severe conditions if left untreated. As previously discussed, while angina alone isn’t considered life-threatening, it is a warning that further cardiovascular complications could occur if left untreated. Below are some of the most common complications that can arise as a result of leaving angina untreated.

Complications

Myocardial Infarction- The American Heart Association8 report that those diagnosed with angina are at an increased risk of suffering from a heart attack. If left untreated, the heart will continue to receive a restricted supply of oxygenated blood flow, which over time can cause damage to the heart’s muscles, increasing the risk of a heart attack.

Stroke- According to statistics9, 5.4% of those diagnosed with angina suffer from a stroke within four years of their diagnosis. As most angina patients suffer from plaque buildup within their arteries, they are at an increased risk of their carotid arteries, the artery that delivers oxygenated blood to the brain, becomes narrowed or blocked, causing an ischemic stroke to occur.

Heart Failure- According to an article published in the ‘Journal of the American Heart Association,9 11% of those diagnosed with angina suffer from heart failure within four years of their diagnosis. Without sufficient lifestyle changes and medical attention, arterial plaque build is allowed to continue, further restricting blood flow. Over time, the heart muscles become weaker and are unable to pump sufficient amounts of blood around the body

Emotional Stress- Emotional stress disorders are present in 8.8%10 of those diagnosed with angina. Being diagnosed with a cardiovascular condition can be extremely stressful, causing some patients to develop anxiety and depression. If you become emotionally distressed as a result of your condition, ensure to reach out to your local GP for a consultation to help ease your fears.

Prevention

Research11 has found that those who lead a healthier lifestyle are significantly less likely to develop CAD and angina. While angina is specifically a cardiovascular issue, there are many areas of our lifestyle that can directly reduce our risk of developing the condition. By following as many of the following guidelines as possible, our risk of angina and a wide range of other health conditions is significantly lowered.

  • Perform 150 minutes of weekly aerobic exercise
  • Eat a healthy and well-balanced diet
  • Eat 5 portions of fruit and vegetables every day
  • Maintain a healthy weight
  • Take time to de-stress
  • Get at least 8 hours of sleep nightly
  • Avoid smoking and drug usage

When to see a doctor

If you regularly experience random chest pain or any of the other aforementioned angina symptoms and have not already been diagnosed with the condition, ensure to book an appointment with your local GP immediately. To recap, here are some of the key symptoms to look out for.

  • Chest pain that subsides with rest
  • Experience tightness, squeezing and/or pressure in the chest
  • Light-headedness or nauseous after physical activity

As angina can be a warning sign for a more severe cardiovascular issue, some people may suffer from more severe symptoms. In the event that you or someone around you is suffering from any of the following symptoms, call 999 immediately.

  • Chest pain that lasts longer than 10 minutes
  • Shooting or indigestion-like pain that spreads to other parts of the body (especially arms, abdomen, stomach, neck, back, and jaw)
  • Breaking out into a cold sweat

Summary

While angina alone is not life-threatening, the primary causes of angina pain, such as plaque build-up and restricted coronary blood flow, can cause more severe conditions. It is universally agreed that those with angina can go on to lead a normal life provided they treat their condition and make alterations to their lifestyle. Whilst getting medical attention for your condition may seem daunting, your local GP will help you provide you with the medication and lifestyle changes to help you lead a healthier and pain-free lifestyle.

References

  1. Hemingway, Harry, et al. ‘Prevalence of Angina in Women Versus Men’. Circulation, vol. 117, no. 12, Mar. 2008, pp. 1526–36. ahajournals.org (Atypon), https://doi.org/10.1161/CIRCULATIONAHA.107.720953
  2. Physical Inactivity. https://www.bhf.org.uk/informationsupport/risk-factors/physical-inactivity
  3. Feingold, Kenneth R. ‘The Effect of Diet on Cardiovascular Disease and Lipid and Lipoprotein Levels’. Endotext, edited by Kenneth R. Feingold et al., MDText.com, Inc., 2000. PubMed, http://www.ncbi.nlm.nih.gov/books/NBK570127/
  4. Rodgers, Jennifer L., et al. ‘Cardiovascular Risks Associated with Gender and Aging’. Journal of Cardiovascular Development and Disease, vol. 6, no. 2, Apr. 2019, p. 19. PubMed Central, https://doi.org/10.3390/jcdd6020019
  5. Lee, Ji-Eun, and John P. Cooke. ‘The Role of Nicotine in the Pathogenesis of Atherosclerosis’. Atherosclerosis, vol. 215, no. 2, Apr. 2011, pp. 281–83. PubMed Central, https://doi.org/10.1016/j.atherosclerosis.2011.01.003
  6. ‘Unstable Angina’. Www.Heart.Org, https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain/unstable-angina
  7. Winchester, David E., and Carl J. Pepine. ‘Angina Treatments and Prevention of Cardiac Events: An Appraisal of the Evidence’. European Heart Journal Supplements : Journal of the European Society of Cardiology, vol. 17, no. Suppl G, Dec. 2015, pp. G10–18. PubMed Central, https://doi.org/10.1093/eurheartj/suv054
  8. ‘Understand Your Risks to Prevent a Heart Attack’. Www.Heart.Org, https://www.heart.org/en/health-topics/heart-attack/understand-your-risks-to-prevent-a-heart-attack
  9. Eisen, Alon, et al. ‘Angina and Future Cardiovascular Events in Stable Patients With Coronary Artery Disease: Insights From the Reduction of Atherothrombosis for Continued Health (REACH) Registry’. Journal of the American Heart Association, vol. 5, no. 10, p. e004080. ahajournals.org (Atypon), https://doi.org/10.1161/JAHA.116.004080
  10. Tsai, Ching-Ching, et al. ‘The Association between Psychological Distress and Angina Pectoris: A Population-Based Study’. PLoS ONE, vol. 14, no. 11, Nov. 2019, p. e0224451. PubMed Central, https://doi.org/10.1371/journal.pone.0224451
  11. Cole, Judith A., et al. ‘Systematic Review of the Effect of Diet and Exercise Lifestyle Interventions in the Secondary Prevention of Coronary Heart Disease’. Cardiology Research and Practice, vol. 2011, Dec. 2010, p. 232351. PubMed Central, https://doi.org/10.4061/2011/232351
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