Angina When To See A Doctor

Overview (About angina)

Angina, also known as Angina Pectoris, is a type of chest pain caused by the decreased rate of oxygen delivered to the muscles of the heart.¹ This happens due to a reduction in the blood flow (which carries oxygen) in the arteries of the heart, and it is a sign of heart disease.¹

The leading cause of angina is coronary artery disease, which obstructs the arteries, leading to less blood flowing to the heart and consequently affecting the functioning of this organ and causing chest pain.

Depending on the severity of coronary heart disease, the obstruction can lead to a heart attack, also known as myocardial infarction, and irreversible damage to the myocardium (heart muscle) and the other structures of the heart.

Angina is a symptom presented most of the time as chest pain, which can also be felt as tightness, pressure, heaviness, or squeezing sensation, mostly on the central or left side of the chest.³ However, this discomfort can also occur or radiate to the shoulders, arms (especially the left side), neck, jaw, abdomen, and back.¹

Some other symptoms associated with angina are dizziness, breathlessness, nausea, sweating, and fatigue.⁴ The angina attack symptoms are mainly triggered by exertion or stress and tend to go away when resting, this type is known as stable angina, but situations where the symptoms happen without triggers and even when resting are known as unstable angina.²

Stable angina

Stable angina is the most typical type of angina, and it happens when the pain is triggered by something and tends to stop with rest. In this type of angina, pain or discomfort happens:

• When the heart muscle is working harder, likely during physical exertion
• It doesn’t come out of the blue, and the episodes tend to be similar and triggered by similar activities
• Doesn’t last for long
• It is relieved by resting or for medicines that can optimise blood flow
• Can feel like heartburn or indigestion
• Can radiate to arms, back, neck and jaw

Stable angina can be triggered by:

• Emotional stress
• Exertion and physical activity
• Extreme temperatures (very hot or cold)
• Smoking
• Very heavy meals (and can be misleading with indigestion)

This type of angina is generally managed with medications and rest, but we will see more about treatments further.⁵

Unstable angina

This type of angina is less common than stable angina but is also more concerning. Generally caused by blood clots that come from the rupture of a fatty plaque (atherosclerosis) in the walls of the heart arteries.

This type of angina generally:

• Happens even when the individual is resting, sleeping, or with little exertion.
• It generally comes as a surprise
• Last for longer than stable angina
• Not relieved by resting or medicines
• Pain can increase over time
• If lasting for very long might mean a heart attack

As a more serious condition, unstable angina needs quick attention from the medical care team since it can lead to a heart attack and cause irreversible damage to the heart muscle and the treatment for this is more aggressive. Generally, the intervention needed will be done through Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft (CABG). Both procedures will be discussed in more detail below.⁶

Warning signs of angina

The most feared and dangerous complication of Angina is a heart attack, also known as myocardial infarction. The warning signs of chest pain that could indicate a myocardial infarction are:

• Chest pain, which can be identified as pressure, constriction, or squeezing pain that lasts more than a few minutes. It is not fading with rest
• Pain that can radiate to arms, neck, jaw, and shoulders
• Chest pain followed by loss of consciousness
• Chest pain associated with nausea, vomiting, and sweating
• Continued pain in the upper area of the abdomen (might be mistaken for indigestion or heartburn)
• Shortness of breath

People with ongoing and long-lasting symptoms like the ones above should seek urgent medical help since they might be presenting a heart attack and every minute counts in trying to preserve heart muscle function.

The above symptoms could also represent unstable angina, and although this might not request urgent action, it needs to be addressed as soon as possible to prevent heart attacks.³

When to consult your doctor and what to expect

People who are presenting symptoms of stable or unstable angina, but don’t have a diagnosis yet should seek medical advice urgently. Different conditions might cause chest pain; therefore, it is essential to clarify what might be causing it and if the symptom is really angina.

 You can be expecting from your doctor to be making you questions like:

• When the pain started
• The features of the pain
• Where it is located
• If the pain travels to any other part of your body
• What makes the pain come and what makes the pain disappear
• If the pain comes gradually or suddenly
• How long it can take for the pain to go away
• If there is anything that makes the pain worse or better
• If there are any symptoms associated with the pain⁷

Some tests might be performed to help identify the cause of the symptoms, being them:

• ECG: a test that checks the heart rhythm and electrical activity. Some changes in the pattern can be suspected of angina
• Exercise ECG or stress ECG: monitor the heart's electrical activity during exercise, and changes in the electrical pattern or chest pain can indicate angina
• Computed Tomography Coronary Angiography: scan to check inside the heart’s blood vessels and identify blockages or narrowing
• Cardiac Magnetic Resonance Imaging (MRI): this can help to see reduced blood flow into cardiac areas
• Echocardiogram: helps to identify heart damage caused by reduced blood flow
• Nuclear stress test: also helps to identify areas where the blood is not flowing normally³

Not necessarily all these tests will need to be performed to identify angina. However, these might be required depending on the case. The doctor will identify which will be the one to be used and will be required in each situation.

Prevention and treatments

The prevention of Angina consists mainly in controlling the risk factors and treating the causes and angina itself. This would involve:

• Healthy diet
• Exercising regularly
• Controlling high blood pressure
• Do not smoke
• Limit amount of alcohol consumption
• Comply with medications
• Controlling cholesterol and sugar levels
• Reduce stress levels.

The treatment for angina will depend on which type it is, stable angina will generally require medications to control pain, and the risk factors and medicines for coronary heart disease such as:

• Nitrates – these medicines help in the relaxation of the blood vessels and widen up the lumen of the vessel increasing the blood flow to the heart muscle. It can come in the form of pills, tablets, sprays, and IV medication
• Medicines to control cholesterol (Statins) – help to control cholesterol levels and atherosclerosis, both risk factors for heart disease
• Medicines to control high blood pressure – high blood pressure can damage the vessels and increase the risk of heart disease, which is why it is so important to control it with the right medication if you have hypertension
• Antiplatelets (like Aspirin) – reduce blood clotting, and therefore makes the blood flows better and also prevent clots that can block the arteries⁷

Unstable angina and patients with a high risk of heart attack might need other interventions like:

• Percutaneous Coronary Intervention (PCI) – a procedure involving cardiac catheterisation in which a balloon is inserted to dilate the artery in the narrowing place, and a stent is placed to keep the arteries open
• Coronary artery bypass graft (CABG) – open surgery where a vein or artery of another part of the body is used to replace the narrowed heart artery that is providing blood flow to the heart muscle⁶

Remedies you can do at home

If you have signs of angina, you must seek medical help and be orientated about the treatments you should be getting. It is not advisable to take medicines without medical supervision, but some changes can be done in your home that can help you with angina.

• Stop smoking - if you have problems stopping smoke, there are healthcare programs for smoking cessation that might help you
• Practising physical activity – you should try to have at least 30 min of moderate activity five days per week
• Control overweight – healthy ways to reduce overweight and obesity can help you to avoid and control angina
• Healthy diet - avoid salt and saturated fats and eat more fibre and vegetables
• Controlling other health issues - diseases such as diabetes, high blood pressure, and high cholesterol are risk factors for developing angina. Having them controlled will help you in avoiding angina
• Managing your stress - controlling your stress levels and practising mindfulness, meditation, and other stress management exercises can help you prevent angina
• Reducing alcohol consumption - consuming alcohol in moderation can help you manage angina

Summary

Angina is a condition caused by the limited flow of blood to the heart, mainly caused by narrowing and blockages of the heart arteries. There are different types of angina. Stable angina is the most common one and is generally chest pain clearly triggered by exertion or stress and improved with rest. However, unstable angina is not the most common but very dangerous since it can easily evolve into a heart attack and is characterised by chest pain not related to exercise which doesn’t get better with resting.

You should seek urgent medical advice if you are presenting severe chest pain, which can be associated with other symptoms and radiate to the arms, neck, jaw, or shoulders, especially if this pain is not improving, since this might be a cardiac attack.

If you have chest pain of any type, you should take a doctor’s advice to identify the cause and treat it accordingly.

Lifestyle changes can prevent angina, and its management will depend on the type of angina, which can be managed with medicines or require procedures such as PCI and CABG. Lifestyle changes are remedies that you can have at home that help in managing angina