Angina

Angina is a condition that affects the heart. It is characterized by chest pain or discomfort that occurs when the heart muscle does not receive enough oxygen-rich blood. This lack of blood flow to the heart is usually caused by narrowed or blocked coronary arteries, which supply blood to the heart. 

If you or someone you know is experiencing symptoms of angina, please consult with a Cardiologist. 

Causes

Understanding the causes of angina is crucial in managing and preventing this condition. Angina, a common symptom of coronary artery disease, occurs when there is an inadequate supply of oxygen-rich blood to the heart muscle. This insufficient blood flow is often caused by narrowed or blocked arteries. The primary cause of angina is atherosclerosis, a condition characterized by the buildup of plaque on the inner walls of the arteries. Plaque consists of cholesterol, fat, calcium, and other substances that accumulate over time. As plaque builds up, it narrows the arteries and restricts blood flow to the heart. 

Other factors that can contribute to angina include: 

1. Physical exertion: Engaging in activities that require increased oxygen demand can trigger angina symptoms. The heart muscle requires more blood flow during exercise or strenuous physical activity. 

2. Emotional stress: Strong emotions such as anger, anxiety, or excitement can lead to an increase in heart rate and blood pressure, potentially triggering angina symptoms. 

3. Smoking: Smoking damages blood vessels and accelerates the development of atherosclerosis. It also reduces oxygen levels in the blood and increases the risk of developing angina. 

4. High cholesterol levels: Elevated levels of LDL (bad) cholesterol increase the risk of plaque formation and subsequent narrowing of coronary arteries. 

5. High blood pressure: Uncontrolled hypertension puts strain on arterial walls and contributes to their narrowing over time. 

6. Diabetes: Individuals with diabetes are at higher risk for developing atherosclerosis due to elevated blood sugar levels causing damage to blood vessels. 

Risk Factors

Several risk factors increase the likelihood of developing angina:

Coronary Artery Disease (CAD): The primary cause of angina, CAD occurs when plaque builds up in the coronary arteries, reducing blood flow to the heart.

Age: Risk of angina increases with age, especially in men over 45 and women over 55.

Smoking: Smoking damages blood vessels, increases blood pressure, and lowers HDL (good) cholesterol, all of which contribute to angina.

High Blood Pressure (Hypertension): Elevated blood pressure strains the heart, increasing the risk of angina and other heart-related conditions.

High Cholesterol Levels: High levels of LDL (bad) cholesterol can lead to plaque buildup in the arteries, restricting blood flow to the heart.

Diabetes: Diabetes increases the risk of angina by damaging blood vessels and nerves, affecting blood flow and heart function.

Obesity: Excess weight puts strain on the heart and increases the likelihood of developing other risk factors such as high blood pressure and diabetes.

Sedentary Lifestyle: Lack of physical activity contributes to obesity, high blood pressure, high cholesterol, and diabetes, all of which are risk factors for angina.

Family History: A family history of heart disease or angina increases an individual's risk due to shared genetic and environmental factors.

Stress: Chronic stress can lead to unhealthy coping mechanisms such as overeating, smoking, or lack of exercise, all of which contribute to angina risk.

Unhealthy Diet: Diets high in saturated fats, trans fats, cholesterol, and sodium contribute to high blood pressure, high cholesterol, and obesity, increasing the risk of angina.

Alcohol Consumption: Excessive alcohol consumption can raise blood pressure, contribute to obesity, and increase triglyceride levels, all of which are risk factors for angina.

Sleep Apnea: Sleep apnea is associated with hypertension and other heart-related conditions, increasing the risk of angina.

Chronic Kidney Disease: Kidney disease is associated with an increased risk of cardiovascular disease, including angina.

Peripheral Artery Disease (PAD): PAD is a condition where narrowed arteries reduce blood flow to the limbs, often indicating similar issues in the coronary arteries, increasing the risk of angina.

Symptoms

Chest Discomfort: The most common symptom of angina is a feeling of pressure, squeezing, fullness, or pain in the center of the chest. This discomfort may also be described as tightness or heaviness.

Pain Radiation: The chest pain or discomfort may spread to the neck, shoulders, arms (especially the left arm), back, or jaw. This radiation of pain is a characteristic feature of angina.

Shortness of Breath: Some people with angina experience difficulty breathing or a feeling of breathlessness, especially during physical exertion or stress.

Fatigue: Unexplained fatigue or weakness may occur with angina, particularly if it is recurrent or severe.

Nausea: Angina can sometimes cause feelings of nausea or abdominal discomfort, often mistaken for indigestion.

Dizziness or Lightheadedness: Some individuals may feel dizzy or lightheaded during an angina episode, particularly if blood flow to the brain is compromised.

Sweating: Profuse sweating, often described as cold or clammy skin, can occur with angina, especially during episodes of severe chest pain.

Anxiety: Angina attacks can cause feelings of anxiety or fear, particularly due to the chest discomfort and associated symptoms.

Diagnosis

Here are the key steps and diagnostic tests commonly used:

Medical History and Physical Examination: The healthcare provider will inquire about symptoms, risk factors, family history of heart disease, and lifestyle habits. A thorough physical examination, including measuring blood pressure, listening to the heart and lungs, and checking for signs of heart disease, will be conducted.

Electrocardiogram (ECG or EKG): This test records the electrical activity of the heart and can help identify abnormal heart rhythms, evidence of a previous heart attack, or signs of inadequate blood flow to the heart muscle.

Stress Test: A stress test, also known as an exercise stress test or treadmill test, evaluates how the heart performs during physical activity. It involves walking on a treadmill or using a stationary bike while the heart rate, blood pressure, and ECG are monitored. Stress tests can help diagnose angina by revealing abnormalities in heart function during exertion.

Echocardiogram: This imaging test uses sound waves to create detailed images of the heart's structure and function. It can detect abnormalities such as reduced blood flow to the heart muscle or structural heart defects that may contribute to angina.

Coronary Angiography: This invasive procedure involves injecting a contrast dye into the coronary arteries and taking X-ray images (angiograms) to visualize any blockages or narrowing in the arteries. Coronary angiography is considered the gold standard for diagnosing coronary artery disease, the primary cause of angina.

Cardiac CT or MRI: These imaging tests provide detailed images of the heart and blood vessels and can help detect blockages, evaluate heart function, and assess the extent of coronary artery disease.

Blood Tests: Blood tests may be done to assess cholesterol levels, blood sugar levels, and markers of heart muscle damage (such as troponin) to help evaluate the risk of heart disease and determine the underlying cause of symptoms.

Treatments

Here are the common treatments for angina:

Lifestyle Modifications:

Healthy Diet: Adopting a heart-healthy diet low in saturated fat, cholesterol, and sodium while emphasizing fruits, vegetables, whole grains, and lean proteins.

Regular Exercise: Engaging in regular physical activity, such as brisk walking, swimming, or cycling, to improve cardiovascular health and reduce angina symptoms.

Smoking Cessation: Quitting smoking and avoiding exposure to secondhand smoke to reduce the risk of further damage to the heart and blood vessels.

Weight Management: Achieving and maintaining a healthy weight through diet and exercise to reduce strain on the heart and improve overall health.

Medications:

Nitroglycerin: Nitroglycerin tablets, sprays, or patches can help relieve angina symptoms by dilating blood vessels and increasing blood flow to the heart.

Beta-Blockers: These medications reduce heart rate and blood pressure, thereby decreasing the workload on the heart and relieving angina symptoms.

Calcium Channel Blockers: These medications relax and widen blood vessels, improving blood flow to the heart and reducing angina symptoms.

ACE Inhibitors or ARBs: These medications help lower blood pressure and reduce strain on the heart, particularly in individuals with underlying conditions such as high blood pressure or heart failure.

Aspirin: Aspirin therapy may be recommended to reduce the risk of blood clots and heart attack in individuals with angina or coronary artery disease.

Statins: Statin medications lower cholesterol levels and reduce the risk of plaque buildup in the arteries, thereby lowering the risk of heart attack and stroke.

Medical Procedures:

Angioplasty and Stenting: During angioplasty, a catheter with a balloon at its tip is inserted into the blocked artery and inflated to widen the narrowed area. A stent may be placed to help keep the artery open.

Coronary Artery Bypass Surgery (CABG): In severe cases of coronary artery disease, bypass surgery may be performed to reroute blood flow around blocked or narrowed arteries, improving blood supply to the heart muscle.

Enhanced External Counterpulsation (EECP): This non-invasive procedure involves using inflatable cuffs around the legs to increase blood flow to the heart and relieve angina symptoms in some patients.

Cardiac Rehabilitation: Participation in a structured cardiac rehabilitation program can help individuals with angina improve cardiovascular fitness, learn heart-healthy habits, and reduce the risk of future heart problems.

Preventive Measures

Preventive measures for angina primarily focus on reducing the risk factors associated with coronary artery disease (CAD), which is the underlying cause of angina. Here are some key preventive measures:

Healthy Diet: Adopting a heart-healthy diet can help prevent or manage angina by reducing cholesterol levels, controlling blood pressure, and maintaining a healthy weight. Emphasize fruits, vegetables, whole grains, lean proteins, and foods low in saturated fat, cholesterol, and sodium.

Regular Exercise: Engaging in regular physical activity is essential for cardiovascular health. Aim for at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity aerobic exercise each week, along with muscle-strengthening activities on two or more days per week.

Smoking Cessation: Quitting smoking and avoiding exposure to secondhand smoke are crucial for preventing and managing angina. Smoking damages blood vessels, increases the risk of blood clots, and accelerates the progression of coronary artery disease.

Maintaining a Healthy Weight: Maintaining a healthy weight through diet and exercise can help reduce the risk of developing angina and other heart-related conditions. Obesity increases the risk of high blood pressure, high cholesterol, diabetes, and coronary artery disease.

Managing Stress: Chronic stress can contribute to angina by increasing blood pressure, heart rate, and the risk of unhealthy coping behaviors such as overeating or smoking. Practice stress-reduction techniques such as deep breathing, meditation, yoga, or spending time in nature.

Regular Medical Check-ups: Regular medical check-ups are essential for monitoring blood pressure, cholesterol levels, blood sugar levels, and other risk factors for heart disease. Early detection and management of these risk factors can help prevent the development or progression of angina.

Medications: In some cases, medications may be prescribed to manage underlying conditions such as high blood pressure, high cholesterol, or diabetes. Adhering to medication regimens as prescribed by a healthcare provider can help reduce the risk of angina and other cardiovascular complications.

Limiting Alcohol Consumption: Excessive alcohol consumption can raise blood pressure, contribute to obesity, and increase triglyceride levels, all of which are risk factors for angina. Limit alcohol intake to moderate levels or avoid alcohol altogether.

Sleep Quality: Getting an adequate amount of quality sleep is important for heart health. Poor sleep quality or untreated sleep disorders such as sleep apnea can increase the risk of cardiovascular disease, including angina.

Following Medical Advice: Individuals with angina or other heart-related conditions should follow their healthcare provider's recommendations regarding medications, lifestyle changes, and treatment plans. Regular follow-up appointments are important for monitoring progress and making adjustments as needed.

Do's & Don’t's

When it comes to managing angina, there are certain do's and don'ts that can make a significant difference in your overall well-being. By following these guidelines, you can effectively manage your symptoms and reduce the risk of complications. 

If you or someone you know is experiencing symptoms of angina, please consult with a Cardiologist.