Angina is a condition in which pain originates from the heart. This is a common condition, particularly in men, typically developing from late middle age onwards.
Angina occurs when part of the heart muscle has too little oxygen to supply its requirements. The reduction in oxygen supply is caused by a reduced blood supply, usually due to narrowing of one or more of the blood vessels that take blood to the heart muscle (coronary arteries). The pain of angina is usually brought on by exertion and relieved by rest. This is because with increased physical activity, the heart muscle is needing to work harder to pump more and more blood around the body to all its organs. In order for the heart muscle to pump harder, it needs more oxygen. When the coronary arteries delivering blood to the heart muscle are narrowed, this extra blood cannot be supplied and the heart muscle produces pain as a consequence.
In medical terminology, if a tissue of the body does has not have enough oxygen it is said to be "ischaemic". Angina is therefore often called Ischaemic Heart Disease. Similarly, as heart ischaemia usually results from narrowing of the coronary arteries, the phrase "coronary artery disease" is also used.
Narrowing of the coronary arteries is usually due to lumps of fatty material or atheroma developing on the inner lining of the blood vessels. These atheromatous "plaques" are formed from cholesterol and tend to become progressively larger and bulge into the lumen of the artery causing narrowing and an impairment to the flow of blood.
Atheroma tends to build up gradually over many years, therefore the first symptom of angina is typically felt on exertion, for the reasons outlined above, as a pain or ache across the chest which may also, or indeed instead, be felt in the jaw, neck and/or the left or both arms. The pain is often described as crushing or heavy and usually settles quickly with rest. As well as physical exertion, mental exertion such as an argument or stressful experience can precipitate an anginal episode. The level of activity that precipitates angina in an individual person can vary greatly, although in general it tends to develop more easily after meals or whilst walking in cold winds.
Many people with angina have the symptoms outlined above. However, some people are less typical and a clear diagnosis of the exact cause of chest pain may require investigation.
Making an accurate diagnosis of chest pain is important as angina is associated with an increased risk of having a heart attack and specific measures need to be taken to minimise this.
It is therefore increasingly common for people, whose doctor feels that they may have angina, to undergo a "treadmill test" which monitors the ECG heart tracing whilst the patient performs an exercise programme on a treadmill. This test will usually be able to say for definite whether or not chest pain is the result of angina, although occasionally additional heart tests are needed.
If you are diagnosed as suffering from angina, your doctor or practice nurse will want to explain this condition to you and advise how both to treat the symptoms and minimise the chance of your suffering a heart attack in the future.
The good news is that several classes of medication are now available which help to lessen the symptoms of angina and allow affected people to lead normal lives. Where angina symptoms cannot be adequately controlled by medication, it may be possible to perform surgery, eg a coronary artery bypass graft procedure, in which the affected narrowed coronary arteries are bypassed (with "grafts" of healthy segments of blood vessel taken from elsewhere in the body) and a normal blood circulation to the heart muscle thus restored. An alternative to bypass grafting is the procedure known as coronary angioplasty in which localised areas of narrowing can be crushed, or removed, thereby dilating up the affected area and allowing normal blood flow once again. This procedure does not involve surgery to the chest, but is usually not suitable when, as is often the case, several areas of narrowing are present.
Whilst medication can help reduce angina symptoms, lifestyle changes are crucial to lessen the chance of further atheroma developing; causing symptoms to worsen and the risk of developing a heart attack increase. It is therefore important to:
Your doctor will discuss all this (and more!) with you as well as regularly monitoring your weight, blood pressure, cholesterol, other blood tests and angina symptoms.
Disclaimer: This page is for informational purposes only and should not be considered as medical advice or substituted for professional advice. Always consult your doctor with your questions and concerns.
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