Angina

Angina is a painful or uncomfortable feeling in the chest, arm, neck or jaw.  It may be triggered by doing something  physically active, eating a heavy meal, or getting emotionally upset. It is an important warning that your heart is not getting enough oxygen-rich blood. Angina is a symptom of heart disease which can lead to a heart attack.

Angina is a symptom of  coronary artery disease. This is a condition which happens when the blood vessels which supply oxygen to the heart are clogged with fatty material called plaque. The heart is a muscle which pumps blood throughout your body. To work properly, the heart needs a steady supply of oxygen. The Coronary arteries are blood vessels which wrap around the heart. The left main coronary divides into the circumflex and the left anterior descending. These branches supply blood to the front, left side and back of the heart. The right coronary supplies blood to the right side and back of the heart. As the plaque builds up, the supply of blood to the heart ,for example during exercise, may not keep up with the oxygen requirements of the muscle and this will be experienced as angina. If the coronary artery is completely blocked by plaque and sometimes a clot, the part of the heart starved of oxygen will stop working. This is a heart attack and will be experienced as crushing chest pain which lasts longer than angina and causes permanent damage to the heart muscle.

To determine the cause of  your chest discomfort, tests such as an ECG, Echocardiogram, Nuclear scan, and Angiogram may need to be done. An ECG can be done at your doctor’s office. This will give information about the heart in its resting  state. An Echocardiogram is an ultrasound of the heart and gives important information about the function of the heart, the size of the heart’s chambers, the competence of the heart valves and any damage to the heart muscle. The ECG and Echocardiogram can be done while the person is exercising to facilitate a stress test. The stress test can tell if the heart is functioning normally on physical exertion. A nuclear scan is performed at a special facility. This test involves the use of a small amount of weakly radioactive material injected into a vein while your are resting or exercising. The material is temporarily absorbed by the heart muscle. A scanning camera can then detect areas of the heart that are not getting enough blood supply. Angiography is performed in a hospital. A small catheter is placed inside an artery in your groin or arm and guided into your heart. X-ray contrast fluid is then injected into the catheter. This allows X-rays to show pictures of the inside of your heart and the coronary arteries.

Treatment of angina is usually with medication. Nitroglycerin or nitrates can be used to relieve or to prevent angina. It is usually taken in the form of a spray inside the cheek or a tablet under the tongue. Beta blockers and calcium channel blockers reduce the heart’s demand for oxygen by slowing the heart rate and reducing the blood pressure. Aspirin reduces the attachment of platelets to plaque on the artery wall therefore reducing clot formation. Surgery is sometimes used if medication is not effective. The options are angioplasty which uses a catheter and a balloon to push the plaque against the wall and open up the artery. Bypass surgery uses an artery from your leg or chest. Which is sewn into your coronary artery below the blockage, creating a new pathway for the blood to get to the heart muscle. Atherectomy removes the plaque from the wall with a special catheter. Stents can be placed inside the artery to keep it open. Laser catheters use high intensity light beams to clear blockages inside the artery walls.

To prevent angina or reduce the chance of angina getting worse it is important to reduce your risk factors. The major risk factors are: Smoking, High Blood Pressure, High Blood Cholesterol, Lack of Exercise, Obesity, High Stress and Diabetes. Reducing these risk factors involves a complete change of lifestyle encompassing 30 minutes of cardiovascular exercise three to four times per week. Cutting down fat and salt and increasing fibre in the diet. Stopping smoking and getting the available support from your doctor to keep off the cigarettes. Managing stress by relaxation, exercise, and support. Finally, with the help of your doctor, managing chronic diseases like diabetes and hypertension.