Angina (Chest Pain)

Angina is chest pain or discomfort that occurs when an area of your heart muscle doesn't get enough oxygen-rich blood. It's a common symptom of coronary artery disease, which happens when the arteries that supply blood to your heart become narrowed or blocked. Angina is not a disease but a symptom of an underlying heart problem. There are several types, including stable angina (predictable pain triggered by physical exertion or stress), unstable angina (occurs unexpectedly, even at rest, and may signal an impending heart attack), variant angina (caused by coronary artery spasm), and microvascular angina (caused by dysfunction in the small coronary arteries).

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What Causes It?

Coronary artery disease - Narrowing of the arteries that supply blood to your heart due to atherosclerosis (plaque buildup).

Coronary microvascular disease - Damage or dysfunction in the small coronary artery blood vessels.

Coronary artery spasm - Temporary tightening of the muscles in the artery wall that can restrict blood flow.

Severe anemia - Reduced oxygen-carrying capacity of the blood.

Aortic stenosis - Narrowing of the aortic valve, restricting blood flow from the heart.

Hypertrophic cardiomyopathy - Abnormal thickening of the heart muscle.

Tachycardia - Very fast heart rate that increases the heart's demand for oxygen.

Hyperthyroidism - Overactive thyroid gland increasing the body's metabolism and the heart's workload.

Hypertension - High blood pressure increases the heart's workload and oxygen demand.

Shock or low blood pressure - Can reduce blood flow to the heart muscle.

Signs & Symptoms

Chest pain or discomfort - Often described as pressure, squeezing, burning, or fullness in the center of the chest.

Pain or discomfort that radiates - May spread to the shoulders, arms (especially the left arm), neck, jaw, throat, or back.

Shortness of breath - Difficulty breathing, especially during physical activity.

Fatigue - Unusual tiredness, especially with activity.

Nausea - Feeling sick to your stomach.

Sweating - Breaking out in a cold sweat.

Dizziness or lightheadedness - Feeling faint or unsteady.

Indigestion or heartburn-like discomfort - May be mistaken for digestive issues.

Anxiety or feeling of impending doom - Particularly with unstable angina.

Symptom patterns that vary by type - Stable angina lasts 3-5 minutes and is relieved by rest or nitroglycerin; unstable angina is more severe, occurs at rest, and lasts longer.

How We Diagnose

Our specialists use advanced diagnostic methods to accurately identify and assess your condition

Medical History and Physical Examination

Your doctor will ask about your symptoms, risk factors, and family history, and perform a thorough physical exam looking for signs of heart disease or other conditions.

Electrocardiogram (ECG)

Records the electrical activity of your heart to detect abnormalities in heart rhythm or signs of heart damage. May be normal between angina episodes.

Stress Tests

Monitors your heart during physical stress (exercise) or with medication that simulates exercise, to see how your heart responds to increased demand for oxygen.

Echocardiogram

Uses sound waves to create images of your heart, showing its size, structure, and function, and can identify areas of poor blood flow or heart muscle damage.

Nuclear Stress Test

Involves injecting a radioactive substance that shows blood flow to the heart muscle during rest and exercise, identifying areas with reduced blood flow.

Coronary Angiography

An invasive procedure where dye is injected into the coronary arteries and X-rays are taken to visualize blockages or narrowing in the arteries.

CT Coronary Angiography

A non-invasive test using CT scanning and contrast dye to create detailed images of the coronary arteries and identify blockages.

Cardiac MRI

Creates detailed images of your heart structure and function and can identify areas of reduced blood flow.

Blood Tests

May include tests for cardiac enzymes to rule out heart attack, cholesterol levels, and other risk factors for heart disease.

Treatment Options

Personalized treatment plans tailored to your specific needs and condition

1

Lifestyle Changes

Fundamental to managing angina, including quitting smoking, regular physical activity (as advised by your doctor), maintaining a healthy weight, managing stress, and following a heart-healthy diet low in saturated fats, trans fats, and sodium.

2

Nitrates

Medications like nitroglycerin that relax and widen blood vessels, improving blood flow to the heart. Available as fast-acting forms (tablets, spray) for immediate relief during an angina attack, or as long-acting forms to prevent angina.

3

Beta Blockers

Reduce the heart's workload by slowing the heart rate and decreasing blood pressure, which reduces the heart's demand for oxygen and helps prevent angina.

4

Calcium Channel Blockers

Relax and widen blood vessels by preventing calcium from entering the cells of the heart and blood vessel walls, improving blood flow to the heart and reducing its workload.

5

Statins

Lower cholesterol levels to slow or prevent the buildup of plaques in the coronary arteries, addressing a key underlying cause of angina.

6

Antiplatelet Medications

Prevent blood clots from forming in narrowed arteries by reducing the clumping of platelets. Examples include aspirin and clopidogrel.

7

Ranolazine

Improves blood flow to the heart by affecting sodium and calcium movement within heart cells, particularly helpful for people who continue to have angina despite other treatments.

Home Remedies

Recognize and Respond to Angina

Learn to recognize your angina symptoms, stop activity when they occur, and use prescribed nitroglycerin as directed. If symptoms don't resolve with rest and medication within a few minutes, seek emergency medical attention.

Heart-Healthy Diet

Follow a diet rich in fruits, vegetables, whole grains, lean proteins, and low-fat dairy products. Limit saturated and trans fats, cholesterol, added sugars, and sodium. Consider Mediterranean or DASH diet approaches.

Physical Activity Planning

Engage in regular physical activity as recommended by your doctor, but avoid exercising in extreme temperatures, after heavy meals, or when feeling unwell. Warm up before and cool down after exercise.

Stress Management

Practice stress-reduction techniques such as deep breathing, meditation, progressive muscle relaxation, or yoga. Consider counseling or stress management programs if needed.

Medication Adherence

Take all medications exactly as prescribed, even when feeling well. Keep nitroglycerin readily available at all times, and check expiration dates regularly.

Temperature Consideration

Extreme temperatures can trigger angina. In cold weather, cover your mouth and nose with a scarf to warm the air you breathe, and avoid sudden exertion like shoveling snow.

Meal Planning

Eat smaller, more frequent meals instead of large ones, as digesting a large meal requires more blood flow and can temporarily divert blood from the heart.

Prevention Tips

Don't smoke or use tobacco products in any form.

Monitor and control your blood pressure, cholesterol levels, and blood sugar.

Maintain a healthy weight through diet and regular physical activity.

Eat a heart-healthy diet low in saturated fats, trans fats, and sodium.

Exercise regularly, aiming for at least 150 minutes of moderate activity per week.

Manage stress through relaxation techniques and adequate sleep.

Take medications as prescribed for angina and other heart conditions.

Keep all follow-up appointments with your healthcare team.

Know your family history of heart disease and discuss it with your doctor.

Get screened for heart disease risk factors regularly, especially if you have a family history.

Develop an emergency action plan with your doctor for responding to angina symptoms.

Consider cardiac rehabilitation programs to improve your heart health under supervision.

Limit alcohol consumption to moderate levels (one drink daily for women, two for men).

Get vaccinated against influenza and pneumonia to prevent infections that can strain your heart.

Surgical Solutions

Advanced surgical procedures performed by our expert specialists

Percutaneous Coronary Intervention (Angioplasty and Stenting)

A minimally invasive procedure where a catheter with a balloon tip is inserted into the narrowed artery and inflated to widen it. Often, a small mesh tube (stent) is placed to keep the artery open. This restores blood flow to the heart muscle, relieving angina symptoms.

Coronary Artery Bypass Graft (CABG)

An open-heart surgery that creates new pathways (bypasses) around blocked arteries using blood vessels from other parts of your body. This improves blood flow to the heart muscle, reducing angina symptoms, especially for those with multiple or complex blockages.

Transmyocardial Laser Revascularization

A procedure for severe angina that hasn't responded to other treatments. The surgeon uses a laser to create small channels in the heart muscle, which may improve blood flow and reduce angina symptoms through mechanisms that are still being studied.

Enhanced External Counterpulsation (EECP)

A non-surgical outpatient procedure involving inflatable cuffs on the legs that are synchronized with your heartbeat to boost blood flow to the heart. Usually performed in a series of sessions, it may help relieve angina symptoms for people who aren't candidates for invasive procedures.

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