What is angina?
Angina is pain, discomfort, or pressure in your chest that happens when your heart isn't getting enough oxygen. The lack of oxygen is caused by a narrow or blocked artery to your heart (coronary artery disease). Angina is often a warning sign of a heart attack.
Go to the hospital right away if you have pain, pressure, or burning in your chest, back, shoulders, jaw, or arms
Angina happens when you're exerting yourself and gets better quickly when you rest
Doctors usually do an ECG/EKG (electrocardiography) and a stress test or cardiac catheterization
Treatment is with medicines or sometimes a procedure such as angioplasty or bypass surgery
Supplying the Heart With Blood
Like any other tissue in the body, the muscle of the heart must receive oxygen-rich blood and have waste products removed by the blood. The right coronary artery and the left coronary artery, which branch off the aorta just after it leaves the heart, deliver oxygen-rich blood to the heart muscle. The right coronary artery branches into the marginal artery and the posterior interventricular artery, located on the back surface of the heart. The left coronary artery (typically called the left main coronary artery) branches into the circumflex and the left anterior descending artery. The cardiac veins collect blood containing waste products from the heart muscle and empty it into a large vein on the back surface of the heart called the coronary sinus, which returns the blood to the right atrium. |
What causes angina?
The most common cause of angina is narrowing of the arteries that carry blood to your heart (coronary arteries). That narrowing is most often caused by atherosclerosis, commonly known as hardening of the arteries. A fatty deposit builds up and can slowly block your arteries and slow down or stop the flow of blood. When your heart muscle doesn't get enough blood, it hurts.
Severe anemia (low blood count) increases your risk of having angina. With anemia, you have fewer red blood cells to carry oxygen.
In people with atherosclerosis, patchy deposits of fatty material (atheromas or atherosclerotic plaques) develop in the walls of medium-sized and large arteries, leading to reduced or blocked blood flow.
This photo shows an atherosclerotic plaque (atheroma; see arrow) visible in an artery.
BSIP VEM/SCIENCE PHOTO LIBRARY
In people with atherosclerosis, patchy deposits of fatty material (atheromas or atherosclerotic plaques) develop in the walls of medium-sized and large arteries, leading to reduced or blocked blood flow.
This photo shows an atherosclerotic plaque (atheroma; see arrow) visible in an artery.
BSIP VEM/SCIENCE PHOTO LIBRARY
What are the symptoms of angina?
You may feel:
Discomfort, pressure, or aching in the middle of your chest
The discomfort may travel to your shoulder, down your arm, or to your throat, jaw, or teeth
Angina usually comes when you exert yourself, for example, by climbing stairs or walking up a hill. It goes away in a few minutes when you rest. You usually get angina each time you do the same amount of exertion. For example, you may get angina every time you walk up a certain hill. As your coronary arteries get narrower, you get angina with less and less exertion. For example, if you first got angina climbing 2 fights of stairs, later you might get it with only 1 flight of stairs.
Angina that comes without any exertion or that gets worse very quickly is:
Unstable angina is a warning you might be about to have a heart attack.
How can doctors tell if I have angina?
If you have symptoms that suggest angina, doctors will do tests such as:
Stress test—a test to see whether your heart is getting enough blood when it works hard (is under stress), such as when you exercise
ECG/EKG—a test that measures your heart’s electrical activity, which can be abnormal in coronary artery disease
CT (computed tomography) scan—an imaging test to look for hardening of the coronary arteries
If your angina is severe or getting worse, doctors may do:
Cardiac catheterization—an invasive test that allows doctors to see if and where your coronary arteries are blocked
In cardiac catheterization, doctors put a long, thin catheter (small flexible tube) into an artery in your arm or leg, up to your heart, and into each of your coronary arteries and then inject contrast material that is seen on x-ray.
How do doctors treat angina?
Doctors will give you treatments for:
When you get angina
Preventing angina
The problem that's causing your angina
When you get angina, doctors will have you take:
Nitroglycerin should work in a few minutes.
To prevent angina, doctors may give you:
Medicines to keep your heart from working too hard
To treat the problem that's causing your angina, doctors usually give you:
Medicines to lower your cholesterol
Medicines to treat high blood pressure
Sometimes a procedure to open a blocked artery
They will also have you change any behaviors that are hurting your heart, such as smoking, not exercising, and eating a poor diet.
Depending on how much your coronary arteries are blocked, doctors may do a procedure to clear your artery. They may do angioplasty or bypass surgery (also called coronary artery bypass grafting or coronary artery bypass surgery).
During angioplasty:
The doctor puts a small, flexible tube (catheter) into an artery in your upper leg (groin) or in your wrist
The catheter is pushed up the artery to your heart and then into one of your coronary arteries
A small balloon on the tip of the catheter is inflated
The balloon pushes the blockage open
Then the doctor slips a wire mesh tube (stent) off the end of the catheter into the blocked area
The wire mesh tube helps hold the blocked area open
During bypass surgery:
Doctors take a piece of healthy artery or vein from another part of your body
They sew one end of that piece of artery or vein to your aorta (the major artery that takes blood from your heart to the rest of your body)
They sew the other end to your blocked artery past the point of the blockage
Your blood then flows through this new route, bypassing the blockage
In coronary artery bypass grafting (CABG), doctors take an artery or vein from another part of the body to connect the aorta (the major artery that takes blood from the heart to the rest of the body) to a coronary artery past the point of its blockage. Blood flow is thus rerouted, skipping over (bypassing) the narrowed or blocked area.
In coronary artery bypass grafting (CABG), doctors take an artery or vein from another part of the body to connect the aorta (the major artery that takes blood from the heart to the rest of the body) to a coronary artery past the point of its blockage. Blood flow is thus rerouted, skipping over (bypassing) the narrowed or blocked area.
