Angina

GENERAL INFORMATION:

What is angina?

• Your heart is always working to pump blood to your entire body. Blood carries oxygen and other things that your body needs in order to do its work. Your heart needs a constant supply of oxygen-rich blood for itself as well. The blood vessels that supply blood to your heart muscle are called coronary (KOHR-oh-nar-ee) arteries. Sometimes one or more of the coronary arteries become narrowed or blocked. This may cause you to feel pain or discomfort in your chest at certain times. This chest pain that comes and goes is called angina (AN-ji-nah).
  
  
• Angina starts when your heart muscle does not get enough oxygen to do its work. If the heart goes too long without enough oxygen, part of the heart muscle may start to die. This is called a myocardial (meye-oh-KAR-dee-al) infarction (in-FARK-shun), which is also called an "MI" or a "heart attack". Angina can be a warning sign that you may be at risk for a heart attack.

• Blockage: The most common cause of angina is fatty deposits (plaque) inside one or more of the coronary arteries. The disease that causes fatty deposits to narrow arteries throughout the body is called atherosclerosis (ath-er-oh-skle-ROH-sis). The fatty deposits alone can cause angina. Also, a blood clot can form on the rough fatty deposits and block the arteries even more. Atherosclerosis is also called "hardening of the arteries".
  
  
• Spasm: Sometimes a coronary artery can spasm (suddenly tighten) and cause angina. Most people with coronary artery spasms have fatty deposits as well. Sometimes people have spasms even when they do not have fatty deposits. It is not known what causes coronary artery spasms.
  
  
• Other causes: Other medical problems can cause angina or make it worse. For example, heart valve disease, an enlarged heart, or very high blood pressure may cause angina symptoms. Inflammation (swelling), infection, anemia (iron-poor blood) and blood clots can also cause angina. Talk to your caregiver if you have questions about what is causing your angina.

• A family history of heart problems.
  
  
• Atherosclerosis (hardening of the arteries) in other areas of the body. For example, you may have poor circulation (blood flow) in your legs, or carotid (neck) artery disease. You may have had a stroke in the past.
  
  
• Being overweight.
  
  
• Being a female who smokes and takes birth control pills.
  
  
• Being a female who has gone through the "change of life" (menopause).
  
  
• Cocaine use.
  
  
• Diabetes.
  
  
• High blood pressure.
  
  
• High cholesterol (koh-LES-ter-ol).
  
  
• Lack of exercise.
  
  
• Being male.
  
  
• Older age (over 55).
  
  
• Smoking now or in the past, or being exposed to cigarette smoke on a regular basis.

• Stable angina: A person with stable angina usually knows what activities will trigger their chest pain. The pain often starts slowly and may last a few seconds to 30 minutes. Stable angina is often triggered by exercise or physical work. It may be triggered by extreme temperatures, heavy meals, or getting upset. Ten minutes of rest, or medicine (such as nitroglycerin, or "nitro") usually makes stable angina go away.
  
  
• Unstable angina: Unstable angina is chest discomfort that is not expected and may occur at rest. Unstable angina may be more painful, and last longer than the pain of stable angina. Some people get unstable angina without ever having stable angina. Stable angina that changes to unstable angina may mean that your heart is getting worse. Unstable angina is serious. If you have an angina attack that is worse or different than usual, you need to be seen in an emergency department right away.
  
  
• Prinzmental's or variant angina: This type of angina is caused by a spasm of a coronary artery.
  
  
• Microvascular angina: This is angina that occurs without narrowing, blockage, or spasms of the coronary arteries. A problem with tiny blood vessels that supply the heart is thought to cause this kind of angina.
  
  
• Atypical angina: Women and people who have diabetes may not have typical chest pain when they have a heart problem. The discomfort may be in an unusual place, or there may not be pain at all. With atypical angina, a person may have symptoms like shortness of breath or nausea as their only sign of a problem.

• Sometimes it is hard to tell the difference between angina and a heart attack. Your caregiver will review your medical history and the symptoms you are having. A test called an EKG may be done to look for problems or damage in different areas of the heart. You may need an exercise or chemical (drug) stress test to see how your heart handles work. Your caregiver may do tests on your blood and urine to get important information about your health. You may need a chest x-ray to check your heart and your lungs. You may also need an ultrasound of your heart called an echocardiogram (ek-oh-KAHR-dee-oh-gram).
  
  
• You may need a more detailed test called a cardiac catheterization (kath-e-ter-i-ZAY-shun), or "heart cath". This procedure uses dye and a special x-ray to check the blood flow in your coronary arteries. A heart cath can help your caregiver decide how your angina should be treated. Sometimes blockages can be treated during a heart cath.

• Control of risk factors: High blood pressure, high cholesterol, diabetes, and being overweight increases your risk of heart problems. If you have any of these medical conditions, ask caregivers for help to control them. Smoking can further damage your heart, as well as your blood and lungs. With time, this can cause a stroke or a heart attack. It is very important to stop smoking.
  
  
• Medicines: You may be treated with medicine that helps blood flow better through your heart. You may also need medicine that can help make sure your heart does not work too hard. Some medicines may keep you from having spasms in your coronary arteries. Heart medicine may decrease how often you have angina, how long it lasts, and the amount of pain you have. Your caregiver may have you take aspirin or other medicines to prevent blood clots in your coronary arteries. You may need a medicine called nitroglycerin, or "nitro", to help during an angina attack.
  
  
• Angioplasty and stenting: For this procedure, your caregiver makes a small puncture into an artery (usually in the groin area). A small wire with a balloon on the end is sent up into a blocked artery in your heart. The caregiver inflates the balloon to push the fatty deposits against the artery wall. This makes more room for blood to flow. This process is called angioplasty (AN-jee-oh-plas-tee). Sometimes a stent is placed during an angioplasty procedure. A stent is a metal mesh tube that is placed in the artery to keep it open after an angioplasty.
  
  
• Heart bypass surgery: You may need surgery to help your chest pain or to keep you from having a heart attack. A coronary artery bypass graft (CABG) can improve blood flow to the heart by sending blood around a blocked artery. This surgery is also known as "open-heart surgery" or a "cabbage".

• If you do not get treatment your angina may get worse. You may have a heart attack or even die. Following your caregiver's advice decreases these risks. With treatment, you may decrease your pain and have a more normal lifestyle. Call your caregiver if you are worried or have questions about your medicine or care.
  
  
• If you are taking nitroglycerin medicine, you should not take drugs like Viagra® (sildenafil citrate). Some drugs used to treat certain sexual or impotence problems may interact with your nitroglycerin. For example, taking Viagra® within 24 hours of taking a nitrate-type of medicine can kill you. Ask your caregiver if any of your medicines contain nitroglycerin.

• Angina is a life-changing disease for you and your family. Accepting that you have a heart problem is hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. Let them help you. Encourage those close to you to talk to your caregiver about how things are at home. Your caregiver can help your family better understand how to support a person with angina.
  
  
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  You may want to join a support group. This is a group of people who also have heart problems. Ask your caregiver for the names and numbers of support groups in your town. You and your family may also want to learn CPR. A CPR class teaches how to help a person who is not breathing or has no heartbeat. You can contact one of the following national organizations for more information.
  • American Heart Association National Center
    7272 Greenville Avenue
    Dallas, TX 75231-4596
    Phone: 1-800-242-8721
    Web Address: http://www.americanheart.org
    
  • American Red Cross National Headquarters
    2025 E Street NW
    Washington, DC 20006
    Phone: 1-202-303-4498
    Web Address: http://www.redcross.org
    
  • National Heart, Lung and Blood Institute
    Health Information Center
    P.O. Box 30105
    Bethesda, MD 20824-0105
    Phone: 1-301-592-8573
    Web Address: http://www.nhlbi.nih.gov/health/infoctr/index.htm