Overview Of Condition
|Diagnosing Angina In Women
Studies show that women with chest pain often fail to be evaluated properly for angina or coronary heart disease (CHD) in general. This is partly due to the persistent myth that heart disease in women is not as serious as it is for men, and partly because CHD in women can present differently than in men. Women for example are more likely to suffer symptoms of angina after an emotional event (anger, sadness) than men who more are likely to feel symptoms in a classical manner after physical exertion. As a result they may tend to dismiss the pain as stress related rather than anything more serious. Experts now agree that all chest pain in women which persists or is recurrent should be reported to a doctor. This is particularly important for postmenopause women where the risk factors for heart disease increase significantly. Although the risks are lower in premenopausal women, women under the age of 50 with chest pain should still ask their physician for an evaluation.
How Is Angina Diagnosed?
The first step is an evaluation by a doctor. The doctor will take a complete medical and family history to assess your risk factors for angina; he will perform a physical examination and ask about your symptoms. Ideally you will have tracked your symptoms for the previous few weeks to help the doctor with the evaluation process (see angina heart diary below). After the examination the doctor may order some tests to be performed, including an electrocardiogram (ECG, see image) at both rest and during exercise. Usually these tests are all that is required. Occasionally however more complicated heart disease testing will be required and this could include heart catheterization (cath) or pharmacological stress testing (administering drugs to stress the heart so it can be monitored by X-ray, PET or MRI scan).
The physician will ask a lot of different questions to determine the cause of pain. Specifically you will need to describe where the pain occurs, how often it occurs, how it feels and how long it lasts. You may be asked which activities trigger pain and what you do to stop symptoms. You will be asked about any medications you are taking, if you have recently lost blood or have had a chest infection (to rule out other causes).
In many cases the medical history will provide the doctor with much of the information he needs to make a diagnosis. In most people there is very little to find out with a physical examination. However by checking the overall appearance of the patient a doctor will look for any obvious symptoms of CHD (the main cause of angina pain) or associated risk factors. This includes:
Xanthelasma: Yellow deposits of cholesterol which collect under the skin around the eyes (image). This indicates high levels of bad cholesterol in the bloodstream which can lead to buildup and blockages in the arteries, a process called atherosclerosis.
Cyanosis/Raynaud's Phenomenon: Blue or purple appearance of the skin, most noticeable on the lips and fingers (image). It is an indication of circulation issues caused by blockages in the arteries.
The doctor will also:
1. Take your blood pressure and check your pulse rate.
2. Use a stethoscope listen to the carotid arteries in the neck and feel the pulse at your ankles.
3. Ask if you are a smoker.
4. Check your body mass index (BMI) to determine if you are overweight or obese for your height.
At this point, your doctor may:
1. Make a diagnosis of angina and prescribe nitrate medications.
2. Make a diagnosis of angina but order further diagnostic tests to determine the extent of heart disease present.
3. Be unable to make a diagnosis and require further diagnostic testing.
4. Be satisfied that the chest pain is unrelated to heart disease and diagnose or investigate other conditions.
The doctor may order some blood tests as part of the evaluation process. These include:
Fasting Glucose Test
To check blood sugar levels.
Fasting Lipid Panel
To check blood cholesterol and triglyceride levels.
C-Reactive Protein Test
A C-reactive protein test (CRP) checks for a protein in the blood which is present in elevated levels where there is inflammation. Inflammation is the body's response to injury, and high levels can be a risk factor for heart disease.
Hemoglobin is the part of the red blood cells which carry oxygen around the body (see what is blood? for more details). Low levels can worsen angina pain in people with low levels.
Sometimes it is easier to diagnose angina by monitoring the heart at rest and during exercise, and comparing the results. Recording the electrical activity of the heart can show up certain problems such as abnormal heartbeats (heart arrhythmias) or damage to the heart. It can also indicate the likelihood of blockages in the arteries. For a stress test, the patient's heart will be monitored with an electrocardiogram (ECG or EKG) before the stress is applied, during the stress and for a period of time after. Depending on the patient's physical capabilities the stress can be created by asking the patient to exercise on a treadmill (image) (an exercise test) or by injecting a medicine to make their heart work faster (chemical stress test).
If the results of a regular stress test are inconclusive, other tests may be ordered. Chest pain clinics in your locality may be recommended by your doctor to undertake possible procedures, including:
Nuclear Heart Scan: Radioactive material is injected into the bloodstream and is monitored with specialized imaging equipment as it travels towards the heart (image).
Echocardiogram: A non-invasive ultrasound test of the heart.
Shows structures of the beating heart.
Shows accurate pictures of blood flow to the heart.
An invasive test (image) which requires surgery. Surgeons insert a thin tube called a catheter into the arteries and inject a contrast dye. An X-ray machine takes constant pictures (angiograms), tracking the progress of the dye. It should also show the exact location of the blockage and size (how tight the blood vessels look).
Helps to detect blockages in the circulatory system (the body's entire network of blood vessels).
This device (image) is worn for 24-48 hours and may be recommended if the results of an exercise stress test are not conclusive.
Angina Heart Diary
Maintaining a heart diary daily for 2 to 3 weeks to record possible episodes of angina attacks will help your doctor with a diagnosis. In your diary record the following:
1. What triggers symptoms?
Exercise, eating heavy meals, stress or anger?
2. How often do symptoms strike?
Once a week or every day?
3.What do the symptoms feel like?
An uncomfortable dull ache, severe sharp pain, choking pain?
4.Where do you feel pain?
Across the chest, one side of the chest, back or jaw?
5.Do you experience any other symptoms such as nausea or dizziness?
6.How long do symptoms last?
5 or 10 minutes?
7.What relieves the symptoms?
Rest, nitrate medications or both?
Tell Your Doctor If:
1. Symptoms are starting to occur more often than they did in the past.
2. More things seem to trigger an attack than they did in the past, such as climbing a stairs.
3. Symptoms start occurring when you are not exercising, eating heavy meals or feeling stressed.
4. Symptoms feel different than they did in the past. For example pain during an attack used to be quite mild but now gives you a crushing sensation.
5. Location of symptoms have changed. For example if they used to only appear in the chest, but now spread to the arms or back.
6. Symptoms start lasting longer.
7. Symptoms are not improving as quickly as they used to with rest or nitroglycerin tablets.
What If It Is NOT Angina?
Other possible chest pain causes include:
2. GERD: Gastroesophageal reflux disease.
3. Peptic ulcer: an ulcer in the stomach.
4. Cervical disk disease
5. Severe arthritis of the spine or shoulder.
6. Aortic stenosis: a problem with the heart valves.
7. Pericarditis: an inflammation of the tissue that surrounds the heart.
9. Pulmonary embolism: blockage in the artery that supplies blood to the lungs.
10. Stress related to anxiety.
Next: Angina treatment and natural treatment for angina.