|What Is Angina?
Angina is a strangling pain in the chest which is caused by a poor supply of blood and oxygen to the heart. It is not a disease in itself but rather a symptom of other heart conditions. It is usually a symptom of coronary heart disease (CHD) although it can also be a symptom of coronary microvascular disease (MVD). When pain is triggered it is known as an angina attack. An attack can be triggered by emotional stress, physical activity, exposure to cold temperatures, even eating a heavy meal - whatever activity increases the heart's workload and need for blood and oxygen. As the heart does not receive enough blood (usually due to fatty deposits narrowing the arteries), chest pain occurs. It can feel like a pressure or squeezing in the chest which radiates to the shoulders arm, neck and jaw. Some women report it feels more like a case of bad indigestion. Typically an angina attack lasts a few minutes and is relieved by rest and medications. Women are more likely to experience an episode after stress than men.
An estimated 6.3 million Americans experience angina, and 18 percent of heart attacks are preceded by angina (according to the Framingham Heart Study). The prevalence of angina increases with age in both men and women, but it is more common in men after 45 and women after the age of 55. If you have angina, it is important to treat the underlying cause so that you can stop it from becoming worse and leading to a heart attack.
Are There Different Types of Angina?
Yes, there are 4 different types of angina. Learning which type is present is an important part of the diagnosis process because different types require different treatments.
Stable Angina (Angina Pectoris)
This is the most common form of angina (image). Angina is considered stable if symptoms have remained the same for several months and have a regular pattern ('pattern' refers to the way in which pain occurs - frequency, severity and what triggers it). It is usually triggered by stress or physical activity, cold weather or eating too much. Those with stable angina learn to quickly recognize the symptoms, as well as the activities or triggers likely to cause them. Pain is usually quick to disappear after rest or taking prescribed medication. Stable angina is not a heart attack, but it usually is an indication of CHD and blockage in the arteries. If symptoms last longer than 5 minutes and last after taking angina medication, call 911 or get to an emergency room as soon as possible.
Unstable angina (image) does not follow a pattern which means that angina symptoms are spiraling out of control. It is a warning sign that a heart attack may soon strike. People with a history of stable angina who suddenly discover that symptoms will not go away, even with medication or rest should instantly call 911. Unstable angina occurs when a coronary artery becomes blocked because a blood clot has formed on the plaque in its walls. An 'unstable' attack will feel more severe than usual, it occurs while the person is resting and last at least 20 minutes.
This type of angina, sometimes referred to as Cardiac Syndrome X (image), mostly affects women (nearly 70 percent diagnosed are nearing or past menopause). Although women with microvascular angina may show characteristic abnormalities in an electrocardiogram heart test (see also heart disease testing), very often they turn out to have clear arteries and normal heart function. Some scientists suspect that microvascular angina is a symptom of coronary MVD and may be due to some dysfunction of the tiny arteries near the larger coronary arteries. Pain typically lasts longer than other types of angina, and may also be accompanied by shortness of breath, tiredness and sleep problems.
Variant Angina (Prinzmetal's)
Women under 50 who experience angina usually find it is due to either atherosclerosis (indicating CHD) or spasms of the arteries supplying the heart. A spasm is the sudden but temporary narrowing of the muscle inside the coronary arteries that help to regulate blood flow. This kind of angina, characterized by pain at rest is called variant angina, rest angina or Prinzmetal's angina (image). Variant angina helps to explain why some younger women, whose arteries are free of coronary artery disease, can still get angina. Typically the pain is severe and usually happens between midnight and early morning. Medication can relieve symptoms. Variant angina rarely results in serious complications or death. The causes are unknown but it may be linked to stress or smoking.
What Are The Signs?
General Symptoms of angina include the following:
1. Pain occurs when the heart has to work harder – when exercising for example.
2. Pain does not come as a surprise, the patient can usually predict what events will cause an incident.
3. Pain builds in a crescendo like pattern, building up over a few minutes and then vanishes if the trigger cause is stopped.
4. Pain is described as a tight band like, crushing or suffocating sensation in the chest which can radiate to the neck, throat, jaw, shoulder or arms (image).
5. Pain typically occurs behind or to the left of the sternum.
6. It can radiate to the arm, back and other areas.
7. Pain is relieved by rest or angina medication.
8. If there is no pain, there may be a feeling of indigestion.
9. Shortness of breath, dizziness, weakness (more common in older women with diabetes).
1. Pain occurs at rest or while sleeping at night with little or no physical exertion.
2. Pain comes as a surprise and may be accompanied by nausea, weakness or fainting.
3. Is not usually relieved by medication or rest.
4. It can get continually worse.
5. It may mean a heart attack is on the way.
1. Pain may be more severe or last longer than other types of angina pain. Usually it lasts longer than 10 minutes but can go on for 30 minutes.
2. Shortness of breath, fatigue, sleep problems and lack of energy.
3. Attacks can appear during normal daily routines (such as cleaning, shopping, traveling to work) or at times of stress.
4. Women are less likely to notice symptoms occurring during physical activity such as walking fast or jogging.
5. Medicine may not relieve symptoms.
1. Pain commonly occurs at rest, during the night or early morning hours.
2. It tends to be severe.
3. It is relieved by medication.
Symptoms Which Are NOT Angina
Many people have chest pain that does not come from the heart. According to the American Heart Association, the following pain descriptions are NOT characteristic of angina:
1. Sharp searing knifelike pain bought on by coughing or breathing.
2. Discomfort mainly in the lower or middle abdominal region.
3. Pain that can be pinpointed with the tip of one finger, particularly over the left breast.
4. Constant pain which lasts for hours.
5. Very brief episodes which last a few seconds.
6. Pain that radiates to the lower extremities.
See: Causes of chest pain and chest pain symptoms for more information. Or, if you have questions on other conditions see womens health questions.
What Causes It?
Causes of angina: Stable angina is usually a symptom of CHD. CHD results in reduced blood flow to certain areas of the heart, and this restriction causes angina pain. However there are a number of immediate causes which can trigger pain, and these are:
1. Physical exertion like walking up a hill or stairs.
2. Emotional stress. Read about the dangers of stress.
3. Hot or cold temperatures.
Unstable angina is also linked to CHD but more immediately it is caused by a blood clot formed around plaque in one of the coronary arteries. This causes severe blockages and hence the more severe symptoms. Microvascular angina is more likely to occur in women near or just past menopause which suggests that falling estrogen levels play a role, as well as coronary microvascular disease (MVD).Some women with variant angina also have other conditions such as migraines or Raynaud's phenomenon (where the fingers and toes turn blue or white after exposure to cold or stress). Many are also heavy smokers so it is possible that smoking causes the arteries to go into spasms.
How Is It Diagnosed?
Angina diagnosis: Women with chest pain too often fail to be diagnosed for angina or CHD generally. Although the risks are low in premenopausal women, any chest pain in women should at least be evaluated by a doctor. The first thing a doctor will do is to ask the patient to describe their symptoms. Where possible it is useful to keep a heart diary, noting what events trigger symptoms, how often they occur, what they feel like and how longer they last for. Next an exercise stress test is likely to be ordered as it can show signs of damage or reduced blood flow. A physical examination will also be carried out, including measurement of vital signs, listening to the heart and lungs, and checking for any swelling. The doctor may also draw blood to send to the labs for cholesterol levels, a kidney test and cardiac markers. In older women, any abnormalities highlighted by a stress test should receive further tests such as a nuclear heart scan or heart catheterization.
How Is It Treated?
Angina treatment: Most people with controllable angina benefit from drug therapy. Among the most effective drugs are nitrates, beta blockers and calcium-channel blockers. Just which drug is suitable will vary according to the person's overall health. The medications work in one of two ways: (1) by increasing blood flow through the arteries or (2) by reducing the amount of blood and oxygen needed by the heart.
Also known as nitroglycerin and nitro, nitrate medications are the mainstay treatment of angina. Nitrates dilate (widen) the blood vessels allowing blood to flow more easily past blockages. When symptoms occur the patient pops a pill under the tongue and waits for the pain to pass. Nitrates are also available as sprays, topical ointments and slow-release patches.
Beta blockers are drugs which lower blood pressure and stabilize heartbeat, allowing more time for partially blocked coronary arteries to fill with blood. These medications have proven in countless studies to lower the risk of heart attack in angina patients. Occasionally they cause problems with blood sugar levels in women with type 1 diabetes but this can normally be managed by close monitoring.
These are alternatives for people with classical angina or variant angina. They work by preventing the arteries from going into spasm by reducing the amount of calcium inside the muscle cells of the heart and the arteries. They also help to dilate the arteries making blood flow easier. Women with microvascular angina may need no treatment at all, but if chest pain is troubling, calcium channel blockers are the most likely treatment.
Aspirin has become a mainstay for the prevention of angina caused by CHD. It works by helping to reduce stickiness of platelets in the blood, thereby reducing the occurrences of clots. A low dose of aspirin therapy once a day reduces the risk of a heart attack in people with angina.
If symptoms due to CHD do not respond to medication, surgery may be necessary. Procedures such as heart angioplasty or bypass surgery may be necessary. See also CHD treatment options.
Can Angina Be Prevented?
The long-term treatment and prevention of the condition involve eliminating some of the risk factors for angina. For some women who are overweight, this may mean losing weight. Those who smoke will need to quit. Controlling high cholesterol or high blood pressure should also be a part of the plan. While exercise can cause an angina attack, it can still improve symptoms and the underlying problem of heart disease. Although it makes sense to stop exercise at the first sign of chest pain, there is good reason to develop a moderate exercise program under the supervision of a doctor. Cardiac rehabilitation programs usually offer good advice in this area. Worried about your health? Check out the main causes of death in women.