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What is Angina?

Angina pectoris (usually just called "angina") is one of the most common forms of cardiac related chest pain.  This is a sudden,burning,  intense chest pain, often accompanied by feelings of suffocation, caused by momentary lack of adequate blood supply to the heart muscle. Angina may be so sever that it can be confused with a heart attack, although sometimes people confuse it with severe indigestion.  Angina is not a disease itself, but a symptom of a more serious condition, usually coronary artery disease or atherosclerosis. Although angina most commonly affects males who are middle-aged or older, it can occur in both sexes and all age groups.  Unfortunately, women with angina often delay seeking treatment for this condition.

Like a heart attack, angina pain typically centers under the breastbone (sternum), but it also can spread to the throat, arms, jaws, between the shoulder blades or downward to the stomach. Often, angina is accompanied by nausea, dizziness or light-headedness, difficulty breathing or shortness of breath, and sweating.  Angina can be "stable" or "unstable".  In stable angina, the pain is predictable and usually occurs with physical or emotional strain, straining with a bowel movement, eating a large meal, smoking, or cold weather.   In these situations, the pain will usually subside after a short rest period.  In unstable angina, however, the symptoms and their precipitants are unpredictable.   Unstable angina pain may occur at rest or even during sleep.  The pain generally lasts longer, feels more intense, and may not subside on its own.  It is sometimes difficult for a patient with unstable angina to tell if they are having an angina attack or a heart attack (myocardial infarction). 

Patients with angina need a complete history and physical exam, as well as a full cardiac work-up.  This may include blood pressure and cholesterol testing, an electrocardiogram (EKG),  a cardiac stress test (the "treadmill test"), and even a coronary angiogram.

As with most cardiac conditions, the best treatment for angina is prevention.  This involves taking steps to reduce cardiac risk factors:  don't smoke, control blood pressure, control cholesterol, prevent or manage diabetes, exercise daily, maintain a healthy weight, and employ stress management strategies.  Ask your doctor if taking a low-dose aspirin each day should be part of your heart-healthy prevention strategy. 

If angina cannot be prevented, it can usually be treated by first employing the same prevention strategies, including daily aspirin use.  In addition, there are numerous prescription medicines which can be used including vasodilators (e.g. nitroglycerin or other nitrates), beta-blockers (e.g. atenolol or metoprolol), calcium-channel blockers (e.g. nifedipine, verapamil, diltiazem, or amlodipine).

Sometimes drug therapy fails to relieve anginal symptoms.  In these cases, treatments such as balloon angioplasty or coronary artery bypass surgery may be recommended.

Created: 11/18/2003  -  Donnica Moore, M.D.

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