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Understanding Angina
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Expert advice on a confusing condition
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By Christina Frank
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MediZine's Healthy Living Spring 2009
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Nearly 7 million Americans have angina. William E. Boden, M.D., clinical chief of cardiovascular medicine at the University of Buffalo schools of medicine and public health, explains.
Angina is not a disease but a symptom that occurs in those with narrowed coronary arteries (atherosclerosis). A person with arteries that are at least 70 percent blocked is likely to experience angina when the heart works harder than usual, such as during physical exertion, stress or sexual activity. The heart can’t meet the extra demand from heightened activity because an increase in blood flow is restricted by blocked arteries.
Angina typically presents with tightness and pressure—an oppressive sensation. Patients sometimes describe feeling as if an elephant were sitting on their chest. I always ask patients to distinguish between pain and pressure. Less typical symptoms are shortness of breath, nausea, vomiting and sweating.
Atypical symptoms tend to be more prevalent in women, which explains why women are diagnosed less frequently.
A heart attack is a more catastrophic complication of atherosclerosis, associated with a complete blockage in a coronary artery, which acutely obstructs blood flow. Symptoms are more severe and prolonged (usually 20 minutes or longer) and can come on suddenly. Angina typically lasts 5 to 10 minutes and subsides when the activity that triggered it is curtailed or stopped.
The four main risk factors are diabetes, high blood pressure, smoking and abnormal cholesterol levels. Other risk factors include family history, obesity and sedentary behavior.
Standard treatments include drugs such as beta blockers, calcium channel blockers, statins and nitrates. Sometimes angioplasty or bypass surgery is indicated.
Usually, people who have had angina can predict what will set off an attack. If the usual pattern changes, especially if symptoms persist after 15 to 20 minutes of rest or occur abruptly at rest or in the middle of the night, the best advice is to call 911 and get to the ER.
Microvascular angina, according to Dr. Boden, is a type of angina that
has been identified in the past 5 to 10 years and is much more common
in women than men. “People with microvascular angina can have normal
major coronary arteries (where blockages cause heart attacks) but
narrowings in the very small arteries supplying blood flow to the heart
muscle, which can cause chest discomfort,” he explains. Those with
microvascular angina rarely have heart attacks. |
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