Angina pectoris : Symptoms & Prevention

What is angina pectoris ?

Angina pectoris, also known as angina, is a heart disease that causes chest pain. This pain occurs when the heart is poorly oxygenated due to a narrowing of a coronary artery (which carries oxygenated blood to the heart).

The onset of angina pectoris can be related to stress or physical effort. But it can also, more rarely, occur at rest.

The pain caused by angina pectoris is of the type of tightening (sensation that the thorax is taken in a vice, one speaks then about constrictive pains), suffocation or burning. These pains, which may be accompanied by palpitations or difficulty breathing, usually subside within a few minutes when sufferers lie down or rest. Certain medications (nitroxide) can help relieve the pain.

The pain is mostly a warning that the heart is not getting enough oxygen and is in pain. Angina is ultimately a warning sign of a more serious heart problem to come, especially a heart attack (MI).

Angina pectoris can be the first step in the development of coronary heart disease.

It is therefore necessary, as soon as the first symptoms appear, to rest immediately and to quickly consult a general practitioner, then a cardiologist for a complete medical check-up. The latter will confirm the diagnosis of angina through various medical examinations, will find its causes and will propose a treatment if necessary.

Angina pectoris should not be ignored. The onset of pain must be explained and the warning signs known. Managing, monitoring and treating angina pectoris can prevent other more serious heart diseases. Moreover, if the pain lasts or is of significant intensity, it is imperative to contact the SAMU (15 or 112). The person may not be suffering from angina but from a myocardial infarction.

Prevalence


Angina pectoris is a very common disease. It affects more than 10% of people over 65 in France.

Different types of angina pectoris


There are different types of angina pectoris, some presenting a pain that passes quickly, others occurring suddenly, without any link with stress or physical activity. In stable angina, the pain remains the same over time. Their intensity is more or less the same and the triggers are known (climbing stairs for example). This type of angina, which can be triggered by stress or cold temperatures, is usually caused by chronic coronary insufficiency.

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Conversely, in the case of unstable angina, the pain appears suddenly, without any warning sign. The pain that occurs varies in intensity. This type of angina is caused by acute coronary insufficiency and is not relieved by rest or by the usual medication (when treatment has already been started).

In some cases, stable angina may worsen and become unstable. The pain becomes more frequent, stronger and occurs with less physical effort, for example. Or the pain responds less well to medication. People affected by this evolution go from stress angina to resting angina and sometimes to myocardial infarction.

Diagnosis


To confirm angina, the physician, after having listed the risk factors of the person being followed, may prescribe an electrocardiogram and blood tests. He will try to explain the origin of the pain. For this, an echocardiography and an effort test may be necessary, before eventually performing an X-ray of the heart arteries (coronarography).

Complications


The pain caused by angina pectoris may interfere with certain daily activities and require rest. But the most serious complication is of course the heart attack or myocardial infarction, with a risk of sudden death. In this case, the artery of the heart, the coronary artery, is not only narrowed as in angina pectoris, it is completely blocked. And this risk must be taken into account. Hence the need for a medical follow-up as soon as the first pains appear.

Causes


Angina pectoris is caused by poor oxygenation of the heart muscle, which is itself most often due to a narrowing of the blood vessels. This narrowing in the coronary arteries is caused by atherosclerosis. Atherosclerotic plaques (composed mainly of fats) gradually form on the walls of the vessels and gradually prevent the blood from flowing properly.

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Other heart diseases such as heart valve damage or cardiomyopathy can also cause angina.

Prinzmetal angina.

This is a particular type of angina that is very rare. Indeed, the angina attacks occur here outside of an effort. They are not related to an atherosclerotic plaque narrowing the caliber of one of the arteries of the heart, but to a spasm of one of these arteries. This spasm slows down the flow of blood to the heart muscle which, suffering from this lack of oxygen, produces symptoms identical to classic angina (pain of the same type).the pain usually occurs at regular times and recurs in a cyclical manner. Two times are typical: the second part of the night or the period following a meal. The pain can lead to syncope.

These signs usually occur in coronary arteries that also have atheroma. Prinzmetal’s angina must be treated quickly because it exposes to a high risk of infarction.

Symptoms of angina pectoris

Symptoms associated with angina pectoris are:

  • chest pain of the tightening type
  • burning sensation, cramps
  • pain in the arm, neck, jaw, shoulder, back…
  • nausea, vomiting
  • feeling of indigestion
  • fatigue
  • shortness of breath
  • anxiety
  • sweating
  • dizziness
  • If the symptoms progress, it is imperative to consult a doctor quickly.

People at risk and risk factors

There are 5 major risk factors:

  • Smoking,
  • Diabetes,
  • High blood pressure,
  • Dyslipidemia (especially high cholesterol),
  • Coronary heredity: people at risk are men from 55 years old and women from 65 years old,
  • Those who have a family member who has suffered or is suffering from a cardiovascular disease.

Prevention of angina pectoris

The prevention of angina pectoris requires the reduction of the risk factors of this disease. It is therefore recommended not to smoke, to eat a balanced diet, not to be overweight or obese and therefore to lose weight if necessary, to control diabetes as best as possible for those who suffer from it, and to practice regular physical activity.

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Medical treatments for angina pectoris

Treatment of angina pectoris

To alleviate the pain caused by angina pectoris, the doctor may prescribe nitroxide, either as a spray or sublingual (to be melted under the tongue), to be taken at the time the attack occurs. The person suffering from an angina attack must stop all efforts and take the prescribed medication. In general, the effect of nitroxide is very fast. When suffering from angina pectoris, it is necessary to keep this medication on one’s person, in order to use it quickly in case of need.

Basic treatment of angina pectoris


It aims to slow down the worsening of angina by keeping the arteries of the heart (coronary arteries) in the best possible condition.
The treatment starts with the adoption of healthy lifestyle rules that are essential to reduce the risk factors of cardiovascular disease and to stop the progression of atheroma.
Prescribed medications must be taken regularly, such as:

  • blood thinners like aspirin, or anothermolecule,
  • cholesterol medication if necessary.

Interventional treatment aims to dilate the coronary artery at the point where it is narrowed. This treatment can be done in two ways:

  • Placement of a “stent”, a kind of spring that dilates the artery in the area where the atheroma is located.
  • Coronary artery bypass surgery: this is a surgical procedure to insert a piece of artery that bypasses the narrowed area, so that the heart continues to be well irrigated.

The medical follow-up in case of angina must be regular. And if a new symptom appears, it is essential to consult quickly, without waiting for the next scheduled appointment.

Complementary approaches

Fish oils. Thanks to their omega-3 fatty acids, they have widely demonstrated their effectiveness in reducing the risk of heart disease such as myocardial infarction.