Angina Symptoms and Treatment

Angina is a pressure-like, squeezing pain or tightness in the chest, usually central, that starts suddenly, often during exercise, and settles with rest. It may extend into the left arm, neck, upper abdomen and back. It is due to a narrowing of one or more of the three small arteries that supply blood to the heart muscle. This narrowing can be due to hardening of the arteries, or a spasm of the artery caused by another disease or stress. If the heart is deprived of blood because of these narrowed arteries, it does not receive sufficient oxygen, it cannot work effectively, and waste products build up in the heart muscle. This inflames the nerves in the muscle to cause the characteristic pain of angina.

Diagnosis may be difficult, as the pain has usually subsided when the patient sees a doctor, and all blood tests and electrocardiographs may be completely normal at this time. Quite often the history from the patient is sufficient to make the diagnosis, but sometimes a stress ECG must be performed (under strict medical supervision) to recreate the pain and observe the abnormal pattern on the cardiograph. Coronary angiography is a special type of X-ray that can detect the narrowed arteries around the heart.

Treatment involves two different approaches - prevention of further attacks, and treatment of any acute attacks that may occur. Prevention is always better than treatment, and tablets (such as beta-blockers) may be taken regularly to keep the arteries as widely dilated as possible. Skin patches or ointments containing similar drugs, which can be absorbed through the skin and into the blood stream, can be used instead of, or as well as, tablets.

Treatment of the acute attack involves immediately resting, and placing a tablet containing nitroglycerine, nifedipine or a similar drug under the tongue, from where it will be rapidly absorbed into the bloodstream and dilate the heart arteries to relieve the attack.

About 5% of all patients with angina will have a heart attack each year, and half of these will die from that heart attack. Heart failure can gradually affect those remaining, reducing their mobility and eventually leading to premature death. High blood pressure, diabetes and an irregular heart beat are unfavorable findings and will also lead to an early death. For this reason, if a narrowed artery can be demonstrated by coronary angiography, it is sensible to have this narrowing bypassed in an operation called a coronary artery bypass graft (CABG). It involves using a small piece of vein from elsewhere in the body to provide a channel around the narrowed section of artery. These are now a routine procedure in many major city hospitals and help to improve the quality and length of life of many angina sufferers.

Another technique involves passing a tiny deflated balloon through the arteries in the leg or arm, into the heart, and then into the small narrowed arteries around the heart. The balloon is then inflated, enlarges the artery, and improves the blood flow. Balloon angiography is not appropriate for all patients but is proving effective in a specially selected category of angina sufferers.

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