Angina Pectoris is a chest pain that occurs when the arteries that supply blood to the heart become narrowed, causing less blood to reach the heart. When the heart is deprived of blood, the heart muscle does not receive enough oxygen. Patients will feel a tightness in the chest, like being squeezed or like a weight is pressing down on the chest. The symptoms may occur during exertion or may occur while resting if the disease is severe.
Sometimes these symptoms may go away on their own, but in some cases, they can be life-threatening. Therefore, you should not ignore them and see a doctor immediately. However, diagnosing this disease can be difficult because it is similar to the causes of other types of chest pain , such as indigestion. Therefore, if you have unexplained chest pain, you should see a doctor for diagnosis and treatment.
Symptoms of Angina Pectoris
Common symptoms include a feeling of tightness or squeezing in the chest, often in the middle of the chest or on the left side of the chest; pain radiating to the neck, jaw, shoulders, or both arms, especially on the left side of the body; shortness of breath, sweating profusely, feeling tired or weak, dizziness, and possibly stomach discomfort, nausea, and vomiting.
Angina Pectoris can be divided into several types, each with different symptoms, including:
- Stable Angina is the most common type. It can occur during physical exertion, such as exercise or climbing stairs. It usually occurs for a short period of time, and symptoms may last for about 5 minutes or less. Symptoms go away with rest or with the use of coronary lozenges.
- Unstable Angina occurs while resting or not doing strenuous activities. It occurs without the patient expecting it or without any prior signs of disease. It can occur frequently. The patient may feel more severe pain and the symptoms can last longer than Stable Angina. The patient may have symptoms for up to 30 minutes or more. The symptoms may not go away even with rest or using lozenges to dilate the coronary arteries. This can be a sign of ischemic heart disease. Therefore, it is considered a serious type and should be treated as soon as possible.
- Microvascular Angina is chest pain caused by abnormalities in the coronary arteries, which prevent the heart from receiving enough blood. Symptoms usually last for more than 10 minutes and are more common in women.
- Prinzmetal’s Angina or Variant Angina is a very rare condition that can occur at night while sleeping or resting, where a coronary artery suddenly narrows. This can be very painful, so you should see a doctor right away for treatment. However, the symptoms usually improve with coronary dilatation medication.
If you find that you have these symptoms, you should see a doctor immediately for a clear diagnosis of what type of Angina Pectoris it is and for appropriate treatment. This is because the symptoms that occur may be similar to other diseases.
Causes of Angina Pectoris
Angina Pectoris is most often caused by coronary artery disease . When fat accumulates as plaque in the arteries, it causes the blood flow to the heart muscle to become blocked and causes the coronary arteries to narrow. The heart must work without oxygen, causing chest pain. In some cases, it may be caused by a blood clot blocking the arteries, leading to ischemic heart disease.
Other causes of Angina Pectoris, however, are less common and include pulmonary embolism, hypertrophic cardiomyopathy, aortic stenosis, pericarditis, or aortic dissection.
Angina Pectoris occurs more easily than normal when the body needs more oxygen, such as when exercising or when using force. However, when at rest, the heart muscle needs less oxygen, so it does not stimulate Angina Pectoris as much.
Other risk factors that may cause Angina Pectoris include:
- Having underlying diseases such as diabetes, obesity , high blood pressure, high levels of triglycerides or bad cholesterol in the blood, which will increase the risk of coronary artery disease or atherosclerosis and may lead to Angina Pectoris and ischemic heart disease.
- If your family has a history of heart disease, such as coronary artery disease or ischemic heart disease, your children are at a higher risk of developing Angina Pectoris.
- Older age, especially men over 45 and women over 55, are at higher risk of developing Angina Pectoris than younger people.
- Poor lifestyle behaviors such as smoking, prolonged exposure to secondhand smoke from close friends, lack of exercise, and accumulated stress, etc.
Diagnosis of Angina Pectoris
The doctor will ask about symptoms, medical history or family members who may have a history of heart disease, which is a risk factor for Angina Pectoris. They will also perform a basic physical examination and may conduct additional tests as follows:
- An electrocardiogram (ECG/EKG) is a test that records the electrical signals from each heartbeat. It is recorded on an electrocardiograph, allowing the doctor to see the pattern of the heart’s activity, which may detect abnormalities in blood flow or heart ischemia.
- Exercise Stress Test – In some cases, Angina Pectoris can be easily detected by exertion. The doctor will have the patient walk on a treadmill or exercise bike, then check their blood pressure and electrocardiogram. If the patient is unable to exercise, the doctor may prescribe medication that stimulates the heart to work as if exercising.
- An echocardiogram is a test that uses sound waves to create an image of the heart. It is used to check for heart abnormalities and to see if any parts of the heart muscle may be damaged by poor pumping. In some cases, your doctor may do an echo during an exercise test to see which areas of the heart are not getting enough blood.
- A chest X-ray is an X-ray of the chest that shows images of the lungs and heart. This can help your doctor check for abnormalities and, in some cases, detect an enlarged heart. Your doctor may also do a computed tomography (CT) scan or magnetic resonance imaging (MRI) to look for abnormalities in your heart or blood vessels.
- Blood test: Because blood test results show abnormal amounts of certain enzymes or proteins in the blood, they help doctors diagnose ischemic heart disease.
- Coronary angiography (CAA) is a procedure that uses X-rays and a dye to examine the internal function of the coronary arteries.
Angina Pectoris Treatment
Treatment can be done in many ways, depending on the type and severity of the disease. The goal of treatment is to reduce the frequency and severity of symptoms, as well as the risk of heart attack and death. Treatment can be divided into several types, including:
Behavior Modification
If the patient’s symptoms are not severe, changing their behavior may help treat the disease. Or if the symptoms are severe, it may help the patient’s symptoms improve. This can be done by:
- Quit smoking or avoid exposure to secondhand smoke from other people.
- Control your weight and exercise as advised by your doctor.
- When doing strenuous activities, do not overdo it. Slow down or take breaks at regular intervals.
- Eat healthy foods such as whole grains, vegetables, fruits, etc.
- Avoid foods high in saturated fat and eating large meals that make you feel too full.
- Take special care of yourself if you have diabetes, high blood pressure or high cholesterol.
- Avoid stress and find ways to relax. If you can’t do this on your own, consult your doctor for advice on how to reduce stress.
- Reduce the amount of alcohol consumed to no more than 2 units per day for men and 1 unit per day for women. The amount consumed per unit may be classified according to the type of drink as follows: beer with 5% alcohol will have one unit approximately 360 milliliters, wine with 12% alcohol will have one unit approximately 150 milliliters, and liquor with 40% alcohol will have one unit approximately 45 milliliters.
Drug treatment
If behavior modification methods are ineffective, medication may be used, including the following:
- Nitrate drugs help dilate blood vessels, allowing blood to flow better to the heart muscle. Popular drugs used to treat Angina Pectoris include nitroglycerin and isosorbide dinitrate.
- Aspirin prevents blood clots from forming and helps blood flow through the coronary arteries. However, it should be taken under the supervision of a doctor.
- Antiplatelet drugs to prevent blood clots are often used when a patient cannot take aspirin, such as Clopidogrel, Prasugrel , or Ticagrelor .
- Beta -blockers slow down the heart rate and help lower high blood pressure. They also help blood vessels function and improve blood flow.
- Statins help lower blood cholesterol levels and prevent blood clots.
Medical treatment
If medication does not improve symptoms, patients may need to undergo surgical treatment for blockage of the arteries, including:
- Balloon angioplasty and stenting to expand blocked arteries, allowing the circulatory system to function better. It is suitable for patients with unstable angina or patients who have not been treated with behavioral modification and medication.
- Heart bypass surgery, in which the doctor uses healthy blood vessels taken from other parts of the body to replace blocked or narrowed blood vessels, helps increase blood flow and relieves Angina Pectoris symptoms. This method is suitable for both Stable Angina and Unstable Angina patients who do not respond to other treatment methods.
Complications of Angina Pectoris
Angina Pectoris is often a symptom of coronary artery disease, causing parts of the heart to not receive enough blood and causing chest pain. It can also make daily activities such as walking inconvenient or may increase the risk of coronary heart disease.
Angina Pectoris Prevention
Angina Pectoris may not be completely preventable, but taking care of your health can help slow down or reduce your risk of developing the disease. Here’s how:
- Eat a healthy diet and avoid foods high in saturated fat.
- Exercise regularly as advised by your doctor.
- Dealing with stress
- Do not smoke or quit if you are a smoker.
- Maintain a normal weight
- Take the medication as prescribed by your doctor.
- Take special care of your health if you have symptoms of diabetes, high blood pressure, high cholesterol, and are overweight.
- Limit alcohol consumption to no more than 2 units per day for men and no more than 1 unit per day for women.
- Get a flu shot every year to help prevent possible complications from the virus that can affect your heart.
