Angina, or angina pectoris, is the medical term used to describe the temporary chest discomfort

that occurs when the heart is not getting enough blood.

• The heart is a muscle (myocardium) and gets its blood supply from the coronary arteries.

• Blood carries the oxygen and nutrients the heart muscle needs to keep pumping.

• When the heart does not get enough blood, it can no longer function at its full capacity.

• When physical exertion, strong emotions, extreme temperatures, or eating increase the
demand on the heart, a person with angina feels temporary pain, pressure, fullness, or
squeezing in the center of the chest or in the neck, shoulder, jaw, upper arm, or upper
back. This is angina, especially if the discomfort is relieved by removing the stressor
and/or taking sublingual (under the tongue) nitroglycerin.

• The discomfort of angina is temporary, meaning a few seconds or minutes, not lasting
hours or all day.

Angina Pectoris Symptoms

Angina itself is a symptom (or set of symptoms), not a disease. Any of the following may signal
angina:

• An uncomfortable pressure, fullness, squeezing, or pain in the center of the chest

• It may also feel like tightness, burning, or a heavy weight.

• The pain may spread to the shoulders, neck, or arms.

• It may be located in the upper abdomen, back, or jaw.

• The pain may be of any intensity from mild to severe.

Other symptoms may occur with an angina attack, as follows:

• Shortness of breath

• Lightheadedness

• Fainting

• Anxiety or nervousness

• Sweating or cold, sweaty skin

• Nausea

• Rapid or irregular heart beat

 • Pallor (pale skin)

• Feeling of impending doom

Angina Pectoris Treatment

The treatment for angina depends on the severity of the symptoms and the results of tests that are
done to find the underlying cause.

Self-Care at Home

Stop doing whatever it is that causes the symptoms and call 911. Immediate help and
intervention is the best chance for survival if someone is having a heart attack or other serious
problem.

• Lie down in a comfortable position with the head up.

• Chew a regular adult aspirin or its equivalent (as long as the patient is not allergic to
aspirin). Chewing more than one will not do any good and may cause unwanted side
effects.

If the patient has had angina before and been evaluated by a healthcare provider, follow his or
her recommendations.

• This may mean rest and the immediate use of sublingual nitroglycerin.

• It may include a visit to the hospital emergency department.

Medications

Nitroglycerin: Nitroglycerin is a sublingual (under the tongue) medication relieves angina

symptoms by expanding blood vessels and decreasing the muscle's need for oxygen. This allows
more blood to flow through the coronary arteries. Nitroglycerin is taken only when the patient
actually has symptoms or expect to have them. Slow - or long-acting nitroglycerin can be used as
a preventative treatment for angina but not until beta blockers are tried first.

Beta blockers: Beta blockers lessen the heart's workload. They slow the heart rate, decrease
blood pressure, and lessen the force of contraction of the heart muscle. This decreases the heart's
need for oxygen and thus decreases angina symptoms. Beta blockers are taken every day,
regardless of whether the patient is having symptoms, because they are proven to prevent heart
attacks and sudden death.

Calcium channel blockers (CCBs): Calcium channel blockers are used primarily when beta
blockers cannot be used and/or the patient is still having angina with beta blockers. Calcium
channel blockers also lower blood pressure and certain ones slow heart rate. Calcium channel
blockers have to be taken every day.
Aspirin: Daily aspirin therapy is mandatory to decrease the possibility of sticky platelets in the
blood starting a blood clot.

Statins: Statins lower cholesterol and have been shown to stabilize the fatty plaque on the inner
lining of the coronary artery, even when the blood cholesterol is normal or minimally increased.
Low density lipoprotein (LDL) or "bad cholesterol" levels should be less than 70 mg/dL for
those at high risk of heart disease. Every person with angina needs to know exactly what his or
her blood lipids/fats are.

Miscellaneous anti-anginal drugs: New drugs are being studied to treat angina. In 2006, the
FDA approved ranolazine (Ranexa). Because of its side effects (potential to cause abnormal
heart rhythm), ranolazine is indicated only after other conventional drug treatments are found to
be ineffective.

Prevention

The best action is to reduce risk factors early in life. The goal is to not have angina, a heart
attack, or sudden death in the first place. Although no one can escape aging, inherited risk, or
gender, certain risk factors are in your control.

• Stop smoking and using nicotine in any form.

• Control high blood pressure.

• Lower blood fats (through diet, exercise, and medications).

• Maintain a healthy weight.

• Control diabetes and blood sugar

• Do not use stimulants such as cocaine or amphetamines.

If a person already has atherosclerosis and angina, they can learn to take precautions to avoid
having symptoms. Avoiding the "triggers" will help keep the person comfortable and free of
symptoms.

• Quit smoking

• Do not use caffeine, cocaine, amphetamines, or other stimulants

• Drink alcohol moderately (no more than 1-2 drinks daily)

• Avoid large and heavy meals that leave you feeling "stuffed"

• Decrease stress

• Establish a regular exercise routine (discuss the plan with your healthcare provider)
The question of exercise for a person with angina is important. Exercise is recommended.

• If the patient has been exercising strenuously, they may need to cut back to avoid
symptoms.

• If the patient has not been exercising, or has been exercising moderately, talk to a
healthcare provider first about physical activity that will be safe and comfortable.
Sometimes a structured cardiac rehabilitation program is a beneficial way to begin an
exercise program.

The healthcare provider may recommend taking an aspirin daily.

• Aspirin has been shown to reduce the risk of a second heart attack in people who have
already had one, and may reduce the risk of a first heart attack.

• Taking aspirin is not without risks, especially in elderly people, people with digestive
diseases or blood clotting disorders, and people who take certain types of medications.

• Allergy to aspirin is not uncommon. Tell your healthcare provider if you are allergic to
aspirin or have a reaction to aspirin.