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What is angina?

Angina (also called angina pectoris) is chest pain caused when not enough oxygen is reaching the heart muscle.

Angina can occur in men and women of any age but it is more common among the middle-aged and elderly.

How does it occur?

Angina can occur from conditions that affect the way your blood flows, such as:

• Coronary artery disease: The walls of the arteries that carry blood to the heart become lined with fatty deposits. This restricts the flow of blood, and less oxygen reaches the heart muscle. This is by far the most common cause of angina.
• Coronary artery spasm: A narrowing of the coronary artery causes blood to stop flowing through the artery briefly. When the spasm stops, the artery and blood flow return to normal.
• Abnormal heart valves.
• Abnormal heart rhythms.
• Anemia: The levels of red blood cells or hemoglobin (the oxygen-carrying chemical in the blood) are too low.
• Polycythemia: An excess of red blood cells causes the blood to thicken.
• Some thyroid conditions.

Angina is more likely to occur when increased demands are placed on the heart, as with exercise, emotional upset, exposure to cold air, and digestion of a big meal. However, angina may also occur at rest or even during sleep.

What are the symptoms?

The symptoms of angina may include:

• chest pain that feels like a strangling or heavy pressure on the chest
• pain that starts in the chest and spreads to the throat, arms (usually the left arm), and jaws, and between the shoulder blades; the pain can also spread to the stomach and feel like an ulcer or indigestion
• a feeling of tightness or heaviness
• nausea
• sweating
• light-headedness
• difficulty breathing.

How is it diagnosed?

Angina may be diagnosed in various ways depending on how severe your symptoms are.

If you are having occasional chest pain and make an appointment to see your health care provider, he or she will carefully study your medical history. You will be examined, with special attention to your pulse (including ankle pulse), blood pressure, neck, heart, lungs, and abdomen. Your health care provider may order an electrocardiogram (ECG) to record your heart rhythms. A treadmill or exercise stress test may be done within a few days. Your provider will tell you what to do if you have chest pain before all test results are in.

If you are having chest pain and go to the emergency room, you will be examined and asked about your symptoms and medical history. An ECG and blood tests may be done to look for possible damage to the heart muscle from a heart attack. You may be placed on a monitor (a continuous ECG) and watched for several hours to a couple of days for signs of a heart attack.

Special exercise stress tests may be done to see how well your heart muscle is working.

If tests show that you may have a serious blood vessel blockage, you may need to have a heart catheterization. This is a special procedure used to locate and measure blockages. Some blockages are emergencies and must be treated right away.

How is it treated?

Lifestyle:
When angina is caused by coronary artery disease, treatment involves following a healthy lifestyle. This includes:

• not smoking
• weighing what you should
• getting regular exercise, as prescribed by your health care provider
• lowering your blood pressure (if high)
• lowering your blood cholesterol (if high)
• lowering your blood sugar (if high).

Medication:
Often the symptoms of angina can be controlled by medication. Several types of medication are available, including beta blockers, nitrates, and calcium channel blockers. Your health care provider will determine which type is right for you based on your test results and any other medical problems you may have.

Surgery:
Angina caused by blocked arteries can be treated with two types of surgery: balloon angioplasty and coronary bypass graft surgery.

Balloon angioplasty is a simpler procedure than coronary bypass surgery. A tube with a balloon tip is placed in your artery. The balloon is inflated where the artery is blocked. This expands the artery enough to let blood flow normally. If you have this surgery, you may need only a brief hospital stay of a day or two. With this surgery the blockage recurs in about 30% of patients, usually within 6 months.

In coronary bypass graft surgery, the blocked areas of coronary artery are bypassed with grafts of arteries taken from the chest, abdomen, or arm or veins from the leg. This procedure usually requires a stay in the hospital of at least 1 week and several weeks for recovery.

How can I take care of myself and prevent angina?

Follow the treatment prescribed by your health care provider. In addition, follow these guidelines:

• Begin a regular exercise program under your health care provider's supervision.
• If you are overweight, begin a weight-loss program under the supervision of your health care provider or a dietician.
• Eat a healthy, well-balanced diet and avoid foods high in fat (especially saturated fat) and cholesterol.
• Have your blood pressure checked regularly. High blood pressure is a risk factor for heart disease.
• Get enough sleep each night.
• Avoid emotional upset and stressful situations.
• Always carry your medicine with you.
• Take nitroglycerin if stopping an activity doesn't help your pain, or if the pain occurs when you are resting. It may be more comfortable to take it while sitting in a chair.
• Keep your follow-up appointments with your health care provider. Let him or her know if your angina symptoms are worsening.