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Each year in the UK around 320 000 people visit their doctor for angina. Over six million people in America and two million in the UK are affected. Angina (pronounced ‘ann-jy-na’) is a symptom of a problem,not a disease in itself. It is usually caused by narrowing of the coronary arteries by atheroma (see introduction to Chapter 2). It can also be caused by a high blood pressure (see the section Risks of high blood pressurein Chapter 2), disease of the aortic valve (see Chapter 7), severe anaemia, and rapid palpitations (see Chapter 6) or a mixture of conditions. Far and awaythe commonest cause is coronary artery disease (see Chapter 2).
The coronary arteries supply oxygen to the heart and the heart gets this supply between its beats, when it is refuelling itself. This means that the faster your heart beats, the less oxygen there is for the heart itself. If your arteries are narrowed, the flow is restricted. The balance will function well enough when you are not doing anything but, when your heart speeds up, there will come a point when the narrow arteries restrict the supply of oxygen to your heart muscle and pain develops. This is when angina is most often felt, as a chest pain, when you are active or when you are worked up about something, because the demands of your heart for oxygen are not being met by the supply of oxygenated blood to your heart muscle.
SYMPTOMS
My husband has got angina. He is obviously in pain but cannot describe it easily. What does it feel like?
The pain usually begins behind the breast bone. It is often felt as a tightness or a squeezing sensation; your husband probably describes it best by clenching his fist in front of his chest (see Figure3.1).
The pain of angina can be regarded as a built-in warning device and tells him that the heart has reached its maximum workload. The onset of pain or discomfort indicates that he should slow down or stop any exertion. Alternatively, if emotion (such as anger) has lead to this, then he should relax and remove himself from the situation. You cannot usually point to where angina pain is felt; it is more widespread and felt across the chest. It is brought on usually by effort, so it will build up if that effort is continued. When it begins, it is often quite mild – more of an ache – so it is easily confused with indigestion. Angina pain may spread (radiate) to the throat or neck, the jaw (like toothache), to the left or right arm or both, and sometimes to the back or stomach. It usually goes down the inside of the arm, in contrast to muscle pain which runs over the shoulder and down the outside of the arm. Rarely, angina occurs in one of these places without being in the chest; for example, a person gets pain in the left arm on effort which is relieved by resting.
Can my husband’s chest pain be from causes other than heart disease?
There are many other causes of chest pain and here are some pointers to stop you worrying unnecessarily.
• Joint or muscle painThis is often worse when someone is changing position. This sort of pain can be reproduced by pressing on the ribs or breastbone.
• Lung disordersThis pain is aggravated when you take a deep breath.
• Stomach problemsIndigestion after a meal or on bending with an acid taste in your mouth (acid reflux).
• Gallbladder problemsColicky pain after a fatty meal may suggest gallstones.
• Stress,anxietyoroverbreathing.
Nobody should have chest pain that is a mystery. Do not assume your husband has angina but also do not let him ignore the pain. Get him to ask his doctor’s advice. Table 3.1 shows the main differences in signs between heart and not-heart pain.
What is the difference between angina and a heart attack?
Angina is the result of a temporary shortage of oxygen available to the heart muscle, usually caused by exercise or strong feelings. Angina pain usually passes off when you stop activity, or very shortly after taking a ‘nitrate’ tablet (see the section Treatment below). Angina results from narrowed coronary arteries.
A heart attack is different (see Chapter 4). The pain build-up is more severe, lasts longer and does not decrease when you stop any activity. It may be modified if you take nitrate tablets but is not relieved. You will often find that you sweat and you may feel sick. A heart attack is caused by an artery blocking off, usually when a clot forms on a narrowed area.
I have been diagnosed as having unstable angina. What is this?
Angina that occurs more frequently with ever-decreasing activity is known as unstable angina. For example, if it is worse when you walk 22 metres (25 yards) rather than 0.8 km (half a mile). It may also occur at minimal activity or at rest, or wake you from sleep. You should see your doctor urgently if:
• you are getting angina for the first time;
• the pain is getting worse and occurring more frequently;
• the pain happens when you are not doing anything.
I am on medicine for angina and I still often get pains. If I get an attack of angina, it is difficult to know when I should bother the doctor. What should I do?
There are various instances when this would be advisable.
• If you have been newly diagnosed with angina and pain occurs when you are walking less than 22 metres (25 yards) on the flat.
• If it occurs at rest (usually in bed).
• If the pain lasts longer than 20 minutes in spite of nitrates (see below).
• If you are very breathless.
• If you feel faint or light-headed with the pain.
• If the pain comes on while you are convalescing from a recent heart attack.
When should I dial 999 rather than just call a doctor?
If the pain lasts longer than 20 minutes, in spite of nitrate tablets or spray, then dial 999. Tell them that you need an ambulance and have a ‘possible heart attack’. Try another nitrate tablet or spray if the pain continues; crunch a 300 mg tablet of aspirin and then swallow it. Aspirin thins the blood and can help prevent unstable angina developing into a heart attack as well as limiting the damage a heart attack can do.
I have angina, but I want to live an active life. Is there any activity that is likely to bring my angina on?
Any form of exercise can bring angina on – climbing stairs, carrying shopping, walking up an incline and rushing. Angina may be more of a problem in cold or windy weather, or when you are
carrying something heavy or going for a walk too soon after a large meal. It also occurs when you are under emotional stress, especially anger. It can vary a lot from day to day, but if it is becoming more frequent and the distances you can walk shorter, you should report back to your doctor.
I sometimes get a pain after eating. The doctor told me this was ‘post-prandial angina’. What exactly is this?
As your doctor says, this is angina which occurs after a meal. Eating a large meal can increase the work that the heart has to do by 20% (to digest the food) so angina may occur if you have coronary narrowings. The usual sequence goes something like this: meal – walk the dog – angina. This happens because you have exercised too soon after a meal, adding stress to the heart. Post¬prandial angina can be a warning of more severe coronary disease and I expect your doctor will be giving you some more tests.
Sometimes when I drive, for instance in the rush hour, I get angina symptoms – am I wise to carry on?
No. You must not drive until your symptoms are controlled, either by medication or surgery.
Reference:
All questions are answered through articles indexed in www.PubMed.com and edited by: Dr G. Jackson in Heart Health 4th edition.
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