Definition

Angina pectoris is a term that describes chest pain caused by

myocardial ischemia - a condition in which the amount of oxygen
getting to the heart muscle is insufficient. It usually occurs on exertion
and is relieved by rest. Angina generally is a symptom of coronary
artery disease. In most severe cases, it may occur with minimal effort or
at rest.

Description

Angina pectoris is a common manifestation of coronary artery disease.
The pain is caused by reduced blood flow to a segment of heart muscle
(myocardial ischemia). It usually lasts for only a few minutes, and an
attack is usually quickly relieved by rest or drugs (such as nitroglycerin).
Also, it is possible to have myocardial ischemia without experiencing
angina.

Typically, angina is described as a "pressure" or "squeezing" pain that
starts in the center of the chest and may spread to the shoulders or
arms (most often on the left side, although either or both sides may be
involved), the neck, jaw or back. It is usually triggered by extra demand
on the heart: exercise, an emotional upset, exposure to cold, digesting
a heavy meal are common examples.

Some people experience angina while sleeping or at rest. This type of
angina may be caused by a spasm in a coronary artery, which most
commonly occurs at the site of atherosclerotic plaque in a diseased
vessel.

Most people with angina learn to adjust their lives to minimize attacks.
There are cases, however, when the attacks come frequently and
without provocation - a condition known as unstable angina. This is
often a prelude to a heart attack and requires special treatment,
primarily with drugs. Angina affects both men and women, usually in
middle age. Men are much more likely than women to experience it
before age 60. It may develop weeks, months or even years before a
heart attack, or may be experienced only after a heart attack has
occurred.

Causes

The two main causes of angina are coronary artery spasm, and
atherosclerotic plaque buildup which causes critical blockage of the
coronary artery.

The risk factors include:

smoking
sedentary lifestyle
high blood pressure, or hypertension
high blood fats or cholesterol
hypercholesterolemia
diabetes
family history of premature ischemic heart disease
Men are at higher risk than women.

Symptoms

Classic or typical angina occurs predictably with physical exertion or
strong emotional reactions, and goes away just as predictably with rest.
Starting immediately behind the sternum (breast bone), the pain may
radiate to the left arm and shoulder or up to the jaw.

Most people describe the pain as a kind of squeezing pressure,
tightness or heaviness.

There may be anxiety, increased or irregular heart rate, paleness and
cold sweat, and a feeling of doom. The symptoms are like the ones for a
heart attack.

In some instances, chest pain results from other types of heart
problems, including diseases that affect the heart muscle itself or the
valves that control blood flow through the heart. Occasionally, ulcers,
gallstones, abnormal contractions of the esophagus or severe anxiety
and panic attacks can cause chest pain. However, if you do experience
these symptoms, your best plan of action is to get immediate help. Stop
doing whatever is causing the symptoms and call 911. Lie down with
your head slightly elevated. If you are not allergic to it, take one adult
aspirin.

Diagnosis

Diagnosis of angina is based upon the classic history of chest pain on
exertion and by means of tests, demonstrating the presence of
coronary artery disease.

Treatment

In most instances, drugs are recommended for the treatment of angina
before surgery is considered. The major classes of drugs used to treat
angina include the following:

Nitrates. These come in several forms: nitroglycerine tablets to be
slipped under the tongue during or in anticipation of an attack;
ointment to be absorbed through the skin; long-acting medicated skin
discs; or long-acting tablets. The latter three forms are used mostly to
prevent rather than relieve attacks. The nitrates work by reducing the
oxygen requirements of the heart muscle.

Beta-blocking Drugs. These agents act by blocking the effect of the
sympathetic nervous system on the heart, slowing heart rate,
decreasing blood pressure, and thereby, reducing the oxygen demand
of the heart. Recent studies have found that these drugs also can
reduce the chances of dying or suffering a recurrent heart attack if they
are started shortly after suffering a heart attack and continued for two
years.

Calcium-channel Blocking Drugs. These drugs are prescribed to treat
angina that is thought to be caused by coronary artery spasm. They can
also be effective for stable angina associated with exercise. All muscles
need varying amounts of calcium in order to contract. By reducing the
amount of calcium that enters the muscle cells in the coronary artery
walls, the spasms can be prevented. Some calcium-channel blocking
drugs also decrease the workload of the heart and some lower the
heart rate as well