Angina is a symptom of coronary artery disease (CAD), the most common type of heart disease. CAD occurs when plaque builds up in the coronary arteries. This buildup of plaque is called atherosclerosis. As plaque builds up, the coronary arteries become narrow and stiff. Blood flow to the heart is reduced. This decreases the oxygen supply to the heart muscle.

Types of Angina

The three types of angina are stable, unstable, and variant (Prinzmetal's). It is very important to know the differences among the types.

• Stable angina. Stable angina is the most common type. It occurs when the heart is working harder than usual.
  • There is a regular pattern to stable angina. After several episodes, you learn to recognize the pattern and can predict when it will occur.
  • The pain usually goes away in a few minutes after you rest or take your angina medicine.
  • Stable angina is not a heart attack but makes it more likely that you will have a heart attack in the future.
• Unstable angina. Unstable angina is a very dangerous condition that requires emergency treatment. It is a sign that a heart attack could occur soon. Unlike stable angina, it does not follow a pattern. It can occur without physical exertion and is not relieved by rest or medicine.
• Variant angina. Variant angina is rare. It usually occurs at rest. The pain can be severe and usually occurs between midnight and early morning. It is relieved by medicine.

Not all chest pain or discomfort is angina. Chest pain or discomfort can be caused by a heart attack, lung problems (such as an infection or a blood clot), heartburn, or a panic attack. However, all chest pain should be checked by a doctor.

What Causes Angina?

Angina is caused by reduced blood flow to an area of the heart. This is most often due to coronary artery disease (CAD). Sometimes, other types of heart disease or uncontrolled high blood pressure can cause angina.

In CAD, the coronary arteries that carry oxygen-rich blood to the heart muscle are narrowed due to the buildup of fatty deposits called plaque. This is called atherosclerosis. Some plaque is hard and stable and leads to narrowed and hardened arteries. Other plaque is soft and is more likely to break open and cause blood clots. The buildup of plaque on the inner walls of the arteries can cause angina in two ways:

• By narrowing the artery to the point where the flow of blood is greatly reduced
• By forming blood clots that partially or totally block the artery

What Are the Signs and Symptoms of Angina?

Pain and discomfort are the main symptoms of angina. These symptoms

• Are often described as pressure, squeezing, burning, or tightness in the chest
• Usually start in the chest behind the breastbone
• May also occur in the arms, shoulders, neck, jaw, throat, or back
• May feel like indigestion

Some people say that angina discomfort is hard to describe or that they can't tell exactly where the pain is coming from. Symptoms such as nausea, fatigue, shortness of breath, sweating, light-headedness, or weakness may also occur.

Symptoms vary based on the type of angina.

How Is Angina Treated?

Treatment for angina includes lifestyle changes, medicine, special procedures, and cardiac rehabilitation. The main goals of treatment are to:

• Reduce the frequency and severity of symptoms
• Prevent or lower the risk of heart attack and death

Lifestyle changes and medicine may be the only treatments needed if your symptoms are mild and are not getting worse. Unstable angina is an emergency condition that requires treatment in the hospital.

Lifestyle Changes

The first thing that you need to do is change your living habits to avoid bringing on an episode of angina.

• Slow down or take rest breaks, if angina comes on with exertion.
• Avoid large meals and rich foods that leave you feeling stuffed, if angina comes on after a heavy meal.
• Try to avoid situations that make you upset or stressed, if angina comes on with stress. Learn techniques to handle stress that can't be avoided.

You can also make other lifestyle changes, for example:

• Eat a healthy diet to prevent or reduce high blood pressure, high blood cholesterol, and obesity
• Quit smoking, If you smoke
• Be physically active, as directed by your doctor
• Lose weight, if you are overweight or obese.
• Follow your doctor's orders and take all medicines as directed, especially if you have diabetes

Medications

Nitrates are the most commonly used medicines to treat angina. Fast-acting preparations are taken when angina occurs or is expected to occur. Nitrates relax and widen blood vessels, allowing more blood to flow to the heart while reducing its workload.

You can use nitrates in different forms to:

• Relieve an episode that is occurring by using the medicine when the pain begins
• Prevent an episode from occurring by using the medicine just before pain or discomfort is expected to occur
• Reduce the number of episodes that occur by using the medicine regularly on a long-term basis

Other medicines can be used to treat angina:

• Beta blockers slow the heart rate and lower blood pressure. They can delay or prevent the onset of angina.
• Calcium channel blockers relax blood vessels so that more blood flows to the heart, reducing pain from angina. Calcium channel blockers also lower blood pressure.
• ACE (angiotensin-converting enzyme) inhibitors lower blood pressure and reduce the strain on the heart. They also reduce the risk of a future heart attack and heart failure.

Special Procedures

When medicines and other treatments do not control angina, special (invasive) procedures may be needed. Two commonly used procedures are:

• Angioplasty. This procedure opens blocked or narrowed coronary arteries. It can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack. Sometimes a stent is placed in the artery to keep it propped open after the procedure.
• Coronary artery bypass surgery. This procedure uses arteries or veins from other areas in your body to bypass your blocked coronary arteries. Bypass surgery improves blood flow to your heart, relieves chest pain, and can prevent a heart attack.

Cardiac Rehabilitation

Your doctor may prescribe cardiac rehabilitation (rehab) for angina or after bypass surgery, angioplasty, or a heart attack.

The cardiac rehab team may include:

• Doctors
  • Your family doctor
  • A heart specialist
  • A surgeon
• Nurses
• Exercise specialists
• Physical therapists and occupational therapists
• Dietitians
• Psychologists or other behavior therapists

Rehab has two parts:

• Exercise training. This helps you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your exercise plan will be based on your individual ability, needs, and interests.
• Education, counseling, and training. This helps you understand your heart condition and find ways to reduce your risk of future heart problems. The cardiac rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and to deal with your fears about the future.