Angina – Causes, Symptoms and Treatment

Chest pain is a common symptom that is caused by many different conditions. Some causes require prompt medical attention, such as angina, heart attack, or tearing of the aorta. Other causes of chest pain that may not require immediate medical intervention include spasm of the esophagus, gallbladder attack, or inflammation of the chest wall. An accurate diagnosis is important in providing proper treatment to patients with chest pain.

Causes of Angina

Angina is rather similar to cramp in a muscle during vigorous exercise. It is caused by the muscles of the heart not receiving enough oxygen (via the blood) for the work they are performing. This is because the blood vessels which supply the heart muscles with oxygen have become narrowed. The main cause of narrowing of the blood vessels is age, but this is accelerated by cigarette smoking.

Angina attacks in men usually happen after the age of 30 and are nearly always caused by coronary artery disease (CAD). For women, angina tends to happen later in life and can be caused by many different factors.

Symptoms of Angina

Pain and discomfort are the main symptoms of angina. Angina is often described as pressure, squeezing, burning, or tightness in the chest. It usually starts in the chest behind the breastbone.

Some people say the pain feels like gas or indigestion.

The pain:

Occurs after activity, stress, or exertion

Lasts 1 to 15 minutes

Is usually relieved with rest or a medicine called nitroglycerin

While these are the general symptoms of angina, angina symptoms can also vary based on the type of angina a person has (stable, unstable, or variant angina).

Treatment of Angina

Medicines called nitrates are useful in preventing and reducing the frequency and intensity of episodes in patients with chronic angina. Nitrates relax the veins and coronary arteries. By relaxing the veins, they reduce the amount of blood that returns to the heart and eases the heart’s workload. By relaxing the coronary arteries, they increase the heart’s blood supply.

In patients with chronic stable angina, the factors influencing the choice of coronary revascularisation therapy (percutaneous coronary intervention or coronary artery bypass surgery) are varied and complex. The severity of symptoms, lifestyle, extent of objective ischaemia, and underlying risks must be weighed against the benefits of revascularisation and the patient’s preference, as well as local availability and expertise.

A beta-blocker (described above) may be sufficient to prevent angina pains. There are also other drugs that can be taken in addition, if required, to reduce the number and severity of angina pains. There are many drugs that can be used, but they fall into three main groups.

The largest randomised trial of an anti-anginal drug to date is the ACTION trial. It included 7,665 patients with stable angina pectoris. ACTION demonstrated that the calcium channel blocker nifedipine (Adalat) prolongs cardiovascular event- and procedure-free survival in patients with coronary artery disease. For example new overt heart failures were reduced by 29% compared to placebo. This finding confirms the vascular-protective effects of nifedipine.

Lifestyle changes and medications are the most common ways to treat and control angina. Sometimes, surgery may be necessary.

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