Angina Pectoris (Chest Heart Pain)

There are many possible reasons for chest pain but most of us are concerned about it arising from the heart. Naturally this is a greater concern if you are over 40, overweight or obese, have a family history of heart disease and smoke tobacco. It immediately raises the concern about a heart attack. However, chest pain is not always due to the heart and not all cardiac (heart-related) chest pain is due to a heart attack. Even if the pain comes and goes away on its own, it can still be caused by potentially serious heart conditions.

What is angina pectoris?

Angina pectoris is a condition where a person experiences attacks of chest pain due to poor blood flow to the heart wall. It is not a heart attack but can be a prelude to one. A person may experience angina attacks for months or years before an actual heart attack occurs. And some people with angina may never have a heart attack. On the other hand, many people who have a heart attack may never have experienced angina attacks in the preceding weeks, months or years.

Angina actually refers to the pain and pectoris indicates that it is emanating from the chest. Therefore angina pectoris is chest heart pain in common terms. It is actually a symptom of coronary artery disease but most people think of it as a condition on its own. Sometimes there is no narrowing of the arteries supplying the heart but a person can still have angina pectoris. This latter form is less common and tends to occur when the coronary artery goes into spasm for short periods.

Causes of Angina Pectoris

Although your heart has litres of blood flowing through it every minute, it still needs its own blood supply. The wall of the heart is primarily composed of a thick muscular layer known as the myocardium. It is in constant need of blood containing oxygen and nutrients because it is working throughout the day.

This blood supply to the myocardium is through the coronary arteries. However, fatty plaques can build up in the wall of the coronary arteries and narrow it. The narrowing may be minor at first. It does not affect functioning of the heart muscle under normal circumstances.

However, when the heart activity increases like during strenuous physical activity or with emotional stress then blood flow through these narrowed arteries is insufficient. Poor blood flow and a reduced oxygen supply causes tissue injury known as ischemia.

A portion of the heart tissue does not die off like in a heart attack. Instead it experiences ischemic injury and pain is one of the symptoms. It is this pain that is referred to as angina pectoris. When the heart activity decreases and the blood supply is sufficient for its needs, then the pain usually eases.

Symptoms of Angina Pectoris

The main symptom is chest pain. It is usually described as a crushing or constricting pain around the centre of the chest. Some people will experience it as a dull nagging breastbone pain and not immediately realise that it is heart related. There are even instances when angina pain is mistaken for heartburn due to acid reflux.

The pain typically occurs as attacks. It arises rather suddenly, persists for a period of time and gradually eases particularly with resting or using nitrates (angina medication). Other symptoms that may also be felt includes pain extending to the neck, jaw or left arm. Dizziness, nausea and shortness of breath also may occur simultaneously.

These symptoms overlap to a large degree with a heart attack. Vomiting, excessive sweating and fainting is not as prominent with an angina attack but it can occur. Despite these other symptoms known to accompany chest pain in an angina attack, some people will have none apart from the chest pain on its own.

Types of Angina Pectoris

There are three types of angina which are classified according to the underlying cause and onset of symptoms.

• Stable angina is the most common type. It is said to have a stable pattern in that the onset of the pain can be predicted as well as the easing of the pain. It is most likely to occur when the heart is working harder than it normally would. Typically it eases within a few minutes after resting.
• Unstable angina has an erratic pattern. It can start at any time, sometimes even when you are not physically active. The pain is usually more severe than in stable angina. Rest and medication may not necessarily relieve the pain.
• Prinzmetal’s angina, also known as variant angina, is a rare type which usually does not respond well to medication. It occurs when the muscles in the artery wall go into spasm thereby causing a narrowing and restriction of blood flow.

Treatment of Angina Pectoris

Angina can be treated with both medication and surgery. The treatment option depends on each individual case. Just as important are lifestyle changes, such as losing weight, stopping smoking and exercising regularly.

Medication

• Nitrates are drugs that work very fast and can relieve angina pain rapidly. It works by relaxing the muscles in the artery wall thereby increasing blood flow through it.
• Aspirin and other clot-preventing drugs help to prevent a blood clot from forming at the site of the narrowing in the artery. It can prevent a heart attack in a patient who has coronary artery disease.
• Cholesterol-lowering agents like statins reduces the blood cholesterol levels and prevents the fatty plaques in the coronary artery from getting any larger. To some extent it can also shrink the plaques that are already there.
• Anti-hypertensive drugs work by keeping the blood pressure within normal limits in a person who has hypertension (high blood pressure). It is known that an elevated blood pressure promotes the build up  of plaques and formation of blood clots.

Surgery

There are two surgical procedures that may done to treat the underlying cause of angina pectoris.

• Coronary artery angioplasty and stenting is a procedure to widen the artery at the point of the narrowing and insert a wire mesh (stent) to keep the artery open. It is often the preferred procedure as it is less invasive than bypass surgery.
• Coronary artery bypass surgery, often referred to as open heart surgery, is where an alternative channel is established to reroute blood around the narrowed portion of the coronary artery.