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What is angina ?Angina is a chest pain or discomfort that arises if an area of your heart muscle does not get enough-rich blood. This may feel like pressure or squeezing and even indigestion in the chest this can also occur in the shoulders, arms, neck, jaw, or back. Angina is a system of an underlying heart problem and it is usually a system of coronary heart disease. Coronary heart disease (CHD) is the most common type of heart disease that mostly occurs in adults. CHD happens if a waxy substance called plaque builds up on the inner walls of the coronary arteries, these arteries carry oxygen-rich blood to your heart.

What Are the Signs and Symptoms of Angina?The pain and discomfort are the main symptoms of angina, it is often described as pressure, squeezing, burning, tightness in the chest, it usually starts behind the breastbone. Signs and symptoms such as nausea (feeling sick to your stomach) fatigue (tiredness), shortness of breath, sweating, light-headedness, and weaknesses can also occur.Women are more likely to feel discomfort in the neck, jaw, throat, abdomen, or back. Shortness of breath is more common in older people and those who have diabetes . Weakness, dizziness, and confusion can mask the signs and symptoms of angina in elderly people.Stable AnginaThe pain or discomfort:• Occurs when the heart must work harder, usually during physical exertion• Doesn't come as a surprise, and episodes of pain tend to be alike• Usually lasts a short time (5 minutes or less)• Is relieved by rest or medicine• May feel like gas or indigestion• May feel like chest pain that spreads to the arms, back, or other areasUnstable AnginaThe pain or discomfort:• Often occurs at rest, while sleeping at night, or with little physical exertion• Comes as a surprise• Is more severe and lasts longer than stable angina (as long as 30 minutes)• Usually isn’t relieved by rest or medicine• May get worse over time• May mean that a heart attack will happen soonVariant AnginaThe pain or discomfort:• Usually occurs at rest and during the night or early morning hours• Tends to be severe• Is relieved by medicineMicrovascular AnginaThe pain or discomfort:• May be more severe and last longer than other types of angina pain• May occur with shortness of breath, sleep problems, fatigue, and lack of energy• Often is first noticed during routine daily activities and times of mental stress

Diagnostic Tests and Procedures?If your doctor thinks that you have unstable angina or that your angina is related to a serious heart condition, he or she may recommend one or more tests.EKG (Electrocardiogram)An EKG is a simple, painless test that notices and records the heart’s electrical activity. The test shows how fast the heart is beating and its rhythm if it’s steady or irregular. An EKG also records the strength and timing of electrical signals as they pass through the heart.An EKG can show signs of heart damage due to CHD and signs of a previous or present heart attack. However, some people who have angina have normal EKGs.Stress TestingDuring stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can’t exercise, you may be given medicine to make your heart work hard and beat fast.When your heart is working hard and beating fast, it needs more blood and oxygen. Plaque-narrowed arteries can't supply enough oxygen-rich blood to meet your heart's needs.A stress test can show possible signs and symptoms of CHD, such as:• Abnormal changes in your heart rate or blood pressure• Shortness of breath or chest pain• Abnormal changes in your heart rhythm or your heart's electrical activityAs part of some stress tests, pictures are taken of your heart while you exercise and while you rest. These imaging stress tests can show how well blood is flowing in various parts of your heart. They also can show how well your heart pumps blood when it beats.Chest X RayA chest x ray takes pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels. A chest x ray can reveal signs of heart failure, it can show signs of lung disorders and other causes of symptoms not related to CHD, however, a chest x ray alone is not enough to diagnose angina or CHD.

CausesAs angina is usually a system of coronary heart disease, this does mean that the underlying causes of angina generally are the same as the underlying causes CHD. Coronary heart disease starts when certain factors damage the inner layers of the coronary arteries. These factors includeSmoking High amounts of certain fats and cholesterol in the bloodHigh blood pressureHigh amounts of sugar in the blood due to insulin resistance or diabetesThe different types of angina and their causes Stable AnginaPhysical exertion is the most common cause of stable angina. Severely narrowed arteries may allow plenty of blood to reach the heart when the request for oxygen is low, for example for when you’re sitting. But with physical exertion such as like walking up a hill or climbing stairs, the heart works harder and it needs more oxygen.Other causes of stable angina include:Emotional stressExposure to very hot or cold temperaturesHeavy mealsSmokingUnstable AnginaBlood clots that partly or entirely block an artery cause unstable angina. If plaque in the artery breaks, blood clots start to form which creates a blockage. A blood clot may become larger to entirely block the artery and which will cause a heart attack. Blood clots may form, partially dissolve, and later form again. Angina can occur each time a clot blocks an artery.Variant AnginaA spasm in the coronary artery which causes the variant angina. The spasm affects the walls of the artery to tighten up and narrow, blood flow to the heart slows or stops.The coronary arteries can spasm as a result of:• Exposure to cold• Emotional stress• Medicines that tighten or narrow blood vessels• Smoking• Cocaine useMicrovascular AnginaMicrovascular can be a system of coronary microvascular disease (MVD).coronary MVD is a heart disease that affects the hearts smallest coronary arteries. The reduced blood flow in small coronary arteries may affect microvascular angina. Plaque in the arteries, artery spasms, or damaged or diseased artery walls can reduce blood flow through the small coronary arteries.

How Is Angina Treated?Treatments for angina include lifestyle changes, medicines, medical procedures, cardiac rehabilitation (rehab), and other therapies. The main goals of treatment are to:• Reduce pain and discomfort and how often it occurs• Prevent or lower your risk for heart attack and death by treating your underlying heart conditionLifestyle changes and medicines may be the only treatments needed if your symptoms are mild and aren't getting worse. If lifestyle changes and medicines don't control angina, you may need medical procedures or cardiac rehab.Lifestyle ChangesMaking lifestyle changes can help prevent episodes of angina. You can:• Slow down or take rest breaks if physical exertion triggers angina.• Avoid large meals and rich foods that leave you feeling stuffed if heavy meals trigger angina.• Try to avoid situations that make you upset or stressed if emotional stress triggers angina. Learn ways to handle stress that can't be avoided.Other important lifestyle changes include:• Being physically active. Check with your doctor to find out how much and what kinds of activity are safe for you. For more information, go to the Health Topics Physical Activity and Your Heart article.• Maintaining a healthy weight. If you’re overweight or obese, work with your doctor to create a reasonable weight-loss plan. Controlling your weight helps you control CHD risk factors.• Taking all medicines as your doctor prescribes, especially if you have diabetes .MedicinesNitrates are the medicines most commonly used to treat angina. They relax and widen blood vessels. This allows more blood to flow to the heart, while reducing the heart’s workload.Nitroglycerin is the most commonly used nitrate for angina. Nitroglycerin that dissolves under your tongue or between your cheek and gum is used to relieve angina episodes.Other medicines also are used to treat angina, such as beta blockers, calcium channel blockers, ACE inhibitors, oral antiplatelet medicines, or anticoagulants (blood thinners). These medicines can help:• Lower blood pressure and cholesterol levels• Slow the heart rate• Relax blood vessels• Reduce strain on the heart• Prevent blood clots from forming

How Can Angina Be Prevented?You can prevent or lower your risk for angina and heart disease by making lifestyle changes and treating related conditions.Making Lifestyle ChangesHealthy lifestyle choices can help prevent or delay angina and heart disease. To adopt a healthy lifestyle, you can:• Quit smoking and avoid secondhand smoke• Avoid angina triggers• Follow a healthy diet• Be physically active• Maintain a healthy weight• Learn ways to handle stress and relax• Take your medicines as your doctor prescribesFor more information about these lifestyle changes, go to “How Is Angina Treated?” For more information about preventing and controlling heart disease risk factors, visit the Health Topics Coronary Heart Disease, Coronary Heart Disease Risk Factors, and Coronary Microvascular Disease articles.Treating Related ConditionsYou also can help prevent or delay angina and heart disease by treating related conditions, such as high blood cholesterol, high blood pressure, diabetes , and overweight or obesity.If you have one or more of these conditions, talk with your doctor about how to control them. Follow your treatment plan and take all of your medicines as your doctor prescribes.

Plaque Buildup in an ArteryFigure A shows a normal artery with normal blood flow. The inset image shows a cross-section of a normal artery. Figure B shows an artery with plaque buildup. The inset image shows a cross-section of an artery with plaque buildup.Plaque narrows and stiffens the coronary arteries. This reduces the flow of oxygen-rich blood to the heart muscle, causing chest pain. Plaque buildup also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow, which can cause a heart attack.Angina also can be a symptom of coronary microvascular disease (MVD). This is heart disease that affects the heart’s smallest coronary arteries. In coronary MVD, plaque doesn't create blockages in the arteries like it does in CHD.Studies have shown that coronary MVD is more likely to affect women than men. Coronary MVD also is called cardiac syndrome X and no obstructive CHD.


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