Angina pectoris is not a disease in itself; it is a term for the pain that occurs when the muscular wall of the heart temporarily remains oxygen-free. Coronary arteries, which supply the heart with blood, are able to supply even more blood than normal if it is needed, but this ability is limited in people with coronary sclerosis or high blood pressure, or in people who have, which is somewhat less frequent, a heart defect or anemia. In such circumstances, oxygen supply may be sufficient for some activities, but insufficient when physical activities – and, sometimes, great temperature differences or high excitement – increase the need beyond a certain threshold. When a person ceases with this activity, the oxygen demand drops and the pain disappears.
The main symptom is a pain in the middle of the chest. The pain can be extended to the throat and upper jaw, and to the back and arms (usually left). These are dull, unpleasant pains, which are characteristic during physical activity and disappear after activity. Pains are rarely occurring in the hands, wrists, or neck, but angina pectoris will be easy to detect if you find that the pain increases whenever you are unusually active or excited and disappears after the activity or when the excitement passes. Additional symptoms, often accompanied by pain, include difficult breathing, sweating, nausea, and dizziness.
Angina pectoris is frequent, though there is no accurate data, since many people do not address the doctor for this discomfort, and the patient usually does not have to stay in the hospital. In men, it usually occurs after 30 years and is almost always a consequence of coronary sclerosis. It seems that angina pectoris in women occurs much later; as with men, the most common cause of it is coronary sclerosis, although other causes are more common in women than in men. Heavy smokers and obese people are more inclined to angina pectoris.
Since angina pectoris is a symptom rather than a disease, the danger is threatened by the condition caused by angina pectoris. The heart can remain oxygen free to the extent that there is a risk of a heart attack. Over time, angina pectoris may be caused by more harmless causes and may last longer. In that case, the patient is forced to live a passive life. Unfortunately, there is an evidence that a passive way of life even further triggers the occurrence of angina pectoris during some activity or excitement, so the ”victim” is basically in a vicious circle.
What to do?
If you think you have angina pectoris, contact your doctor. Some causes can be remedied by medication, and your doctor will provide you with relief agents. Contact with the doctor as soon as possible if the pain lasts for longer than 5 minutes after stopping the activity or if the frequency and length of the seizure increase rapidly. After examination, your doctor will probably take a blood sample to detect thyroid disorder, anemia, or other possible causes of chest pain. It is recommended to examine the lipid (fat) content in the blood; in this case, your blood will be taken in the morning, before meal.
Urine test will determine if you have diabetes (diabetics are more likely to have heart disease). Hospital diagnostic tests, which may also be required, include X-rays, electrocardiogram (EKG) and coronary arteriogram. While the X-ray and the ECG are often part of the usual procedure for assessing heart disease, the arteriogram is usually only recorded if the doctor doubts (based on the results of other, not so complicated) findings that coronary sclerosis has been quite advanced.
An x-ray is used to examine signs of heart attack, e.g. enlarged heart. The ECG will measure electrical impulses that go through the heart to confirm whether the pains actually occur due to angina pectoris. The ECG will also show how much of the heart is affected by coronary sclerosis. The arteriogram, for which the contrast agent (color) is injected into the bloodstream, and then the X-ray of the coronary arteries, will show the exact site where the arteries are narrowed or clogged.
Self-help: if you smoke, quit smoking or reduce the amount of cigarettes as much as you can. If you are overweight, try to reduce the amount of food taken (total of 1000 kilocalories or 41 868 kJ per day is ideal). Even though you have angina pectoris you should not reduce your physical activities, unless your doctor tells you otherwise. You will quickly find out what limits are allowed to your body activities. Relax, especially when driving a car.
Professional help: if (and when) the primary cause of angina pectoris is discovered, the doctor will treat the underlying disease and the angina pectoris will disappear if the treatment is successful. However, coronary sclerosis is often a common cause of this condition; the doctor will focus on it (so the disease won’t get worse) and on relieving the disturbances and difficulties created by the angina pectoris itself.
There are many drugs that will temporarily increase blood supply to the heart muscle. It is important that they are taken accurately to the physician’s instructions. These medicines are usually given in tablets, and your doctor will probably advise you to dissolve your tablet under your tongue when the attack of angina pectoris starts. If you know that an activity, such as climbing up the stairs in your office, is always causing an angina pectoris attack, take the tablet rather than waiting for the pain. If you are under stress, you may also need to take a soothing substance.
An unpleasant side effect of theese tablet is often a headache. Headache is usually mild, and should not be a reason to stop therapy. If your head really hurts after taking the whole tablet, break it and take just a part of the tablet.
Among other agents used to control angina pectoris, doctors most often prescribe a group of agents called beta adrenergic blocking agents or, shortly, beta blockers. Beta blockers reduce oxygen demand by slowing down the heart rhythm. The disadvantage of these remedies is that they must be taken exactly according to the physician’s instructions, because overdose may cause dizziness, unconsciousness, and other side effects. You should never stop taking such medication suddenly; the dose must gradually decrease. Under certain circumstances, your doctor may not even prescribe them to you; e.g. if you have asthma. Follow the recommended advices (under the self-help), and you will reduce the need for a drug therapy.
Most patients do not need a surgical procedure (and they would not benefit from it). However, if the angina pectoris arises due to aortic stenosis, the doctor may recommend the replacement of the heart valve. If the cause is coronary sclerosis, the doctor may recommend surgery if many parts of the coronary artery network are blocked or if angina pectoris can not be controlled by medication. The operation (bypass) of the coronary artery usually significantly mitigates the symptoms, although it does not treat the root causes of coronary sclerosis which may later interfere with other arteries.
Prospects are much better than what is generally thought. If your doctor has just diagnosed an angina pectoris and if you are otherwise a healthy person, you have a 50% chance to live for another 10 to 12 years, but also a good chance to live even longer.