peggy1258
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 Posted: Thu Jul 14, 2011 2:40 am Post subject: When Chest Pain Might Really Be Angina |
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Chest pain is always cause for concern, and many people fear the worst — heart attack — when they have it. While it's often due to a minor problem such as muscle strain or heartburn, a common cause is angina, or pain that results from blocked arteries preventing oxygen from reaching the heart.
Though some people experience angina as chest pain, it can also show up as pain or discomfort in the back, abdomen, arms, shoulders, jaw, or neck. Angina itself doesn’t cause any damage, but it's usually a symptom of coronary artery disease, so it does require treatment.
The American Heart Association estimates that nearly 10 million people in the United States experience angina symptoms. According to the National Heart, Lung, and Blood Institute (NHLBI), 500,000 new cases of stable angina (angina that tends to arise with physical activity) are diagnosed each year.
Angina Symptoms: Chest Pain
While decidedly unpleasant, the pain of an angina attack does not cause any damage itself, says Donna Miller, ANP, a nurse practitioner in the department of cardiology at North Shore Hospital in Manhasset, N.Y. But because it’s usually a symptom of coronary artery disease, which can eventually cause a heart attack, angina should never be ignored.
Angina Symptoms: Types of Angina
There are three types of angina:
* Stable (chronic) angina is the most common.
* Unstable angina is the most dangerous.
* Prinzmetal’s, or variable, angina is the rarest.
Angina Symptoms: Stable Angina
When you first experience angina, your physician will need to determine if you have stable angina. Stable angina typically comes on with physical exertion and goes away with rest. In this type of angina, “the angina symptoms themselves and the pattern of when you develop them will become easier and easier to predict over time,” says Miller. “You’ll learn, for instance, that maybe you can walk on the treadmill if it’s flat but not on an incline, or that maybe you’re fine if you eat small meals but not rich, heavy meals.”
Worried about your heart health? Find a cardiologist in your area.
It’s sometimes possible to reduce the frequency of episodes of stable angina if you make “lifestyle modifications like having good control over your blood sugar, maintaining a healthy weight, and quitting smoking,” says Miller. But most people diagnosed with stable angina will be given one of several medications. These can include “beta blockers and calcium channel blockers, which help to slow down the heart rate and lower blood pressure, in turn decreasing the oxygen demands of the heart,” she explains.
Nitroglycerin, which helps improve blood flow to heart muscle, is also commonly prescribed. It can be given in the form of a pill or skin patch to help prevent angina attacks, or as a tablet that dissolves in the mouth (under the tongue or tucked near the cheek) to stop an angina episode once it’s already begun.
Angina Symptoms: Unstable Angina
By contrast, unstable angina means “the attacks are becoming more unpredictable and frequent, and worse,” says Miller. It can be difficult to distinguish between a heart attack and an episode of unstable angina because in both, intense pain can come on suddenly, without physical activity, and doesn’t ease up when you rest or take medicine.
According to the NHLBI, an incident of unstable angina requires emergency treatment because it could mean that a heart attack is imminent.
Unstable angina is caused by a blood clot in the artery. A clot that completely blocks an artery can cause a heart attack, but a clot that causes a partial blockage can give rise — unpredictably — to angina. Such clots may form and re-form, resulting in episodes of unstable angina.
Having unstable angina puts you at greater risk for heart attack than someone without angina or with stable angina. If changes in your medications and significant heart-healthy lifestyle changes don’t remedy your unstable angina, “you need to look into intervention as a treatment,” says Miller.
Intervention options include:
* Balloon angioplasty, the temporary insertion of a slender tube into the artery to push away blockages
* Stenting, the permanent insertion of a mesh stent to discourage blockage formation and keep the artery open
* Coronary artery bypass surgery, the use of healthy blood vessels from other parts of the body to restore blood flow to the heart by bypassing, or going around, blocked arteries in the heart
Which procedure you have will depend on the severity of your coronary artery disease, your age, and whether you have any other medical conditions.
Angina Symptoms: A Rare Type of Angina
The third type of angina is the rare Prinzmetal's, or variant, angina. Only about 2 to 3 percent of people with chest pain who undergo further testing are found to have variant angina. With this form of angina, the pain is usually intense and often happens during rest, especially at night. The pain in this case is caused by spasms, rather than blockages, of the arteries in the heart.
While the underlying cause of these blood vessel spasms is not well understood, Prinzmetal's angina is linked to smoking, psychological stress, and cocaine use. Medications, including calcium channel blockers and nitroglycerin, are effective at managing this kind of angina, says Miller.
Angina can be an important sign of hidden heart disease. If you experience chest pain — or even neck, jaw, or arm pain, be sure to tell your doctor about what provokes your symptoms and what makes them go away. If you also feel sweaty, sick to your stomach, or lightheaded during an episode of severe chest pain, call 911 as these can be signs of an actual heart attack.
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