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Angina
What is Angina?
Angina is the pain or discomfort that results when the heart muscle does not receive the blood and oxygen it needs. Each person with angina has his or her own pattern of symptoms. The way angina feels will vary from person to person:
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It may be a pressure, heaviness, squeezing, tightness, pain, or burning.
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It is most often a pressure or pain in the chest that may spread to one or both arms.
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It may be felt in the neck, jaw, throat, shoulders, arms, or back (with or without chest symptoms).
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It may feel like indigestion.
What Causes Angina?
Angina is not a heart attack - but it is a warning sign of a condition that can lead to heart attack. It is most often a sign of coronary artery disease. This is the build-up of fatty plaque inside the arteries that feed the heart muscle. The plaque blocks much of the blood flow through the arteries. As a result, the heart muscle is deprived of some of the blood and oxygen it needs (see the diagram).
A rare cause of angina is coronary artery spasm. In some persons, with or without coronary artery disease, a section of an artery contracts or narrows temporarily, and blood flow is blocked. The cause of this is unknown.
What Triggers Angina Symptoms?
The amount of blood and oxygen the heart muscle needs can vary from moment to moment. Anything that causes the heart to work harder will cause a greater demand for blood and oxygen. Although angina can occur at rest, it usually occurs during those times when the heart works hardest and its needs are greatest, such as:
What Should You Do If You Have Angina?
If you have never had angina and you feel any of the symptoms mentioned above:
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Stop what you are doing and rest.
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If you do not have Nitroglycerin (NTG) tablets, call 911 or go to the emergency room.
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If you have NTG tablets, sit down and take one tablet under the toungue. If the symptoms are not relieved in three to five minutes, take another tablet. Repeat every three to five minutes if needed. If symptoms are not relieved within 15 minutes call 911 or go to the emergency room.
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Even if the symptoms are brief, call your doctor to report what happened.
If you have had angina in the past, then you know your own pattern and how to deal with it. You should follow the same steps just listed for NTG. You should always report any change in your usual angina pattern. Call your doctor or emergency personnel if your symptoms become more severe or if they occur at rest for the first time.
Can You Prevent Angina?
Angina cannot always be prevented. But some attacks of angina might be avoided or controlled by steps such as these:
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Your doctor may prescribe certain drugs to help keep the arteries open or to decrease the workload of your heart.
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If you can't avoid certain activities that you know will bring on symptoms, talk with your doctor about taking NTG before these activities. For example, some patients take NTG before sexual activity.
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Learn to pace yourself and your schedule to avoid placing extra demands on your heart. For example: Rest or relax after large meals; avoid heavy pushing or pulling; don't exert yourself in very hot or very cold weather.
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Your doctor may suggest that you start an exercise program to help improve your level of heart and lung fitness
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Don't smoke. Smoking makes the heart work harder and decreases its oxygen supply. It is also a serious risk factor for heart and lung disease.
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Avoid sources of stress if you can. Ask your nurse or doctor for information to help you deal with the stressors you can't avoid.
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Learn to reduce or control other risk factors-high blood pressure, high blood cholesterol, diabetes, being over-weight. Ask for more details.
What are the Signs and Symptoms of a Heart Attack?
Angina is a brief discomfort that is relieved by rest or NTG. The symptoms of a heart attack usually last longer and are not relieved by rest or NTG. Symptoms may vary from person to person and often include one or more of these:
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Prolonged or intense chest pain or discomfort
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Pain or discomfort that starts in or spreads to the neck, jaw, throat, shoulders, arms, or back
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Sweating
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Nausea or vomiting
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Shortness of breath
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Weakness
What Should You do if You Have These Symptoms?
If you think you could be having a heart attack, get help right away. Don't wait to see if the symptoms will go away.
The best thing to do is to call for emergency medical help (911 or the rescue squad) and rest quietly until help arrives. Don't drive yourself to the hospital. And don't have someone else drive you unless they can get you there faster than an ambulance can get to you.
Nitroglycerin Tablets
Nitroglycerin (NTG) tablets provide a fast way to relieve angina. NTG is safe and not habit-forming. The small tablet should be placed under the tongue and allowed to dissolve. Its effect is to dilate (widen) the coronary arteries so that more blood can flow through them. Here are some tips on NTG.
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Carry it with you at all times.
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Keep it in the bottle you were given; remove the cotton once the bottle has been opened.
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NTG tablets can lose their effect over time and may need to be replaced every few months. Ask your doctor or pharmacist for more details. Each tablet should cause a slight stinging or burning under the tongue - if it does not, it will not work well to relieve your symptoms.
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Since it dilates blood vessels, NTG may cause headache or dizziness, so it is best to sit or lie down when you take it.
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