Chest Pain or Discomfort (Angina)

What is Chest Pain (also called angina or angina pectoris)?

Angina can be caused by an insufficient supply of blood and oxygen to the heart muscle. The body responds to this oxygen deprivation with pain (many people refer to the pain as tightness or pressure) in the chest, arms, shoulders, neck and/or jaw. Some people also experience shortness of breath, fatigue, sweating, dizziness and/or vomiting. It is most frequently caused by narrowing of the coronary arteries. The narrowing is due to buildup of fatty deposits (plaque or atherosclerosis) within the artery walls.

Do not ignore these warning signs, as they are strong indicators of an impending cardiac event. If you experience chest pain, immediately call 9-1-1. Do not drive yourself to the hospital.

What are the differences between angina and a heart attack?

During angina, temporarily there is not enough oxygenated blood getting to a portion of the heart muscle. During a heart attack, narrowing effectively blocks the coronary artery, preventing any oxygenated blood from flowing to that part of the heart muscle, which can lead to heart muscle death.

There are usually three characteristics that distinguish angina from a heart attack. They are:

• Angina usually occurs as a result of emotional stress or exercise, but subsides after resting for several minutes. Victims of a heart attack continue to experience pain even after rest. In fact, chest pain resulting in a heart attack can last anywhere from 30 minutes to several hours.
• Unlike the pain from a heart attack, medication called nitroglycerin can and sometimes will relieve the pain of angina.
• Pain from a heart attack is usually more severe than that of angina.

How is chest pain evaluated?

Chest pain is evaluated several different ways, but most often your doctor will order a simple test called an electrocardiogram (EKG). This test monitors the electrical activity within the heart and can aid your doctor in determining if your condition is angina or if you are actually having a heart attack. The doctor may also order blood tests that can determine if there is damage to the heart muscle.

Other possible tests a doctor may order to evaluate chest pain are as follows:

• Stress Tests
• Nuclear Scan
• Echocardiogram
• Blood work to determine if chemicals from heart damage are present

If your doctor concludes you have angina, and are not having a heart attack, he or she will discuss treatment options to 1) care for the condition, and 2) prevent future cardiovascular problems.

What are the treatment options for angina?

There are a variety of treatment options for angina. They include:

• Procedure(s) that open narrowed arteries (for example, Angioplasty) and Coronary Artery Bypass Surgery
• Medication(s) (such as nitroglycerin, Beta Blockers, Calcium Channel Blockers) and ACE Inhibitors
• Lifestyle changes to reduce your risk factors (e.g. smoking cessation, exercise, diet, etc).

Medications

There are several medications a doctor can prescribe for angina, depending upon your condition:

• Aspirin or other anticoagulants (blood thinners)
• Vasodilators (e.g. Nitroglycerin) dilate blood vessels
• Angiotensin Converting Enzyme (ACE) Inhibitors dilate blood vessels to increase blood flow, guard against arteriosclerosis (plaque in the arteries), help strengthen heart muscles, lower blood pressure (B/P)
• Adrenergic Receptive Blockers (Beta blockers) help regulate the heart beat and decrease oxygen demand, lower B/P, protect against heart attack and heart failure
• Calcium channel blockers decrease heart contractility and spasms, dilate arteries, help to treat high B/P and angina
• Other medication may be prescribed for underlying heart disease, or for potential risk factors such as hypertension, high cholesterol or diabetes

Procedures

There are several procedures that can clear narrowing of the coronary arteries to relieve angina and help prevent a possible heart attack. These procedures include:

• Balloon Angioplasty with or without Stenting
• Coronary Artery Bypass Surgery
• External Enhanced Counterpulsation (ECP)

Prevention

If you have been diagnosed with angina, it is extremely important to make lifestyle changes that reduce the risk factors which have contributed to your heart disease. Making such changes can maintain, and in many cases, reverse the damage done to your heart. For more information about prevention of cardiovascular disease, please click here.

Changing your lifestyle to reduce your risk factors is one of the most important steps you can take to improve your overall cardiovascular condition.