Understanding Angina or Heart Pain

What is Angina?

Angina or heart pain occurs when there is insufficient oxygen-rich blood flowing through the heart muscles. It is often characterized by a tight or heavy feeling in a person’s chest, which may also extend up to the shoulders, arms, neck, jaw, or back.

Note that angina is not considered a disease. However, it can still be an underlying symptom of a more serious heart condition, such as Coronary Heart Disease (CHD) and Coronary Microvascular Disease (MVD). Since angina is relatively common, it may be difficult to distinguish it from other types of chest pain, such as those caused by indigestion or overexertion during strenuous activities.

Angina can be classified into four types:
  • Stable Angina or Angina Pectoris is the type of angina that develops when the heart works harder than usual - mostly during physical activities such as exercise or sports. Unlike other types of angina, stable angina can be predicted and the pain only lasts a relatively short time. The discomfort can easily be relieved by resting or through angina medication.
  • Unstable Angina is considered a medical emergency. This type of angina is unpredictable and may occur even when the body is at rest. It is more severe and can last up to 30 minutes or longer. Having an unstable angina might be a signal of an impending heart attack.
  • Variant Angina or Prinzmetal’s Angina usually happens among younger patients. This is not like the typical angina which is often triggered by overexertion or emotional stress. This type of angina frequently occurs when a person is at rest and often strikes around midnight and early in the morning. The pain resulting from Variant Angina can be very painful and is caused by a spasm in the coronary arteries, which is a result of either exposure to cold weather, medicine intake, smoking, or cocaine use.
  • Microvascular Angina is the kind of chest pain that may be a symptom of Coronary Microvascular Disease (MVD). Coronary MVD is a heart disease that affects the heart’s smallest coronary artery blood vessels. When spasms occur, it causes a reduced blood flow to the heart muscle, thus leading to Microvascular Angina. It may be more severe and can last longer than other types of angina pain. It is also characterized by shortness of breath, sleep problems, fatigue, and lack of energy.
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Causes of Angina

When the supply of oxygen-rich blood is reduced in a person’s heart muscles, angina usually occurs.
For those suffering from Stable Angina
Discomfort is usually triggered by too much physical exertion. When a person engages in strenuous activities like exercise and sports, it becomes more difficult for the heart muscles to get the amount of blood it needs.
For those suffering from Unstable Angina
When fatty deposits - also called plaques - blocks the heart’s blood vessel, it reduces the amount of blood flow through the artery. Unstable angina can also be caused by the formation of blood clots that partially blocks the heart’s blood flow.
For those suffering from Variant Angina
This type of angina is caused by a spasm in the heart’s coronary artery which temporarily narrows the passage ways, thus reducing the amount of oxygen-rich blood to the heart.

Other causes of angina include the following:
  • Emotional stress
  • Too much food intake
  • Cold temperatures
  • Illegal drugs
  • Sedentary lifestyle
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Common Signs and Symptoms of Angina

Angina is hard to distinguish from other chest pains because the symptoms are quite common. It is important to consult your doctor if you experience frequent episodes of heart pain.

Common signs and symptoms of angina include:

  • Extreme pain in the chest that radiates down the arms, neck, jaw, and back
  • Dizziness and nausea
  • Unexplainable fatigue
  • Shortness of breath
  • Fainting
  • Excessive sweating

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Risk Factors of Angina

Listed below are the common risk factors that can increase a person’s chances of experiencing angina
  • Family history of heart disease
  • Obesity
  • Lack of exercise
  • Old age
  • Diabetes
  • High blood pressure
  • High blood cholesterol or triglyceride levels
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Diagnosis for Angina

There are several medical examinations that can be done to confirm if a person is suffering from angina.
  • Echocardiography - this is also known as a Diagnostic Cardiac Ultrasound. This test uses sound waves to examine the status of the heart. Results of an echocardiography comes in 2 and 3-dimentional images of the heart and it can show if blood is flowing properly in the chambers and valves of the heart.
  • Stress Test - Angina is easier to diagnose when the heart is working harder. During a stress test, the patient’s blood pressure and ECG readings are examined while he or she exercises by walking on a treadmill or pedaling a stationary bicycle.
  • Electrocardiogram - This procedure records a person’s heartbeat by using an electrical impulse generated from special cells. Through this, the doctor can look for patterns among the heartbeats to see if there is an abnormality in the blood flow through the vessels.
  • Chest X-ray - Images of the heart and lungs are taken with the help of this test. Chest X-rays can determine if there are existing structural abnormalities.
  • Coronary Angiography - This x-ray imaging test examines the inside of the heart’s blood vessels. During this procedure, a type of dye that is visible in an x-ray machine is injected into the heart’s blood vessels.
One way to prevent angina is to engage in an active lifestyle and keep a healthy diet. Treatment can also involve oral medications. In severe cases, an angioplasty or bypass surgery may be required to unblock the arteries and resume normal blood flow. Proper consultation with a heart specialist can also help in the prevention of angina and other serious heart problems.

EH Heart Specialist is dedicated to providing in-depth diagnoses to people experiencing angina or heart pain. For further enquiries about angina, contact our heart specialist at +65 6736 1068 today.
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