Definition
Angina is a symptom characterised by a sensation of heaviness or tightness in the centre of the chest or breast bone induced by exertion or emotion.
It is caused by a significant narrowing of the arteries supplying blood to the heart muscle so that although blood supply at rest is adequate, increased demand for blood for example during exercise cannot be met.
Causes/Preventions
Multifactorial cause, but clearly related to cigarette smoking, high cholesterol levels, falling aerobic activity, incidence of diabetes, hypertension, and family history.
Preventative measures of increased activity, stopping cigarettes, reducing cholesterol and blood pressure and small regular amounts of alcohol may all help.
Signs & Symptoms
Atypical features may include arm or neck pain, back pain and “angina equivalent “ where the pain is perceived as breathlessness.
Complications
Worsening chest pain occurring more frequently or at rest may signify progression to unstable angina with increased risk of progressing to a true heart attack. Otherwise in stable situation may remain as a mild irritant only.
Investigations
The history should give most information but routine measurement of blood pressure, cholesterol and blood lipids and resting electrocardiograph (ECG) are usual. If there is doubt then measurement of heart activity during exertion is performed.
This can be by an exercise ECG, or by a nuclear image of the heart, (Thallium scan ). If symptoms persist then radiological imaging of the heart circulation, angiography is performed, usually at a specialist centre.
Treatment
Simple control of blood pressure, and cholesterol and a daily aspirin are often all that is required. Specific medication, is very effective including B blockers, calcium antagonist, or nitrates. If this fails then surgical intervention is considered. The narrowed arteries can be dilated by balloons (angioplasty) and stented in the open position or bypassed by coronary bypass surgery
Written by Medpages Editorial Team
Last Editorial Review:20/1/2010
