ANGINA (CHEST PAIN)

There are different types of angina:

Stable angina is the most common. Triggered by physical activity or stress. It usually lasts a few minutes, and it goes away when you rest.

Unstable angina. It happens while you’re at rest or not very active. The pain can be strong and long lasting, and can come back again and again.

Prinzmetal’s angina (also called variant angina) is rare where the heart arteries suddenly tighten or narrow. It might happen at night during sleep or while at rest. It can cause a lot of pain, and you should get it treated.

Symptoms

Chest pain is the symptom, but it affects people differently. You may feel:

• Aching
• Discomfort
• Feeling of fullness in the chest
• Heaviness
• Pressure
• Squeezing

You are likely to have pain behind your breastbone, but it can spread to your shoulders, arms, neck, throat, jaw, or back.

You may also have shortness of breath, sweating, or dizziness.

Stable angina often gets better with rest. Unstable angina may not — and could get worse.

DIAGNOSIS

If you’ve been having chest pain, it’s important to see your doctor, even if it goes away.

Your doctor will want to know:

• How have you been feeling?
• Where have you had pain?
• How strong would you say it was?
• How long did it last?
• What were you doing when it started?
• Did it come back?
• Have you felt this before?
• When did you begin having chest pain?
• Have you ever had a heart attack or heart surgery?
• Does anyone in your family have heart disease?
• Do you have any other medical conditions?

Your doctor may recommend these tests:

• Exercise stress test. You run on a treadmill or pedal a stationary bike while the doctor checks your heart rate, blood pressure, symptoms, and changes in your heart’s rhythm.
• Electrocardiogram (EKG). It measures electrical signals from your heart to show how it’s beating. Health workers attach small metal discs or stickers called electrodes to your chest, arms, and legs. With each heartbeat, an electric signal records how it’s working. The test only takes a few minutes, and it’s painless. You can get an EKG at a doctor’s office or the hospital.
• Coronary angiography. A thin tube called a catheter is threaded through a large blood vessel, usually one in your groin or wrist. The doctor injects dye through the tube, which travels to the arteries of your heart. As the dye moves, X-rays show how well your blood is flowing. X-rays use low doses of radiation to make images of the heart. You usually get these tests at a hospital and have to schedule it ahead of time. You may get a mild medicine to calm you beforehand.
• Computed tomography angiography. This test also checks how well blood flows through the arteries to your heart. You’ll first get an injection of dye through a vein. Then X-rays are taken from different angles to create a three-dimensional image of your heart. Each scan takes just a few seconds and is painless. It can be done at a hospital or an outpatient clinic.

You may also have blood tests to check for fat, cholesterol, sugar, and proteins that put you at higher risk for heart disease.

RECOMMENDED MEDICATIONS

Your treatment depends on how much damage there is to your heart. For people with mild angina, medicine along with lifestyle changes can often help blood flow better and control symptoms.

Your doctor might prescribe medicines to:

• Widen blood vessels, allowing more blood to flow to the heart
• Slow the heart down so it doesn’t have to work as hard
• Relax blood vessels to let more blood flow to the heart
• Prevent blood clots from forming

If medicines aren’t enough to treat your angina, you may need to have blocked arteries opened with a medical procedure or surgery. This could be:

• Angioplasty/stenting.
• Coronary artery bypass grafting (CABG), or bypass surgery.