Definition

Angina pectoris is a medical term for chest pain caused by coronary heart disease. Depending on when the pain occurs, it is classified into stable angina and unstable angina. The incidence of angina pectoris increases with age in both men and women.

Causes

Angina pectoris is caused by reduced blood flow to the heart muscles. Blood delivers oxygen to all organs, and the heart muscles need oxygen to pump blood effectively. Ischemia occurs when any body part, such as the heart muscles, lacks oxygen due to decreased blood flow.

This reduction in blood flow is usually caused by coronary heart disease, where the arteries in the heart narrow due to plaque buildup from fatty deposits. These plaques can rupture or become injured, leading to blood clot formation. If this occurs, the arterial space narrows, reducing or even completely stopping blood flow, causing the heart muscles to lack oxygen.

When the body has low oxygen demand (such as during rest), the heart muscles can still function without causing chest pain despite reduced blood flow. However, chest pain may occur if oxygen demand increases (such as during exercise).

Risk factor

The risk of angina pectoris increases due to the following factors:

1. Elderly
Chest pain symptoms of angina are most common in individuals aged 60 years or older.

2. History of cardiac disease in the family
This includes immediate family members such as parents or siblings.

3. Tobacco use
Smoking, chewing tobacco, and long-term exposure to secondhand smoke can damage blood vessel linings, leading to cholesterol buildup and blood flow blockage.

4. Diabetes
Diabetes increases the risk of coronary heart disease, which can result in chest pain and heart attacks by accelerating the formation of fatty plaques in the blood vessels and raising cholesterol levels.

5. High blood pressure
Elevated blood pressure can damage arteries by making them stiff.

6. High cholesterol or triglyceride levels
High levels of bad cholesterol (low-density lipoprotein, LDL) in the blood can narrow arteries. Elevated LDL levels increase the risk of angina and heart attacks. High triglyceride levels in the blood can also cause similar effects.

7. Other health conditions
Conditions like chronic kidney failure, peripheral artery disease, metabolic syndrome, and a history of stroke can increase the risk of angina.

8. Lack of exercise
A sedentary lifestyle can elevate cholesterol levels, blood pressure, the risk of diabetes, and obesity.

9. Obesity
Excess weight can strain the heart in pumping blood.

10. Stress
Frequent stress and anger can raise blood pressure. Additionally, increased hormones during stress can narrow arteries.

11. Medications
Drugs that constrict blood vessels, such as migraine medications, can cause certain types of angina.

12. Substance abuse
Cocaine and other stimulants can stiffen blood vessels and trigger angina chest pain.

13. Cold temperatures
Cold weather can trigger a type of angina known as Prinzmetal's angina (chest pain occurring at rest due to coronary artery spasm).

Symptoms

Angina pectoris is marked by chest pain on the left side, with specific characteristics. Stable angina typically shows signs such as:

• Pain occurs when the heart works harder, such as during physical activity.
• It does not happen suddenly and has similar episodes of chest pain.
• It lasts for a short time (under 5 minutes).
• It improves with rest or certain medications.
• Pain can feel like gas or bloating.
• It may radiate to the neck, arm, jaw, and back.

However, if the chest pain worsens and does not improve with rest or medication, it could be unstable angina. Severe symptoms can indicate a heart attack. Any worsening of angina symptoms should be promptly consulted with healthcare providers. Other symptoms accompanying angina include dizziness, fatigue, shortness of breath, nausea, and excessive sweating.

Diagnosis

Diagnosing angina pectoris involves asking about the patient's history and conducting examinations. History includes previous episodes, worsening severity, and risk factors.

Examinations include:

ECG (Electrocardiogram)
This test measures the heart's electrical activity. Patches placed on your skin detect the heart's electrical signals.

Chest X-Ray
A chest X-ray uses X-rays captured on film to view your chest cavity contents (like the heart and lungs).

Complete blood count
This test measures hemoglobin (the oxygen-carrying substance in blood), red blood cells, white blood cells, and platelets.

Basic metabolic panel
This test checks blood sugar, kidney function, and electrolytes that maintain fluid balance.

Stress test
This test compares heart function before and after physical activity or medication use, conducted while walking on a treadmill or cycling on a stationary bike.

Cardiac enzyme test
If available and a heart attack is suspected, cardiac enzymes like troponin can be measured. Troponin levels rise in the blood when heart muscle cells are damaged.

Cardiac catheterization
A catheter is inserted into the heart to view blood flow in the arteries.

Management

Stable angina pectoris usually improves with rest or certain medications. Typically, nitrate medications are prescribed to alleviate angina symptoms by relaxing blood vessel muscles, making them more elastic and easing the heart's blood-pumping process.

If symptoms worsen, such as persistent left chest pain despite rest or medication, consult a doctor. The doctor may refer you for tests to determine your condition and subsequent treatment.

Lifestyle changes are also recommended. These include maintaining an ideal weight, regular exercise, and quitting smoking. Consult your doctor for the best weight loss targets and methods. Recommended exercises include moderate-intensity activities like aerobics, jogging, cycling, or swimming, done for about 30 minutes per day, 3-5 times per week.

If you have other health conditions such as diabetes, high cholesterol, or chronic kidney disease, consult a doctor on managing these conditions. Controlling these conditions can reduce the risk of angina chest pain.

Complications

Chest pain due to angina can make activities uncomfortable, but the greatest complication is a heart attack. If you experience chest pain symptoms that are warning signs of a heart attack, go to the nearest emergency room immediately.

Warning signs and symptoms of a heart attack : 

• Chest pain that feels like heavy pressure or squeezing in the center or left side of the chest lasting more than 5 minutes.
• Pain that is not localized but may radiate to the shoulder, arm, back, and jaw.
• Fainting
• Severe pain
• Increased frequency of pain episodes
• Nausea and vomiting
• Pain radiating to the stomach
• Shortness of breath
• Excessive sweating

Prevention

You can prevent angina and chest pain symptoms by improving lifestyle habits. These changes include:

• Not smoking
• Eating a nutritious diet with an emphasis on vegetables and fruits
• Avoiding or limiting alcohol
• Regular exercise
• Maintaining an ideal weight
• Managing other health conditions that increase the risk of angina pectoris
• Reducing emotional stress

When to see a doctor?

If you experience angina-like symptoms for the first time, consult a doctor. The doctor may perform tests to assess your heart health and prescribe medications and advice to control the condition.

If symptoms worsen, such as prolonged chest pain that does not improve with rest or medication, go to the nearest emergency room immediately. Do not drive yourself to the emergency room; it is unsafe. If symptoms worsen, ask someone nearby to take you to the emergency room.

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