ANGINA PECTORIS

General Information

DEFINITION--Chest pain arising from the heart--usually under the sternum (breastbone)--brought on by exercise, emotional upset or heavy meals in a person who has a heart disorder. Normally the arteries that supply blood to the heart can cope with an increased demand, but if coronary artery disease or high blood pressure is present, the flow is restricted.

BODY PARTS INVOLVED--Coronary arteries.

SEX OR AGE MOST AFFECTED--Men over age 35 and postmenopausal women.

SIGNS & SYMPTOMS--

Any of the following:

• Tightness, squeezing, pressure or mild ache in the chest.
• Sudden breathing difficulty (sometimes).
• Frequent chest pain similar to indigestion.
• A choking feeling in the throat.
• Chest pain that radiates to the jaw, teeth or earlobes.
• Heaviness, numbness, tingling or ache in the arm, shoulder, elbow or hand--usually on the left side.
• Pain between the shoulder blades.

CAUSES--

Insufficient blood to the heart muscle. Causes include:

• Coronary-artery disease with partial block- age or spasm of arteries that supply the heart.
• Anemia.
• Overactive thyroid gland.
• Heartbeat that is too fast.
• Heart-valve disease.

RISK INCREASES WITH

• Smoking, obesity, diabetes mellitus.
• High blood pressure, high blood-cholesterol levels.
• Excess intake of fat or salt.
• Sedentary lifestyle, fatigue, overwork or stress.
• Family history of coronary-artery disease.
• Exposure to cold and wind.

HOW TO PREVENT

• Obtain medical treatment for underlying causes or risks.
• Don't smoke.
• Eat a diet that is low in fat and low in salt. Lose weight if you are overweight (see Appendix for special diets).
• Avoid activities that trigger angina attacks.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Laboratory studies, such as blood tests and stress tests; ECG (See Glossary); x-rays of the heart.
• Therapeutic trial of nitroglycerin.

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment.
• Surgery to bypass severely blocked coronary arteries (sometimes).
• Balloon angioplasty (See Glossary) to open blocked coronary arteries (sometimes).

POSSIBLE COMPLICATIONS--Heart attack, congestive heart failure, potentially fatal arrhythmias.

PROBABLE OUTCOME--Minor angina can be relieved with rest and use of nitroglycerin and other drugs. Other treatment may be necessary to correct underlying diseases.

How To Treat

GENERAL MEASURES--

• Reduce stress (see How to Cope with Stress in Appendix for suggestions).
• Follow suggestions under How to Prevent.
• Avoid situations that increase the heart's workload, such as anger, temperature extremes, high altitude (except in commercial airline flights) or sudden bursts of activity.

MEDICATION--Your doctor may prescribe:

• Nitroglycerin to relieve acute symptoms of angina. It does not affect symptoms of other disorders. It can work within seconds to relieve pain. Always keep it with you for immediate use.
• Other drugs for coronary disease, such as aspirin, beta-blockers or calcium antagonists may be prescribed. If they are, it is important to follow the prescribed drug regimen.

ACTIVITY--

• Adjust your activities to minimize attacks.
• A regular moderate exercise routine (determined by your doctor) can help to control symptoms.

DIET--See diet suggestions under How to Prevent.

Call Your Doctor If

• You have symptoms of angina pectoris.
• The following occurs after diagnosis: An attack of chest pain continues longer than 10 to 15 minutes, despite rest and treatment with nitroglycerin. You wake from sleep with chest pain that does not go away with 1 nitroglycerin tablet. If these attacks continue, report them to your doctor--even if nitroglycerin relieves them. An attack occurs and the pain is different or more severe than usual.