Angina (Chest Pain)

Types of angina

There are a variety of types of angina including:

• Stable angina
• Microvascular angina
• Varian angina
• Prinzmetal’s angina
• Unstable angina

Causes of angina

Angina can be caused by coronary artery disease or coronary microvascular disease (MVD). Coronary artery disease is a blockage in a main artery and the most common cause of angina. Microvascular disease are blockages in the smaller arteries off the main arteries.

Risk factors for angina

Risk factors that increase your likelihood to develop angina include:

• Tobacco use
• Diabetes
• High blood pressure
• Age — women over the age of 55 and men over the age of 45 are more likely to suffer from angina
• Obesity
• Stress
• History of heart disease

Symptoms of angina

If you have angina, you may experience symptoms such as:

• Chest pain
• Nausea
• Fatigue
• Discomfort or pain in the arms, neck, jaw or shoulder in conjunction with chest pain
• Dizziness
• Sweating

Women are more likely to feel nauseous, sharp chest pain, extreme fatigue, shortness of breath and abdominal pain.

Symptoms of angina present differently in women than men because of where heart disease typically develops in the genders. Men develop blockages in their coronary arteries (coronary artery disease) and women develop blockages in the small arteries that branch off the coronary arteries (coronary microvascular disease).

Diagnosis of angina

Your doctor or emergency room physician can typically diagnose angina quickly after discussing your symptoms.

The physician may order the following diagnostic tests to confirm the diagnosis:

• Electrocardiogram (ECG or EKG) — uses electrical impulses linked to the beating heart to check for irregularities in the heart, such as impaired blood flow or signs of heart attack.
• Chest x-ray — takes images of your heart and lungs and can show fluid buildup in the lungs or an enlarged heart.
• Cardiac CT (computerized tomography) — takes images of your heart to determine if your heart is enlarged or your heart’s arteries are filled with plaque.
• Exercise stress test — performed to detect if there is poor blood flow to the heart; your doctor will take an ECG before, during and after you walk on a treadmill.
• Echocardiogram — can be given during a stress test to determine the areas of the heart damaged by inadequate blood flow.
• Nuclear stress test — during a nuclear stress test, a radioactive substance is injected into your bloodstream to show the parts of the heart that are not getting adequate blood flow.
• Coronary angiogram or coronary angiography — also known as a cardiac catheterization, this test uses dye in the blood vessels and x-rays to look inside your heart’s blood vessels.

Treatments of angina

Treatments for angina can range from lifestyle modifications to surgery. Your doctor will work with you to develop an appropriate treatment plan for the type and severity of your angina.

Treatment options include:

Lifestyle modification

Mild angina may respond to lifestyle modifications such as quitting smoking, losing weight, avoiding large meals, avoiding stress, exercising and eating a healthy diet.

Medication

If lifestyle modifications do not help improve your symptoms of angina, medications may be required.

Medications for angina include:

• Nitrates — allow more blood to flow to the heart by relaxing the blood vessels.
• Aspirin — prevents blood clotting, which allows the blood to flow through narrowed blood vessels.
• Clot-preventing drugs — prevent blood clots from forming.
• Beta blockers — prevents angina by relaxing blood vessels and improving blood flow.  
• Statins — work to reduce cholesterol by blocking a substance that the body needs to make cholesterol.
• Calcium channel blockers — work to increase blood flow to the heart by relaxing and widening the blood vessels.

Coronary stent

During a coronary stent or angioplasty, your physician will inflate a tiny balloon in a clogged artery to restore blood flow. To keep the artery open, a small tube can be left inside. There are a variety of stents that can be used in this procedure including metal, drug-eluding and bioresorbable.

• Bifurcated coronary stent — designed to be used on patients who have coronary bifurcated lesions (coronary disease that leads from a branched artery to a main artery); works to open both branches of the artery leading to the main branch.
• Bioresorbable coronary stent — an alternative to traditional metal stents, they are designed to be absorbed by the body after the healing period has lapsed.

Coronary artery bypass surgery (CABG)

During CABG surgery, your doctor will take a healthy artery from another part of your body and build a “bypass” around the blocked blood vessel.

Coronary artery bypass surgery is very invasive and requires the help of a heart-lung machine to keep your heart beating while surgeons repair your blocked vessel.

Minimally-invasive coronary bypass surgery

Minimally-invasive coronary bypass surgery, also called beating heart surgery, is a low-impact alternative to CABG.

During this procedure, you do not have to be put on a heart-lung bypass machine while the surgeon repairs your blocked vessels. Patients typically leave the hospital within two to three days post-surgery and results are positive, even for the frailest patients.

There are two types of minimally invasive coronary bypass surgery, minimally invasive direct coronary artery bypass and off-pump coronary artery bypass.

Enhanced external counter pulsation (EECP) therapy

This procedure can stimulate the blood vessel’s smaller branches to create natural bypasses around blocked arteries. Patients who have chronic stable angina whose symptoms have not been relieved by taking nitrates and do not qualify for bypass surgery, stenting or angioplasty are candidates for this procedure.

During this non-invasive, outpatient treatment, your blood vessels in the lower limbs are compressed to increase blood flow to the heart. The compressions, generated by a set of inflatable cuffs that are wrapped around the calves, thighs and buttocks, are synchronized to your heartbeat and blood pressure. The increase blood flow from the procedure arrives at the heart exactly when the heart is relaxing, allowing blood to be pumped more easily from the heart.

Enhanced external counter pulsation therapy can also encourage blood vessels to form extra branches that could naturally bypass blocked vessels and provide blood to the heart.

Although most patients have successful outcomes with EECP, it is a time-intensive treatment. Treatment is administered one to two hours a day for five days a week for up to seven weeks.

Cardiac rehabilitation

The goal of a cardiac rehabilitation program is to increase your overall fitness, improve your health and decrease the risk factors for coronary heart disease.

Mercy Health’s cardiac rehabilitation team includes doctors, nurses, nutritionists, psychologists and exercise experts who work together to develop a program that will relieve symptoms and get you back to your day-to-day activities as quickly as possible.