Angina pectoris

About your angina

Angina, or angina pectoris, is a recurring discomfort. It usually lasts just a few minutes, most often in the center of the chest, behind the breastbone. People describe it as a heaviness, tightness, oppressive pain, burning, pressure or squeezing. Sometimes it spreads to the arms, neck or jaws. It also may cause numbness in the shoulders, arms or wrists.

Symptoms vary by gender. For women, the pain may be less intense, last longer and occur in locations other than the center of the chest, such as the shoulder, jaw or back. Women also may experience breathlessness and nausea.

Angina occurs when the heart muscle doesn’t get the blood supply and oxygen it needs.

Angina and heart attack

In angina, the blood flow is reduced. This is especially true when the heart must do more work, such as exercise or manual labor.

In a heart attack, blood flow to part of the heart muscle is suddenly cut off because a coronary artery is blocked.

Angina attacks usually don’t permanently damage the heart muscle. A heart attack, on the other hand, may lead to severe damage or even death if not treated quickly.

What causes angina?

Angina and heart attacks have the same root cause: atherosclerosis. This is the narrowing of the coronary arteries caused by the build-up of deposits of fatty substances, such as cholesterol. It usually starts early in life. Everyone has it to some degree by middle age.

Diagnosing your condition

Usually your doctor can diagnose angina from your description of symptoms. Because your physical examination and resting electrocardiogram can be entirely normal, your doctor may recommend an exercise test to increase your heart’s demand for blood and oxygen. An electrocardiogram and other imaging studies recorded during an exercise test can show if your heart isn’t getting enough oxygen.

It can sometimes be hard to diagnose angina even after completing a medical history, a physical examination and an exercise test. If that’s the case, your doctor may order a nuclear medicine (Cardiolite or Myoview) stress test. During this special exercise test, a radioisotope is injected into one of your veins and the blood flow to your heart muscle is measured while you exercise.

Coronary arteriography

Coronary arteriography is an X-ray procedure that is used to examine the arteries of your heart with a special camera. The procedure is done in a catheterization laboratory, or cath lab.

The physician who performs the procedure inserts a thin plastic catheter into an artery in your arm or leg.

When the catheter is in place, a dye will be injected to allow the physician to see what the problem with your coronary arteries might be. The catheter is a radiopaque, meaning that the physician can watch under the fluoroscope and direct the catheter into the coronary arteries.

PTCA

If medication doesn’t control your angina, your doctor may suggest percutaneous transluminal coronary angioplasty (PTCA). This procedure can increase blood flow in a narrowed blood vessel.

In PTCA the doctor inserts a balloon-tipped catheter into an artery. When the tip is guided to where the blood vessel is narrowed, the balloon is inflated, compressing the plaque. Then the balloon is deflated and the catheter withdrawn.

Stent procedure

A stent procedure uses a wire mesh tube called a stent to prop open an artery that’s recently been cleared using angioplasty. The stent is collapsed to a small diameter, placed over an angioplasty balloon catheter and moved to the location of the blockage. When the balloon is inflated, the stent expands and locks in place. This forms a rigid support to hold the artery open. The stent stays in the artery permanently, holding it open, improving blood flow and relieving chest pain.

Surgery

Your doctor may advise bypass surgery. In this operation, an artery or vein taken from the chest or leg is grafted onto the blocked artery, bypassing the blocked area. If more than one artery is blocked, each one may receive a bypass.