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Angina

What is angina?

Angina (or angina pectoris) is a temporary chest pain, pressure, or squeezing in the chest that may feel like a heart attack. It occurs when the heart is not getting enough oxygen because too little blood is flowing to a part of the heart. Often this is due to the narrowing of the arteries from fatty deposits called atheroma, or from some other abnormality that can restrict blood flow to the heart.

Angina is a symptom of heart disease or another life-threatening heart problem, and though it isn’t a heart attack, it is an indication that you are more likely to have one in the future. Contact your doctor if you experience angina.

There are different types of angina with different symptoms and that may require different treatments. The major types include:

  • stable angina, which is the most common type. It typically first occurs when certain triggers, such as physical exertion or emotional distress, cause the heart to work harder and increase its need for more oxygen. The pain usually goes away quickly after you rest or take angina medication.
  • unstable angina, which can occur whether you are active or at rest. It has no particular pattern, and it may occur more often and may be more severe than stable angina. This type of angina is may be a sign that a heart attack may soon happen and requires emergency treatment.
  • variant (or Prinzmetal’s) Angina, which is rare and is caused by a spasm in a coronary artery on the heart. It typically occurs when you are resting late at night or early morning, and causes severe, long-lasting pain. This type of angina is treated with medication.

What are the symptoms of angina?

The symptoms of angina can be different for each person. Most often, pain or discomfort is felt behind the breastbone and can be described as burning, squeezing, or tightness in the chest. The pain can also occur in the shoulders, arms, neck, jaw, or back. Some people experience sweating, dizziness, shortness of breath, nausea, or fatigue. Others may experience burning or aching in the stomach area and mistake it for indigestion, heartburn, or gas.

If chest pain lasts longer than a few minutes and doesn’t go away after rest or taking an angina medication, it may be a sign of a heart attack. In that case, call 911 immediately.

How is angina diagnosed?

Doctors often diagnose angina based on the patient’s description of their symptoms. To determine whether your chest pain indicates stable or unstable angina, the doctor may ask you a number of questions, such as:

  • How often does the pain or discomfort occur?
  • Where does it occur?
  • What brings it on and what relieves it?
  • How strong would you say it was?
  • How long does it last?
  • 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 will also want to do a physical exam and may recommend one or more of the following tests:

  • exercise stress test, during which you walk on a trend mill or ride a stationary bike to make your heart work hard and beat fast while the doctor monitors your heart rate and blood pressure, and watches for any changes in your heart’s rhythm.
  • electrocardiogram (EKG), which is a short, simple test that can be performed in the doctor’s office and shows how fast the heart is beating and whether it has a steady or irregular rhythm; it can also detect signs of any damage due to heart disease or signs of a heart attack.
  • coronary angiography, which involves using an iodine dye and x-rays to show the inside of your coronary arteries so that the doctor can see the flow of blood through your heart and blood vessels. It is the most accurate test for detecting the narrowing of the arteries to the heart. The dye is injected into the coronary arteries during a procedure called cardiac catheterization. The procedure is typically performed in a hospital while you’re awake and with minimal pain.
  • computed tomography angiography, which also uses iodine dye with computer tomography or CT scanning to create a three-dimensional x-ray image of your the coronary arteries. The CT scanner is a large machine with a big hollow ring in the middle. You lay on a table, which then slowly slides into the CT scanner, where the x-ray takes pictures of your heart from different angles. This is the most accurate procedure for diagnosing coronary heart disease.

While your doctor may detect signs of angina, a cardiologist—a doctor who specializes in the diagnosis and treatment of heart problems—will diagnose your condition.

How is angina treated?

Depending on how much damage there is to your heart, the Temple cardiologists at Jeanes Hospital can develop and oversee a treatment plan tailored to meet your specific needs.

When symptoms are stable and mild to moderate, lifestyle changes that lower your risk of coronary disease may be all that’s needed to prevent episodes of angina. These changes may include:

  • quitting smoking
  • following a healthy diet to reduce high blood and high cholesterol
  • maintaining a healthy weight
  • staying physically active

Another option that may lower your risk of coronary disease is the use of medications:

  • nitrates relax or widen blood vessels to allow more blood flow to the heart and reduce strain on the heart
  • beta-blockers slow down the heart rate and reduce blood pressure, which then reduces the heart’s demand for oxygen; they also reduce the risk of heart attacks and sudden death
  • calcium channel blockers keep blood vessels from narrowing and reduce blood pressure
  • ACE inhibitors can reduce the risk of heart attack and death due to coronary disease in people who have shown evidence of coronary artery disease

If changes in lifestyle and the use of medications aren’t effective in controlling your angina, a medical procedure may be needed. Two typical procedures for treating angina include:

  • coronary angioplasty, which involves threading a small tube through a needle, into an artery, then up to your heart. Once there, a small balloon inside the tube is inflated inside of the narrowed artery to get blood flowing again. To keep the artery open, a small wire mesh tube, called a stent, may be inserted. Coronary angioplasty is usually preferred over Coronary artery bypass grafting surgery because it is less invasive and may only require an overnight stay.
  • coronary artery bypass grafting (CABG), commonly known as bypass surgery, involves taking veins or arteries from another part of the body and using them to go around blocked or narrowed arteries.  With the technology available at Jeanes, most of these open heart procedures do not require cardiopulmonary bypass and can be performed "off pump" or as a  "beating heart" CABG.

Advanced Cardiovascular Care at Jeanes Hospital

If you’re experiencing symptoms of angina, the highly-experienced cardiologists at the Temple Heart & Vascular Institute at Jeanes Hospital are ready to assist in the diagnosis and treatment of your condition. From patient consultation to a full range of diagnostic tests and surgical procedures, our Temple doctors are prepared to help you understand and manage all aspects of your angina.

The Temple cardiologists at Jeanes Hospital evaluate hundreds of patients every year, managing a wide range of serious cardiovascular conditions. After careful evaluation, they can develop and oversee a treatment plan tailored to meet your specific needs.

If surgery is required, there's no need to travel to another institution to have it done. Since 2006, Temple cardiovascular surgeons have been performing cardiac surgery procedures at Jeanes Hospital. Our surgeons are supported by a full-time team of cardiac anesthesiologists, surgical technicians, and critical care nurses. Dedicated nurse practitioners also collaborate with surgeons to manage patient care in Jeanes Hospital and in our outpatient settings.

Procedures performed at Jeanes for the diagnosis and treatment of angina include:

  • Diagnostic coronary angiography
  • Balloon angioplasty
  • Coronary artery bypass (CABG)

This is the level and quality of care you would expect to find downtown or in another city. Yet, it’s available right here, in your own community.

To schedule an appointment with a cardiologist at the Temple Heart & Vascular Institute at Jeanes Hospital, click here or call 215-728-CARE (2273).

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