What is Angina?

Angina (angina pectoris), or Cardiac Ischemia, is a type of temporary chest pain or discomfort that occurs when the heart does not receive enough oxygen-rich blood. The most common cause of Cardiac Ischemia is Coronary Artery disease, which stems from an increase in cholesterol in the blood stream. The presence of increased cholesterol causes plaque build up and calcification and hardening of the coronary arterial walls. The arterial walls are then narrowed, resulting in a condition called Atherosclerosis. The flow of oxygen rich blood is restricted through the arteries.

If left untreated Cardiac Ischemia can lead to severe problems such as interruptions in heart rhythms, or Cardiac Arrhythmias. Minor episodes of Angina can eventually lead to Cardio Myopathy, or weakening of the heart muscle.

Other Causes of Cardiac Ischemia and Angina

• Stenosis - When the valve of the main artery (Aorta) narrows, causing blood to leak or regurgitate and therefore stop the flow of oxygenated blood.
• Microvascular Angina (Cardiac Syndrome X) - Though the causes of this condition are not clearly known, this mainly occurs in menopausal women when oestrogen levels can be extremely low. Sufferers experience chest pain but do not have blockages in their coronary arteries.
• Coronary artery spasms - These can lead to the diagnosis of a very rare type of Angina known as Prinzmetal Angina. Two-thirds of people with Prinzmetal Angina have a severe blockage in at least one major blood vessel. They also have a greater risk of developing arrhythmias such as Ventricular Tachycardia and Ventricular Fibrillation.

The symptoms of Angina?

The symptoms of Angina can be aptly described by its Latin name Angina Pectoris which means “a choking sensation of the chest”, as sufferers usually describe the feeling as a vice crushing the sternum or breastbone. The most common reported syptoms of Angina are chest pain, pressure and discomfort. A sensation of deep pressure can be felt in the back, neck, jaw, shoulders and arms. It is not abnormal to also feel light headed and have an abnormal heart rate.

Treatment for Angina

The course of treatment for Angina depends on its severity and the extent of underlying heart or vessel damage.

Lifestyle Changes

For most patients with mild Angina, a combination of medication and lifestyle changes are usually recommended. Tips to create a more heart healthy lifestyle would include the following:

• Eating a healthy diet
• Exercising regularly
• Improving your cholesterol levels
• Controlling diabetes
• Controlling high blood pressure (hypertension)
• Managing your stress
• Achieving and maintaining a healthy weight
• Giving up smoking
• Controlling depression

Medication

Medications used to treat Angina either increase the supply of oxygen to the heart muscle or reduce the heart’s oxygen needs. Medications include the following:

• Nitrates - Such as Nitroglycerin, widens or dilates the walls of the blood vessels. This allows more oxygen rich blood to reach the heart and reduces the pain of Angina attacks.
• Beta blockers - Slow down the resting heart rate and reduce the force with which the heart muscle contracts, giving it less work to do.
• Calcium channel blockers - Also known as calcium antagonists, these block the entry of calcium into the cells and reduces the amount of calcium build up. This causes the coronary arteries to widen and increases the blood flow through the heart. These types of drug can also be used to treat coronary artery spasms associated with Prinzmetal Angina.
• Antiplatelet medications - Stop blood clots from being formed by reducing the number of platelets in the blood, which are the body's natural blood clotting agents. Aspirin is the most common antiplatelet drug used.

Surgical Procedures

For patients with severe or worsening Angina, surgical procedures may be necessary. These include:

• Angioplasty - A procedure in which a balloon-tipped catheter is inserted into a damaged artery. The balloon is inflated and compresses the plaque, pushing it against the artery wall, resulting in improved blood flow.
• Stenting - A small wire mesh tube called a stent, is placed into a damaged artery via a catheter to support and stretch the artery walls and provide for unrestricted blood flow.
• Directional Atherectomy - This technique uses a bladed catheter to cut away plaque build up in the arteries. The plaque is removed when the catheter is withdrawn from the artery. This technique is useful in larger arteries with "softer" plaque.
• Rotational Atherectomy - Performed when hard, calcified plaque is present in the arteries. A device called a Rotablator rotates quickly and grinds the plaque into very small particles. These micro particles can travel safely through the circulatory system without causing any problems in most cases.
• Coronary Artery Bypass Graft - Pieces of the patient’s own veins and arteries from other parts of their body are used to create a bypass. This will re-route the flow of blood to pass around the blocked artery.