Heart and vascular with Dr. Haqqani: Angina and its cardiovascular signals
Angina is the term used to describe chest pain or discomfort in the chest. There are several types of angina and it often signals coronary heart disease and other serious problems relating to the heart and cardiovascular system. It can also occur in the jaw, back, arms, neck or shoulders. There are identifiable symptoms, treatments and ways to help prevent it and the problems angina foretells.
Not all chest pain is the result of angina. It can be caused by asthma, indigestion or other conditions. However, when angina occurs, there are definite characteristics. The four types of angina are stable angina, unstable angina, variant (Prinzmetal) angina and microvascular angina. Angina occurs when blood flows poorly to the heart, denying it the proper amount of oxygen. Stable angina (angina pectoris), is the most common type of angina. Physical or emotional stress is often associated with it. Rest and medicine can offer relief.
Unstable angina (acute coronary syndrome) occurs unexpectedly. Unstable angina is often caused by loosened blood clots and can happen anytime, even when an individual is at rest, sitting or sleeping. Unlike stable angina, rest and medicine often do nothing to stop the pain. It can worsen as time goes by and may signal a heart attack.
Variant or Prinzmetal angina occurs in only about two percent of angina cases. Usually noticed between midnight and early morning by an individual at rest, it is very painful. Spasms in coronary arteries delivering blood to the heart cause variant angina.
Angina in the smallest coronary artery blood vessels is known as microvascular angina, or MVD. The spasms within the smallest arterial blood vessels prevent proper blood flow and can cause pain that can last from ten to thirty minutes. The pain can be very severe and may be accompanied by shortness of breath or fatigue. MVD is more common among women, especially younger women, but may also appear in men.
Symptoms of angina
While chest pain is the common denominator in those suffering angina, how they feel the pain may differ. A feeling of heaviness or pressure may occur in some, while burning or squeezing may describe angina in others. General discomfort and aching may best describe how an individual may experience angina. Pain in the breastbone area may also spread to the back, neck, shoulders, arm or jaw. Sweating, dizziness or shortness of breath may also take place along with pain.
Risk and prevention
Risk factors for angina and the cardiovascular conditions it may indicate, such as heart attack, include diabetes, obesity, high blood pressure and high cholesterol levels. Additionally, smoking, inactivity and an unhealthy diet contribute to risk. Family cardiovascular history may also increase the probability of angina, as could age. Men over age 45 and women over age 55 see an increase in the probability of angina.
Treatment for angina could start with lifestyle changes that would include maintaining a healthy weight, getting appropriate exercise, eating a proper diet and eliminating smoking. Medications to regulate heartbeat, prevent clotting and improve blood flow may be prescribed, as well.
A cardiologist may also recommend angioplasty, a procedure in which the arteries are widened with the use of a tube and a small balloon. Once in place, the balloon helps widen the artery to allow proper blood flow. A stent, or small tube, may be left in the artery to make sure it continues properly deliver blood to the heart. The stent supports the inner artery wall.
If cases are more severe, a cardiovascular surgeon may perform coronary artery bypass grafting (CABG), or bypass surgery. Healthy arteries are installed to route blood around damaged vessels and get oxygen-rich blood to the heart. This replaces (or bypasses) the blocked part of the coronary artery. During the same operation, a surgeon may perform several bypasses. The success rate for CABG is good and can eliminate symptoms for years afterward.
Dr. Omar P. Haqqani is the chief of Vascular and Endovascular Surgery at Vascular Health Clinics in Midland: www.vascularhealthclinics.org