Angina is a pain or discomfort in the chest. It often has a squeezing or pressure-like feel. This discomfort can also be felt in the shoulders, arms, neck, jaws, or back. Anginal pain usually lasts for no more than 2-10 minutes. It is relieved by rest or nitroglycerin .
Types of angina include:
Angina is usually a sign of coronary artery disease (CAD). It occurs when the blood vessels leading to the heart are blocked. The blockage decreases the blood and oxygen flow to the heart muscle. When the heart muscle is deprived of oxygen you will feel chest pain and other symptoms.
Angina occurs when your heart's need for blood and oxygen is increased by:
Stable angina becomes unstable when symptoms:
This type of angina is usually caused by a spasm of a heart vessel. It may indicate that you have one of the following conditions:
Major risk factors for CAD include the following:
Other risk factors for CAD:
The likelihood of a heart attack is increased when chest discomfort is severe, lasts more than 15 minutes, and is accompanied by other symptoms such as:
Tests will be done right away to see if you are having an episode of angina or a heart attack. If you have a stable pattern of angina, other tests may be done to determine the extent of your disease. The test results will help to create a treatment plan.
The doctor will ask about your symptoms and medical history. A physical exam will be done.
Tests may include:
Treatments for angina include:
Patients with severe angina or unstable, progressing angina may benefit from:
If you already have angina, you can prevent an onset by being aware of what starts it.
If you don't have angina, preventing the development of CAD may reduce your chance of getting the condition.
Steps to prevent CAD include managing risk factors:
RESOURCES:
American Academy of Family Physicians
http://familydoctor.org/
American Heart Association
http://www.americanheart.org/
National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov/
CANADIAN RESOURCES:
Canadian Cardiovascular Society
http://www.ccs.ca/
Canadian Family Physician
http://www.cfpc.ca/
REFERENCES:
Dambro MR. Griffith's 5-Minute Clinical Consult . 2001 ed. Philadelphia, PA: Lippincott Williams & Wilkins;2001.
Dickstein K, Kjekshus J. Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial infarction: the OPTIMAAL randomised trial. Lancet. 2002;360:752.
Lopez-Sendon J, Swedberg K, McMurray J, et al. Expert consensus document on angiotensin converting enzyme inhibitors in cardiovascular disease. The Task Force on ACE-inhibitors of the European Society of Cardiology. Eur Heart J . 2004;25:1454.
Reenan J. Clinical Pearl: Indications for bypass surgery. American Medical Association website. Available at: http://www.ama-assn.org/ama/pub/category/11853.html . Accessed November 16, 2006.
What is angina? American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=3007460 . Accessed June 16, 2008.
What is angina? National Heart, Lung, and Blood Institute. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Angina/Angina_WhatIs.html . Accessed June 16, 2008.
*Updated section on Blood Thinners on 7/14/06 according to the following study, as cited by DynaMed's Systematic Literature Surveillance : Andreotti F, Testa L, Biondi-Zoccai GG, et al. Aspirin plus warfarin compared to aspirin alone after acute coronary syndromes: an updated and comprehensive meta-analysis of 25,307 patients. Eur Heart J . 2006;27:519-26.
Last reviewed February 2009 by Igor Puzanov, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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