Angina and heart disease

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Angina and heart disease become more common as we age. This advice can help you spot 'heart trouble' early.

Angina is a tell-tale sign of potentially dangerous heart conditions that can lead to a heart attack.

Over million people in the UK suffer from angina, a form of coronary heart disease.  It is more common in older people, and affects more women than men. Angina presents as chest pain or tightness in the chest, most likely to occur when exercising, after a meal or when stressed.  The pain can spread to the neck and arms.

An attack of angina doesn't normally last for more than a few minutes. Resting will speed recovery.

Angina is often confused with indigestion.

Types of angina

Stable angina

Caused by the narrowing of blood vessels supplying the heart, thereby restricting the blood supply during exertion. The pain lasts for a few minutes and goes away when you rest.

However, it may return when the exertion begins again.

Stable angina can be controlled with medication. If you think you have stable angina, see your GP as the narrowing of blood vessels is dangerous, leading to strokes and circulatory illnesses.

Unstable angina

This begins after only a little effort or even when resting. It usually happens when one of the blood vessels supplying the heart becomes so narrowed that there is an immediate risk of a heart attack. Therefore if the chest pain occurs even when doing little exercise, and if only for a short period of time, you should see your GP.

Variant angina

This occurs without warning and is due to a spasm of a coronary artery. During an attack, there can be irregularities in the normal rhythm of the heartbeat. If you think you have had an attack of variant angina, see your GP.

Angina and heart attack

 A heart attack, also called a myocardial infarction or MI, is when a coronary artery becomes completely blocked and unable to supply blood to the heart muscle which then fails, unless the blockage is relieved rapidly.

The pain is greater and more prolonged than angina and doesn’t go away with normal angina treatment.  Other symptons include feeling sick, vomiting, breathless and excess sweating.

However, a heart attack can be sudden with no early symptoms.

Causes

Angina is normally caused by the narrowing of the coronary arteries by fatty deposits, a process called atherosclerosis.

Other causes are:

  • heart valve disease;
  • anaemia (not enough red blood cells);
  • fast or abnormal heart rhythms;
  • diseased heart muscle;
  • spasm or cramping of the coronary arteries.

Risk factors

You are more likely to have, or be at risk of, coronary heart disease if you:

  • have high blood cholesterol;
  • have high blood pressure;
  • have diabetes;
  • smoke;
  • drink excessive alcohol;
  • don’t exercise enough.

Angina can run in the family, so there could be a higher risk if a close relative has or had angina.

Diagnosis

If you believe you have angina, or are worried by chest pains, see your GP who will ask questions about the pain and listen to your heart and chest, check your blood pressure, and look for signs of anaemia. Further tests to diagnose a heart condition include:

  • An ECG (electrocardiogram), to measure the heart's electrical activity;
  • Blood tests, such as a blood count, cholesterol and lipid levels, and cardiac enzymes (released by damaged heart cells);
  • An echocardiogram to see the heart's chambers and valves;
  • An angiogram, where a dye is injected to show up on X-ray any blockages and narrowing of the coronary arteries.

Treatment

Short-term treatment of symptoms

Glyceryl trinitrate (GTN) is a nitrate that comes as a spray or tablets to take when an angina episode starts.

It is a short acting treatment that relaxes the coronary arteries to enable more blood to reach the heart muscle.

Long-term treatment to prevent angina attacks

Long-acting nitrates (eg isosorbide mononitrate) which widen the coronary arteries to improve blood flow to the heart.

Aspirin, which lowers the risk of heart attack by preventing clotting.

Beta-blockers such as atenolol and bisoprolol slow the heart rate and the pumping power of the heart, thus reducing the heart's demand for oxygen. Beta-blockers aren't suitable for people with asthma.

Calcium-channel blockers such as nifedipine relax the coronary arteries and other blood vessels, and ease the contraction of the heart.

Potassium-channel activators (nicorandil) also relax coronary arteries to increase blood flow.

Statins reduce cholesterol level and so prevent further fatty deposits in the coronary arteries.

Surgery

Surgery may be required for people with severe angina. The two most common interventions are angioplasty and coronary artery bypass graft.

Angioplasty, also known as PCI, is the insertion of a collapsed balloon into the blocked coronary artery where it is inflated to widen the artery. Sometimes a flexible tube will be inserted to keep open the artery.

A coronary artery bypass graft (CABG) is open-heart surgery using vessels from the legs or chest to bypass the blockage.

Prevention

The following will help prevent angina attacks and help stop angina progressing to a heart attack:

  • Stop smoking;
  • If you are overweight, lose weight;
  • Eat less fatty food such as red meat and dairy products;
  • Eat more oily fish and fruit and vegetables;
  • Reduce your alcohol intake;
  • Take regular exercise;
  • Reduce stress and increase relaxation; and
  • Visit your doctor regularly.

More information is available from BUPA and the British Heart Foundation.

Tags: age related illness heart attack angina

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