Angina attack

1. What Is an Angina Attack?

An angina attack is a recurring sensation of chest pain or discomfort caused by an area of the heart not receiving enough blood and oxygen. An angina attack may be a symptom of coronary artery disease. Chest pain occurs when the arteries supplying blood to the heart become narrowed or blocked by atherosclerotic plaque or blood clots. It may also result from unstable atherosclerotic plaque, narrowed heart valves, reduced pumping function of the heart, or coronary artery spasm.

There are also two other types of angina: Prinzmetal (variant) angina and microvascular angina.

1.1. Prinzmetal Angina, Also Known as Variant Angina

Rare
Occurs almost exclusively when the patient is at rest
Usually does not occur after physical exertion or psychological stress
Can be very painful and often occurs between midnight and 8 a.m.
Caused by coronary artery spasm
More common in women
May improve with medications such as calcium channel blockers, which help dilate the coronary arteries and prevent spasms.

1.2. Microvascular Angina

A type of angina that has only recently been studied
The patient does not have obstructive coronary artery disease
Studies show that patients experience chest pain due to impaired function of the small blood vessels supplying the heart, as well as the arms and legs
May be treated with medications used to treat angina
Previously referred to as Syndrome X
More common in women

2. What Causes an Angina Attack?

An angina attack occurs when the heart muscle does not receive enough blood and oxygen to function, a condition known as myocardial ischemia.

3. When Is There a Risk of an Angina Attack?

Any situation that causes the heart muscle to require more blood and oxygen can trigger an angina attack. Risk factors include physical exertion, psychological stress, excessively cold or hot temperatures, heavy meals, excessive alcohol consumption, and smoking.

4. What Are the Symptoms of Stable Angina?

The most common symptoms of angina include:

A feeling of pressure, squeezing, or crushing, usually in the center of the chest
Pain that may radiate to the arm, shoulder, jaw, neck, or back
Shortness of breath
Fatigue
Feeling lightheaded
Chest pain that usually improves after a few minutes of rest or after taking an anti-anginal medication such as nitroglycerin

When you experience an angina attack, part of the heart is not receiving enough blood and is at risk of myocardial infarction. You should pay attention to the progression of your chest pain: when it occurs, how severe it is, how long it lasts, and whether it improves after taking medication. If your chest pain suddenly changes, occurs at rest, or becomes unpredictable, you should seek emergency medical care immediately, as you may be having a myocardial infarction. Have someone else take you to the hospital and do not drive yourself.

An angina attack may make you think that you have another condition unrelated to the heart. You should see a doctor for an accurate diagnosis.

5. How Is an Angina Attack Diagnosed?

The doctor will take a detailed medical history and perform a thorough physical examination. Some tests may be indicated:

Electrocardiography (ECG): Sensors are attached to the patient's skin to detect the heart's electrical activity, helping identify abnormalities in heart rhythm and possible myocardial injury.
Stress testing: The patient exercises on a treadmill while cardiac activity is monitored. Stress tests help diagnose coronary artery disease and determine a safe exercise threshold. Stress testing can also be performed while the patient is at rest by using specific medications to induce cardiac stress.
Coronary angiography: During this procedure, physicians advance a catheter into the arteries supplying the heart and inject contrast material. X-ray imaging is used to clearly visualize areas of narrowing, blockage, or other abnormalities in the coronary arteries.
Cardiac MRI: Using specialized imaging equipment, physicians can assess the amount of blood supplied to the heart muscle; however, this technology is not available at every hospital.
Coronary CT angiography: Specialized imaging equipment helps physicians determine the extent of calcification and atherosclerosis within the arteries supplying the heart.

6. How Is an Angina Attack Treated?

The doctor will develop a treatment strategy based on:

Your age
Your medical history
Your current medical condition
Your ability to take medications or undergo procedures or surgery
Your tolerance of symptoms
Your treatment preferences

Your doctor may prescribe medications to relieve chest pain. The most commonly used medication is nitroglycerin, which dilates the coronary arteries and increases blood flow to the heart muscle. Nitroglycerin is available in extended-release formulations as well as sublingual sprays or tablets used to relieve pain during an attack. Medications such as beta-blockers and calcium channel blockers are also used to relieve chest pain. In addition, your doctor may prescribe other classes of medications.

7. What Complications Can Angina Cause?

Angina is a sign that you have coronary artery disease and that some areas of the heart are not receiving enough blood. Having angina also means that you are at risk of myocardial infarction.

8. Can Angina Attacks Be Prevented?

Maintaining a healthy lifestyle can help reduce or prevent angina attacks. A healthy lifestyle includes:

Eating a healthy diet
Engaging in regular physical activity and exercise
Managing stress
Not smoking or quitting smoking
Maintaining a healthy weight
Taking prescribed medications as directed
Managing other risk factors such as hypertension, dyslipidemia, diabetes, and overweight

9. When Should You Seek Emergency Medical Care Immediately?

You should seek emergency medical care if you experience any of the following:

Your angina symptoms clearly change from your usual pattern
Chest pain occurs at rest
Symptoms do not improve despite taking nitroglycerin
Symptoms last longer than usual
Symptoms become more unpredictable than before
You may be experiencing a myocardial infarction. Have someone take you to the emergency department and do not drive yourself.

The information above is for reference purposes only and is not intended as medical advice. Please contact your doctor for detailed medical consultation.