I.

Introduction

Angina Pectoris, severe chest pain resulting from a reduced supply of blood and oxygen to the heart. It is most often caused by a buildup of fatty deposits called plaques that block blood flow through the coronary arteries (see Arteriosclerosis). The coronary arteries supply oxygen-rich blood to the muscles of the heart. For this reason, angina is considered a symptom of coronary heart disease, which is the leading cause of death in the United States. Angina can also result from uncontrolled high blood pressure or an enlarged heart and other rare forms of heart disease. Angina most often occurs in older people.

Angina is characterized by a viselike squeezing sensation beneath the breastbone. The pain may radiate from the front of the chest, often into the arm. Pain may also appear in the neck, jaw, or back and be accompanied by sweating, nausea, or weakness. Physicians emphasize, however, that not all chest pains indicate angina. Acid reflux, for example, can cause similar but unrelated chest pain.

II.

Stable and Unstable Angina

Physicians distinguish between two main forms of angina: stable and unstable. Stable angina generally occurs when the heart needs an increased supply of blood—for example, during exercise or other physical activities. Emotional stress, smoking, and large meals or rich foods can also trigger an attack. The attacks usually last several minutes. People can usually obtain relief from stable angina through rest, relaxation, and the drug nitroglycerin. Nitroglycerin relaxes the walls of blood vessels, enlarging them and enabling more blood to reach the heart.

Unstable angina occurs unexpectedly, often while the person is resting. It generally lasts longer—as much as 30 minutes—and is more painful than stable angina. An attack of unstable angina is considered a medical emergency. It can indicate that a blood clot is partially blocking a coronary artery, a condition that may lead to a heart attack. Physicians treat unstable angina with clot-busting drugs.

Another form of angina, variant angina pectoris, also occurs unexpectedly and usually during rest. It is caused by a spasm, or contraction, in a coronary artery that narrows the artery and blocks blood flow. Arterial spasms are most often treated with calcium channel blockers. By interfering with the movement of calcium in blood vessel cells, these drugs dilate (expand) the vessels.

III.

Treatment for Angina

Treatment for angina pectoris consists largely of reducing the intensity and frequency of the painful attacks and of reducing the likelihood of a heart attack. If the attacks are fairly mild, physicians generally advise patients to make lifestyle changes such as stopping smoking; eating a healthy, low-fat diet; and losing weight. Drugs prescribed for angina work in various ways. Some, such as nitroglycerin and calcium channel blockers, increase blood flow by expanding blood vessels. Other drugs, such as beta blockers, lower blood pressure and slow the heart rate, thereby reducing the heart’s workload and its need for blood and oxygen. Physicians may also prescribe cholesterol-lowering drugs for patients with angina.

When lifestyle changes and medication are insufficient to control angina, more invasive treatment may be required to improve coronary circulation. Surgical techniques such as angioplasty and atherectomy can clear blocked arteries. In severe cases of blocked coronary arteries, coronary bypass surgery is performed.