Angina Diagnosis and Treatment

Common Symptoms of Angina

• A sensation of pain, aching, discomfort, or tightness across the front of the chest.
• Pain that typically worsens with physical exertion, such as walking uphill or against strong, cold winds.
• Discomfort that may radiate to the arms, neck, jaw, or stomach.
• Other less common symptoms of angina include:
  • Unusual pain, such as discomfort that arises while bending or eating.
  • Shortness of breath during physical exertion.
  • In rare cases, breathlessness may be the only symptom occurring without any chest pain.

These uncommon symptoms can make it difficult to distinguish angina from other conditions like heartburn or a pulled chest muscle.

Causes

Angina occurs when the blood supply to the heart (myocardial ischemia) is reduced. Several coronary artery issues can restrict the heart’s blood flow, including:

• Coronary artery disease (CAD): The most prevalent cause of angina, CAD, occurs when a fatty, waxy substance called plaque accumulates in the coronary arteries. This leads to narrowing or hardening of the arteries (atherosclerosis), limiting blood movement to the heart.
• Coronary microvascular disease: More common in women, this condition damages the small blood vessel walls branching from the coronary arteries. It is not easily detected through standard CAD testing and may require specialized tests.
• Coronary artery spasm: Temporary tightening (constriction) of the coronary arteries, restricting blood supply to the heart. This condition can occur without CAD and may require specialized diagnostic tests.

Risk Factors

Certain factors increase the risk of developing angina by affecting heart health and limiting oxygen-rich blood flow. Some risk factors, such as age, are unavoidable, while others can be managed with lifestyle changes and medical treatment. They include:

• Ageing (men over 45 and women over 55)
• Family history of early heart disease
• Anaemia (low red blood cell count)
• Diabetes
• Chronic stress
• Unhealthy diet full of saturated fat, trans fat, sodium, sugar, or refined carbohydrates
• Excessive alcohol consumption
• Exposure to air pollution, such as dust from farms, roads, or construction sites
• Heart conditions like heart failure, heart valve disease, hypertrophic cardiomyopathy (enlarged heart)
• High blood pressure
• High cholesterol
• Inflammation
• Prolonged exposure to second-hand smoke
• Metabolic syndrome
• Physical inactivity
• Obesity
• Smoking, vaping, or use of tobacco products
• Using recreational drugs

Diagnosis

Angina diagnosis is usually based on factors such as symptoms, medical history, and a clinical examination that may include certain tests.

You most certainly have angina if your chest pain caused by exertion gets better with rest or after using a Glyceryl Trinitrate (GTN) spray. You may still have angina and coronary artery disease even if you don’t fit all of these requirements.

Your doctor will assess your heart rate, blood pressure, and potential signs of obstructive coronary artery disease, such as a fast heartbeat (tachycardia) or raised jugular venous pressure (visible in the neck).

Angina testing:

To confirm an angina diagnosis, several tests may be performed, including:

• Coronary angiogram (primary test for typical angina): A coronary angiogram is a minimally invasive procedure where a tiny tube (catheter) is placed into the radial artery of the arm. The catheter is directed to the heart using X-ray imaging, and a contrast dye is injected to highlight the coronary arteries. X-ray images reveal any blockages and their severity.
• Cardiac CT scan: A CT coronary angiogram is a less invasive alternative to a traditional angiogram. It provides detailed imaging of the coronary arteries without the need for catheter insertion.

Other diagnostic tests:

• Stress testing: Medication is given to increase heart rate and oxygen demand, mimicking the effect of exercise.
• Electrocardiogram (ECG): Measures electrical activity in the heart.
• Echocardiogram: Uses ultrasound to visualise heart function and blood flow.
• MRI scan: Provides a detailed image of heart structure and detects restricted blood flow.

Treatment Options

The primary goal of angina treatment is to enhance blood flow to the heart and reduce the risk of complications. Your healthcare provider will conduct a physical examination and perform diagnostic tests to determine the most effective treatment plan.

Common treatment options are:

• Anticoagulants & antiplatelet medications to reduce the possibility of blood clots
• Blood pressure medications
• Cholesterol drugs
• Angina-specific medications
• Lifestyle modifications
• Percutaneous coronary intervention (PCI) / coronary angioplasty and stenting
• Coronary artery bypass grafting (CABG)

Some patients continue to have angina despite treatment. When you experience discomfort, your doctor could recommend a medication to expand your blood vessels more quickly. One common angina drug is glyceryl trinitrate (GTN).

For those who experience persistent discomfort, enhanced external counter pulsation (EECP) is an additional alternative. By applying pressure to your lower legs, this therapy helps to increase the flow of blood to your heart. This could help alleviate your angina.

Conclusion

Angina is a frequent indicator of heart disease. Many individuals can control their symptoms by recognising triggers and understanding when to take medication or rest. However, in some cases, angina may signal a heart attack. Recognising when to seek emergency medical assistance can be life-saving.

By consulting us, we can help you distinguish between your usual angina symptoms and those that require urgent medical attention.

For more information or to address any concerns, book an appointment with us today.