(Unstable angina, stable angina, breast angina, cardiac angina, variant angina)

What is Angina

Angina is a pain or discomfort in the chest. Often, it causes a feeling of oppression. This discomfort can also be felt in the shoulders, arms, neck, jaw or back. In general, the pain of angina persists no more than two to ten minutes. To relieve it, you have to rest or supply nitroglycerin.

The types of angina are:

1. Stable angina: has predictable characteristics. In general, it is known what produces it and what relieves it. You can also know what will be its intensity.
2. Unstable angina: it is more unpredictable or severe. Chest pain may occur while you rest or even when you sleep (nighttime angina). The discomfort may persist longer and be more intense than that of stable angina.
   Unstable angina can be a sign that you are about to suffer a myocardial infarction. It should be treated as an emergency.
3. Variant or Prinzmetal angina: occurs while resting. In most cases, it occurs in the middle of the night. It can be quite serious.

Typical areas where angina pain is felt

      Women are more likely to suffer atypical pain, in addition to these areas.

What are the Causes of Angina

In general, angina is a sign of coronary artery disease (CAD). It occurs when the blood vessels that lead to the heart become blocked. The blockage decreases the flow of blood and oxygen to the heart muscle. When the heart muscle lacks oxygen, it causes chest pain and other symptoms.

Types of Angina

Stable or unstable angina

Angina occurs when the heart's need for blood and oxygen increases because of:

• Exercise, effort
• Cold weather
• A hearty meal
• Emotional tension

Stable angina becomes unstable when the symptoms:

• They occur more frequently
• They persist longer
• They occur more easily
• Angina variant or Prinzmetal

In general, this type of angina is caused by a spasm of a heart vessel. It may indicate that you have one of the following conditions:

• CAD
• Extreme hypertension
• Hypertrophic cardiomyopathy
• Diseases of the heart valves

What are Risk factors of Angina

The main risk factors of CAD include:

• Sex: male
• Advanced age
• Proven family history of heart disease
• Obesity and overweight
• Smoking
• High blood pressure
• Sedentary lifestyle
• High blood cholesterol level (specifically, high level of low density cholesterol (LDL) and low level of high density
• cholesterol (HDL)).
• Diabetes

Other risk factors of CAD:

• Stress
• Excessive alcohol intake

What are Symptoms of Angina

1. Oppressive chest pain
2. Some people do not feel serious pain
3. Elderly people, women and people with diabetes may be more likely to have atypical or subtle symptoms
4. Some people have asymptomatic ischemia and have no symptoms of chest pain.
5. Chest pain of any kind requires a clinical evaluation to determine its cause.
6. Pain or discomfort in the chest is the hallmark of angina

The probability of suffering a myocardial infarction increases when the pain in the chest is intense, when it persists for more than 15 minutes and when it is accompanied by other symptoms, including:

Pain in the shoulders or arms or in the jaw

• Weakness
• Sweat
• Sickness
• Shortness of breath

Diagnosis of Angina

Tests will be done immediately to see if you are suffering from an episode of angina or a myocardial infarction. If it presents characteristics of stable angina, other tests can be performed to determine the degree of the disease. The results of the test will be useful to develop a treatment plan.

The doctor will ask about your symptoms and medical history. You will have a physical examination.

Tests may include:

1. Blood test: to look for certain blood indicators and determine if you have a myocardial infarction
2. Electrocardiogram (ECG): a record of the heart's electrical activity, to look for signs of previous heart attacks, acute heart attacks, or heart rhythm problems
3. Echocardiogram: high frequency sound waves (ultrasound) are used to examine the structure and function of the heart
4. Exercise stress test: records the electrical activity of the heart when it has a higher demand
   In people who can not exercise, a medication is used to simulate the effects of physical exertion
5. Gammagraphy: radioactive material is injected into a vein to highlight areas of low blood flow
6. Computed tomography with electron beam (coronary calcification scan, cardiac scan, CT angiography) -a type of x-ray that uses a computer to obtain detailed images of the heart, coronary arteries, and surrounding structures
7. Type of CT that measures the amount of calcium deposits in the coronary arteries to determine the risk of heart disease or myocardial infarction.
   The general guidelines of the American Heart Association (AHA) state that cardiac scans are not suitable for everyone and are more likely to benefit patients who are at intermediate risk of CAD.
8. Coronary angiography-a dye is injected into the arteries to highlight abnormalities (stenosis or obstruction) in the arteries

What is Treatment for Angina

Treatments for angina include:

Medicines

1. Nitroglycerin: usually given during an attack of angina in the form of a tablet that dissolves when placed under the tongue or in the form of an aerosol.
   The longest types can be used before performing an activity, to prevent angina. They can be supplied in the form of tablets or they can be applied as patches or ointments.
2. Anticoagulants: it has been proven that a small daily dose of aspirin decreases the risk of suffering a myocardial infarction.
   Some people may benefit from incorporating warfarin (eg, Coumadin). When taking this medication, there is a greater risk of bleeding.  Check with your doctor before taking aspirin or warfarin daily.
3. Beta-blockers and calcium antagonists: can reduce the appearance of angina.
   Medications to reduce cholesterol: can prevent the evolution of a CAD. They can even improve an existing CAD.
4. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs): lower blood pressure and demand for the heart.

Surgery

Patients with severe or unstable angina evolving may benefit from:

1. Coronary Artery Bypass Graft: Arteries from other parts of the body are used to bypass obstructed coronary arteries
2. Coronary angioplasty: uses a balloon to open clogged arteries

How to Prevention Angina

If you already have angina, you can avoid a manifestation by knowing what causes it.

If you do not have angina, avoiding the development of a CAD can decrease the chance of getting the condition.

The steps to prevent CAD involve controlling risk factors:

1. Maintain a healthy weight
2. Begin a safe exercise program with the advice of the doctor.
3. Stop smoking.
4. Eat a healthy diet It must have a low content of saturated fats. In addition, it must have a high content of whole grains, fruits and vegetables.
5. Appropriately treat high blood pressure or diabetes.
6. Appropriately treat abnormal cholesterol levels or elevated triglycerides.