Questions and Answers about Angina
Stephen J. Angeli, M.D., F.A.C.C.

Q
What is Angina?

A
Angina is a temporary pain or discomfort in the chest. Very often, the symptom is described as a pressure, tightness or heaviness across the chest. It usually happens when the supply of blood to the heart is not adequate to meet the metabolic demands of the heart muscle. The heart is an active pump with its own blood supply. The CORONARY ARTERIES are the blood vessels that carry oxygen-rich blood to the heart muscle. Not uncommonly, these arteries can become clogged with fatty deposits called atherosclerotic or cholesterol plaques.


Q
What causes these arteries to become clogged.

A
There are many factors which come into play in causing atherosclerosis. The disease usually progresses silently for many years before finally causing a problem such as angina or a heart attack. We know that certain factors place an individual more at risk. These are:

  1. Cigarette smoking.
  2. High blood pressure, or hypertension.
  3. Heredity and a family history of premature heart disease.
  4. High blood cholesterol levels.
  5. Diabetes.
  6. Possibly a highly stressful lifesyle.

Q
Aren’t women protected in some way from getting this form of heart disease?

A
NO! Women can and do have angina and heart attacks. While it is true that before menopause, a woman will have some protection from estrogen in the blood, after menopause, when estrogen levels drop, women catch up rapidly to men. The same risk factors that were mentioned above apply equally to men and women.


Q
Is angina the same as having a heart attack?

A
No. Although the new appearance of angina can be an important warning symptom to a heart attack. A heart attack usually involves a more severe blockage of the coronary artery and always results in some degree of irreversible damage to the heart muscle. This is why it is so important to pay attention to any new symptoms of chest discomfort. If angina has been a chronic condition, then any change in the pattern or severity of angina can also be an important clue to impending trouble.


Q
What does angina feel like and how do I know if I, or someone I know, is having it.

A
Angina can be confused with many other conditions. As mentioned above it is frequently described as a tightness, heaviness or pressure in the chest. Occasionally, however, discomfort is not even felt in the chest, but is felt in the shoulders, arms or lower jaw. It has been mistakenly thought to be "indigestion", "gas", bursitis of the shoulder, and even toothache! The symptoms may appear during exertion and resolve after a few minutes rest. If you, or someone you know is having symptoms like this, GET IT CHECKED OUT IMMEDIATELY. If caught at this stage, there will be no permanent damage and a life-threatening heart attack can be avoided.


Q
What should I do if I, or someone I know, is having these symptoms?

A
GET TO YOUR NEAREST HOSPITAL EMERGENCY ROOM. Delay and denial wont change the inevitable. Don’t try to diagnose yourself or waste time with a home remedy. If someone you know has told you about these symptoms, insist that they get it checked out. Offer to drive them to the hospital. Most emergency rooms today have a "NO WAIT" policy for chest discomfort. You will be seen immediately. An examination and simple tests can usually determine if a heart attack has occurred. Sometimes a definite answer can’t be given in the emergency room and a short hospital stay will be recommended. If so, tests, such as a stress test, thallium test or angiogram will determine if there is any problem with the heart’s circulation.


Q
What treatment is available for angina?

A
The treatment of angina has improved greatly in the past decade.

  1. MEDICATIONS: Important classes of drugs used to treat angina include the calcium blockers, beta blockers, and nitroglycerin-type agents. These have in common the important property of lowering blood pressure and easing the work of the heart.

    Aspirin is a useful drug that thins the blood and may prevent a heart attack. Other drugs to lower the cholesterol may be used.

  2. ANGIOPLASTY, STENTS, AND ROTATIONAL ATHERECTOMY may be recommended especially when there are one or two critical blockages. These procedures can clear a blockage without surgery. ANGIOPLASTY, which has been around the longest, uses a tiny balloon to push the fatty deposits away from the inside of the artery. STENTS are a new form of treatment in which a tiny, stainless steel mesh is placed inside the artery. This device is very good for larger arteries and can reduce the chance of a recurrent blockage later on. ROTATIONAL ATHERECTOMY is another new technique that makes use of a very high speed "burr" inside the artery. Plaque can actually be removed from the artery with this device.
  3. CORONARY BYPASS SURGERY may be recommended when there are blockages in multiple coronary arteries. In this operation, a section of vein from the person’s leg is brought into the chest and used to "bypass" the diseased coronary arteries. Very often, an artery from the chest wall, called the mammary artery is also used in the bypass operation.


Remember, no two people are the same. Treatment will always be tailored to the individual patient based upon the doctor’s assessment of such factors as seriousness of the blockages and age and coexisting illness of the individual. You are entitled to ask as many questions as you wish. Make sure you understand the risks of any treatment that is proposed. Ask the doctor to discuss alternative treatments with you.


Q
What about lifestyle changes such as diet and exercise.

A
If you have had coronary heart disease or if you are at risk for it, certain lifestyle changes are essential to lowering you risk.

  1. STOP SMOKING! DO WHATEVER IT TAKES. This has repeatedly been found to be the most serious risk factor for heart, lung and circulatory disease.
  2. Follow a diet which is low in cholesterol and saturated fats.
  3. Keep your weight, diabetes and high blood pressure under good control by taking medications and following regularly with your physician.
  4. A regular exercise program can be very beneficial. It improves the cholesterol in the blood and can condition the body to make more efficient use of oxygen. If you have had a heart ailment, consider a supervised cardiac rehabilitation program. If you have never had a heart problem, but would like to start an exercise program on your own, start by contacting your physician so that an initial stress test can be arranged, (recommended for men over 40 and women over 50).

For more information, call your doctor or 201-996-2020


Stephen J. Angeli, MD, F.A.C.C.

Dr. Angeli graduated from The State University of New York, Downstate Medical Center in Brooklyn, New York. He is certified by the American Boards of Internal Medicine and Cardiovascular Diseases. He is the Chief of Cardiology at Holy Name Hospital and is a Fellow of The American College of Cardiology. Dr. Angeli has been on staff at Hackensack University Medical Center for almost ten years. He specializes in all aspects of Clinical Cardiology.

 

For more information, look to The Heart Center or the Cardiac Prevention and Rehabilitation Center web pages.