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Angina: a common symptom of coronary artery disease

I have recently experienced chest pain while exercising. The pain goes away when I stop the exercise. Am I having minor heart attacks?

It is more likely that you are experiencing angina, a recurring pain or discomfort in the chest when the muscle of the heart does not receive enough blood. Angina feels like a pressing or squeezing pain under the breastbone, and sometimes in the shoulder, arms, neck, jaw, or back. For some people, it has features of indigestion, while others feel no pain or discomfort, but rather, sudden breathlessness.

In 1772, William Heberden offered a description of angina to the Royal College of Physicians: “They who are afflicted with it, are seized while they are walking, (more especially if it be uphill, and soon after eating) with a painful and most disagreeable sensation in the breast, which seems as if it would extinguish life, if it were to increase or to continue; but the moment they stand still, all this uneasiness vanishes.”

Unlike a heart attack, which occurs when blood flow to a portion of the heart is suddenly and permanently cut off, the pain of angina is of shorter duration, is less severe, and is generally relieved within a few minutes of resting or by taking prescribed medication. Episodes of angina rarely cause permanent damage to the heart muscle.

“The difference between angina and heart attack is a measure of degree,” says Thomas J. Ryan, M.D., a cardiologist at Boston Medical Center and a professor of medicine at BU’s School of Medicine. “Angina is of a shorter duration -- generally about 2 minutes or so -- while the pain associated with heart attacks usually lasts up to 30 minutes or longer. And since the blood flow is impeded only temporarily, there is no permanent damage to the heart. On the other hand, during a heart attack part of the heart muscle dies.”

Angina is a symptom of coronary artery disease (CAD), the leading cause of death in the United States, in which plaque lining the walls of the coronary blood vessels restricts blood flow to the heart. This underlying disease should be treated by controlling risk factors associated with CAD, including high blood pressure, high blood cholesterol, cigarette smoking, diabetes, and excess weight. “People with angina should control their physical activity, adopt good eating habits, moderate their alcohol consumption, and quit smoking,” says Ryan. These precautions can help angina sufferers live more comfortably and with fewer angina attacks.

The most commonly prescribed drug for treating angina is nitroglycerin, which relieves pain by widening the blood vessels, allowing more blood to flow to the heart muscle and reducing the heart’s workload. Ryan says that beta blockers and calcium channel blockers, common high blood pressure medications, are also given to angina sufferers to slow their heart rate and lessen the force of the heart muscle contraction. Surgery, including coronary artery bypass graft and angioplasty, may be recommended if drugs fail to ease angina or if the risk of heart attack is high. Ryan says that bypass surgery was introduced in 1967 to treat angina that did not respond to medication.

There are two major types of angina -- stable and unstable. Stable angina occurs when patients can more or less predict an attack based on experience. Unstable angina is said to occur when someone with stable angina suffers attacks with increasing frequency and severity. Variant angina, a comparatively rare form of angina, is caused by vasospasm, a spasm that narrows the coronary artery and lessens blood flow to the heart.

Ryan says that recent studies suggest that people with unstable angina are three times more likely to have an “adverse cardiovascular event,” such as a heart attack, than patients whose symptoms are more stable. And, he says, while patients with angina are at an increased risk of suffering a heart attack, an angina attack does not necessarily mean that a heart attack is about to occur.

"Health Matters" is written in cooperation with staff members of Boston Medical Center. For more information on hypochondria or other health matters, call 617-638-6767.

       



1 November 2002
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