Angina: a common symptom of coronary artery disease
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
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.
Matters" is written in cooperation with staff members of Boston Medical
Center. For more information on hypochondria or other health matters,