Angina, more formally referred to as angina pectoris, is a hallmark symptom of heart disease involving the blockage of coronary blood flow. It presents itself when the supply of blood to the heart cannot meet its demand. Signs of angina include chest pain, a feeling of indigestion or shortness of breath. The pain of angina typically lasts 10 to 30 minutes, though it may last longer in some patients, explains Dr. Prediman Shah, co-author of "Current Diagnosis and Treatments in Cardiology."
Character
Angina typically occurs as a pain or discomfort behind the mid-chest area and can radiate outward to the lower jaw, left and right arms, and upper back. This feeling can vary and is described as mild to high pressure crushing or squeezing with an occasional feeling of numbness and burning sensation, explains Dr. Frank Chen, co-author of "Mayo Clinic Cardiology: A Concise Text." When anginal pain does affect the limbs, it usually runs down the outside surface of the left arm, though it can spread to both. Gastrointestinal discomfort, shortness of breath, fatigue and light-headedness are other associated symptoms of angina.
Duration
Angina is commonly characterized by a fast, yet steady increase in the intensity of pain over a period of minutes. However, bouts lasting hours or short-lived periods lasting a few seconds are not typical of angina, notes Chen. It is often triggered by exercise, cold temperature or large meals and alleviated by rest and nitroglycerin, a blood vessel-expanding drug. If the pain does not go away within 5 to 10 minutes of rest or nitroglycerin use, it may indicate a heart attack is happening or has occurred.
Examination
In examining a patient showing symptoms of angina, a physician looks for irregular heart sounds involving the bottom-left heart chamber, referred to as the left ventricle. The lack of cardiac blood flow responsible for causing episodes of angina often results in delayed contraction of the left ventricle. However, some patients with angina may have physical exams that are considered normal without complications, explains Chen.
Grading Severity
The Canadian Cardiovascular Society's guidelines for grading the severity of anginal symptoms are widely accepted in the medical field, explains Shah. Four classes of severity are used, with four being the most severe. Class one angina is used to categorize symptoms that present only with sudden and strenuous physical activity. Symptoms of Class two angina are brought about by walking rapidly or climbing stairs after meals. Class three angina describes the occurrence of symptoms during light activity, such as walking around the house or one block down the street. Class four angina, the most severe category, is used to describe instances in which symptoms manifest at the lowest level of physical activity and possibly at rest.
Other Diagnoses
Symptoms of angina resemble those of many other medical conditions, including heart attack, rupture of the aorta, pulmonary hypertension, pulmonary embolism, inflammation of the heart, upset stomach, acid reflux, gall bladder diseases, Tietze Syndrome and shoulder tendonitis, and all may result in pain similar to the symptoms of angina.
References
- "Current Diagnosis and Treatments in Cardiology"; Unstable Angina/Non-ST Elevation Myocardial Infarction; Dr. Prediman Shah; 2009
- "Mayo Clinic Cardiology"; Chronic Stable Angina; Dr. Prediman Shah, Dr. Frank Chen; 2007
