Angina is an uncomfortable symptom of coronary artery disease. If untreated, angina has one major complication: a heart attack. Damaged and narrowed coronary arteries that normally carry oxygenated blood from the lungs to the heart contribute to angina. When the heart needs more oxygen than it is receiving, angina symptoms of chest pain, possibly radiating to the jaw and left arm, sweating, anxiety, shortness of breath and nausea occur. Risk factors for angina include high blood pressure, smoking, obesity, diabetes, alcoholism, inactivity, poor diet, male gender, advanced age and a family history of heart disease.
Heart Attack
While angina normally lasts a few minutes and goes away with rest and medication, such as nitroglycerin, the signs and symptoms of a heart attack may last longer or be more intense. The National Heart, Lung and Blood Institute advises that changes in the pattern of angina, such as additional symptoms or a poor response to nitroglycerine, may signal the beginning of a heart attack. Plaque in the coronary arteries breaks off, causing a blood clot to form and occlude circulation to the cardiac muscle. Immediate emergency medical care is needed.
Types of Angina
Stable angina is predictable and less serious than unstable angina. Symptoms occur when the heart needs more oxygen, such as during exercise, emotional stress, cold weather or following a heavy meal. The National Institutes of Health reports that most attacks of stable angina occur between 6 a.m. and noon. Rest and medication generally relieve symptoms in less than 15 minutes. Without treatment, stable angina may progress to the unstable form.
Unstable angina occurs suddenly and unpredictably, such as in the middle of the night. Attacks may be frequent and last 15 to 20 minutes with intense symptoms. In unstable angina, the risk of a heart attack is very high; emergency medical attention should be sought.
Treatment Planning
Stable angina is treatable and even reversible, if patients are educated to participate in their own care. The Angina Plan, developed by a cardiologist in the United Kingdom, uses a trained facilitator to interview angina patients and family members to dispel misconceptions about the disease. Many believe that angina is a sign of heart damage, when in fact the problem lies in the blood vessels leading to the heart. Another myth is that angina patients should not exert themselves or do any form of exercise. In fact, exercise such as walking can improve blood flow to the heart by dilating small blood vessels to compensate for damaged arteries. The facilitator also teaches healthy diet and relaxation techniques to help relieve symptoms. In a study published in 2002 in the "British Journal of General Practice," 130 patients from 25 practices were randomly assigned to the Angina Plan or standard care. Subjects on the Angina Plan reported less depression and anxiety, had fewer angina attacks, needed less medication, and were more active than those in the control group.
