Angina Pectoris

About Your Angina
Angina, or angina pectoris, is a recurring discomfort. It usually lasts just a few minutes. It's often in the center of the chest, behind the breastbone. People describe it as a heaviness, tightness, oppressive pain, burning, pressure or squeezing. Sometimes it spreads to the arms, neck or jaws. It may also cause a numbness in the shoulders, arms or wrists.

Symptoms in women sometimes differ. The pain may be less intense, last longer and occur in locations other that the center of the chest, such as the shoulder, jaw or back. Women may also experience breathlessness and nausea.

Angina occurs when the heart muscle doesn't get the blood supply (and oxygen) it needs.

Angina and Heart Attack
In angina, the blood flow is reduced, especially when the heart must do more work.

In a heart attack, blood flow to part of the heart muscle is suddenly cut off when a coronary artery is blocked.

Angina attacks usually don't permanently damage the heart muscle. A heart attack, on the other hand, may if not treated promptly.

What Causes Angina?
Angina and heart attack have the same root cause - atherosclerosis. This is the narrowing of the coronary arteries caused by deposits of fatty substances such as cholesterol. It usually starts early in life. Everyone has it to some degree by middle age.

Diagnosing Your Condition
Usually your doctor can diagnose angina from your description of symptoms. Your physical examination and resting electrocardiogram can be entirely normal. That's why your doctor may recommend an exercise test to increase your heart's demand for blood and oxygen. An electrocardiogram or imaging studies recorded during an exercise test can show if your heart isn't getting enough oxygen.

It can be hard to diagnose angina even after a medical history, a physical examination and an exercise test. If that's the case, your doctor may order a nuclear medicine (Cardiolite or Myoview) stress test. During this special exercise test, a radioisotope is injected into a vein and the blood flow to your heart muscle is measured while you exercise.

Coronary Arteriography
Coronary arteriography is an x-ray procedure that is used to examine the arteries of your heart with a special camera. The procedure is done in a catheterization laboratory ("cath lab").

The physician who performs the procedure inserts a thin plastic tube into an artery in your arm or leg.

When the catheter is in place, a dye will be injected to allow the physician to see what the problem with your coronary arteries might be. The catheter is a radiopaque so that the physician can watch under the fluoroscope and thus direct the catheter into the coronary arteries.

PTCA
If medication doesn't control your angina, your doctor may suggest percutaneous transluminal coronary angioplasty (PTCA). This procedure can increase blood flow in a narrowed blood vessel.

In PTCA the doctor inserts a ballon-tipped catheter into a artery. When the tip is guided to where the blood vessel is narrowed, the balloon is inflated, compressing the plaque. Then the balloon is deflated and the catheter withdrawn.

Stent procedure
A stent procedure uses a wire mesh tube (a stent) to prop open an artery that's recently been cleared using angioplasty. The stent is collapsed to a small diameter, placed over an angioplasty balloon catheter and moved to the blockage. When the balloon is inflated, the stent expands and locks in place. This forms a rigid support to hold the artery open. The stent stays in the artery permanently, holding it open, improving blood flow and relieving chest pain.

Surgery
Your doctor may advise bypass surgery. In this operation, an artery or vein (taken from the chest or leg) is grafted onto the blocked artery, bypassing the blocked area. If more than one artery is blocked, each one may receive a bypass.