Why is your chest hurting?
You’re walking up the flight of stairs in your house just like you’ve done multiple times a day, every day for the past 20 years, when all of a sudden, your chest starts hurting. You stop on the stairs and after a moment the pain is gone and you continue going up. What caused this to happen? Is it serious?
Angina is when you have chest pain as a result from reduced blood flow to your heart. Since blood carries the oxygen that your cells need to survive, when the flow is decreased, the level of oxygen reaching the cells is decreased. This lack of oxygen is called ischemia. One of the main reasons you can have reduced blood flow to your heart is coronary artery disease (CAD), which is when your arteries become narrowed due to buildup of fatty deposits, as known as plaques. This process is known as atherosclerosis. Until the buildup of plaque becomes significant, your body will compensate and be able to function without you noticing much difference. The problem arises when you increase the demand for oxygen in the cells through increased physical activity and your body can’t supply it because it can’t get enough blood to your heart due atherosclerosis. This is why when you exert yourself you have pain, but when you aren’t, then you don’t have pain.
There are two types of angina: stable and unstable. Stable angina is the most common and develops when your body works harder to get oxygen to the cells of your heart. It usually lasts a short time and can disappear sooner if you rest or take angina medication. Typically, there is a pattern to the severity, duration and characteristics of your pain. Unstable angina can occur at rest, is unexpected, different from your usual pattern of angina, more severe, lasts longer and may not be relieved by angina medication. This type can signal that you are having heart attack and should be treated immediately by emergency personnel. The main symptom of angina is chest pain/discomfort (usually described as a pressure, squeezing, burning or fullness sensation) and the pain radiates to your arms, neck, jaw, shoulder or back. Also, many people have nausea, fatigue, shortness of breath, sweating and dizziness. Women can experience symptoms that are different from the typical angina symptoms. This can result in them not seeking treatment as quickly as they should. While women can have chest pain, it is not the most prevalent symptom. Usually they have nausea, shortness of breath, abdominal pain, discomfort/ache in neck, jaw or back and a stabbing pain in the chest rather than a pressure sensation.
There are two main goals in treating angina. The first is to reduce the frequency and severity of symptoms and the second is to decrease the risk of heart attack and death. For lifestyle changes that you can make to help treat your angina, please see the Prevention section since they are the same techniques. As far as medications to treat angina, there are several options. Your doctor may prescribe a medicine from the nitrate family, such as nitroglycerin. These medications work by relaxing your blood vessels, which allows more blood to flow through. A side effect of these medications is that they can lower your blood pressure rapidly. Depending on the severity of your angina, your doctor may have you take it daily, prior to doing something that would increase your activity level or only if you are having an angina episode. Calcium channel blockers work similarly to nitrates, but usually have a longer lasting effect. Another class of medicine that your doctor might prescribe are those that prevent blood clots from forming, such as aspirin, warfarin, clopidogrel, prasugrel and ticagrelor. Your doctor might also prescribe a beta blocker medication, which causes your heart to beat slower with less force resulting in a lower blood pressure. Two other classes of medicine that lower your blood pressure are angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). The reason why there are so many medications that can control your blood pressure is due to the fact that your blood pressure is a delicate balance of several processes that occur at the same time. So, different medicines work at different points in the process. This is why you might be on more than one medication to control your blood pressure. One final area that your doctor will take a look at addressing is your cholesterol. By reducing the amount of the build up of plaques and, in some cases, reabsorbing some of what has already accumulated, the narrowing of your blood vessels can be decreased. The class of medications that deal with this are called statins. Unfortunately, if your angina is severe and you aren’t getting relief from medication, then your doctor may suggest angioplasty (inserting a tiny balloon into the narrowed artery, inflating it to widen the space and placing a small wire mesh coil, or stent, to keep it open) or coronary artery bypass surgery (using an artery or vein from elsewhere in your body and grafting it on to your heart to bypass the affected coronary artery).
The key to preventing angina from occurring is lifestyle changes. Maintain a healthy weight by eating a balanced and nutritious diet. Exercising regularly is also key in being able to do this. Don’t drink excessive amounts of alcohol (ex. more than two drinks a day for men and more than one drink a day for women). Manage your stress level so it doesn’t get out of control. Don’t smoke and quit if you do. Keep your other health conditions in check.
Angina is your body’s way of warning you that all is not well. It is vital you listen to this message! If you have any questions or concerns, please speak with your doctor. If you would like more information, please visit the American Heart Association’s Angina page at https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain