Chest pain or angina is one of the most common symptoms of coronary artery disease. It is usually described as chest pain on the left side, sometime extending down the left arm and up to the jaw. The chest pain frequently comes on with exertion and subsides with rest. It is important to know that angina can be experienced in many different ways: for example, at mealtimes, when exposed to cold weather and stress of all kinds; or as pain on the right side, back, and in the abdomen. Angina can mimic other conditions like reflux, peptic ulcer and gallbladder disease. In some patients, typically a diabetic, coronary artery disease can be silent. Other symptoms of coronary artery disease may include shortness of breath and fatigue.
Frequently Asked Questions
What causes angina?
Angina is caused by an insufficient blood supply to one or more regions of the heart. The most common cause is a blockage in a coronary artery. Infrequent causes are coronary artery spasm and blood clots. Angina is a warning from the heart that it is not getting a sufficient amount of oxygen.
How do I know that I am experiencing angina and not a heart attack?
Angina is usually brief in duration, less severe in intensity, and subsides with rest or with nitroglycerin. In contrast, the chest pain of a heart attack is severe and unrelenting. It may be associated with difficulty in breathing, sweating, light-headedness, and a sensation of doom. When you are doubtful about whether it is a heart attack or angina you are experiencing, seek medical advice immediately.
What should I do if I have angina?
Stop whatever activity has brought on the angina. Sit down and take a rest. If you have a known history of coronary artery disease and your doctor has prescribed sublingual nitroglycerin, take the medication as directed by your doctor.
If you've never experienced these symptoms before, make an appointment to see a physician. If you are uncertain if it is urgent that you see a doctor, speak with your family physician or one of the office nurses. For more severe pain or pain that persists, call an emergency medical service without delay. It is probably best to start with your primary care physician because many causes of chest pain are unrelated to the heart.
What if the angina persists?
If the angina doesn't subside with rest or with several sublingual nitroglycerin tablets, you should treat this as an emergency and call an emergency service for help.
Health
What should I do if the angina has changed recently?
If you have a history of coronary artery disease and your previously stable angina pattern has changed, an appointment with the treating physician should be made immediately. Changes in how you typically experience angina may suggest progression of coronary artery disease and the need for additional therapy or intervention.
How is my chest pain evaluated by a physician?
The physician begins with a medical history and physical examination. An electrocardiogram (a test which measures electrical flow through the heart to measure the functioning of the muscle -- referred to as either an EKG or ECG) and blood tests are usually part of the initial evaluation. If your physician suspects coronary artery disease, you will likely be referred to a heart specialist, although some primary care physicians will continue to evaluate you themselves. The next step is a treadmill stress test, which determines if your chest pain can be brought on by exercise and if there is evidence of coronary artery disease. After the stress test, there are many different diagnostic and treatment options. If the stress test is positive, many patients will undergo a cardiac catheterization.
How is angina treated?
There are several treatment options: lifestyle and diet changes, drug therapy, catheter-based intervention procedures, such as balloon angioplasty, and surgery. Usually several options will be used simultaneously. The decision on what treatments to use is usually complicated and is based on a consideration of many factors, such as
- type of symptoms the patient is having
- severity of symptoms
- number of vessels blocked
- nature of the blockage
- patient's responsiveness to medication
- patient's family and medical history, such as type of employment, age, associated medical problems
- patient's preference for treatment
Is exercise a good idea if I have a history of angina?
This question should be addressed to your treating physician because every patient is different. However, several general statements can be made. There is no reason why someone with coronary artery disease cannot exercise. It should not be a sudden effort but rather a gradual increase in intensity. For example, walk until you begin to experience angina; stop and rest until the pain subsides: then resume the activity again. However, any exercise program must be done under the supervision of the treating physician.
