Angina and Heart Disease

What is angina?
Angina (say: "ann-gye-na" ) is a squeezing pain or a pressing feeling in the chest. It is most often caused by blockages in the arteries that supply blood to your heart. This is called coronary artery disease, or heart disease. The symptoms you describe to your doctor will help your doctor decide if you need to be tested for heart disease. Your doctor will also check if you have any conditions that can increase your chance of heart disease. These conditions include:

• High blood pressure
• Diabetes
• Smoking
• High cholesterol level
• Menopause in women
• Family members who have had heart disease at a young age
  

If you have heart disease, your angina can be treated by treating the heart disease.

How do I know if my pain is angina?
Angina can bother you when you are doing activities like walking, climbing stairs, exercising or cleaning. The pain of angina may make you sweat or make it hard to catch your breath. You may feel pain in your arm or neck as well as in your chest. If the pain is mild, it may go away after a minute or so of rest. If the pain is more severe, medicine may be needed. A medicine
called nitroglycerin often is used to treat severe angina.
Some people have angina that comes on with a certain level of activity and goes away easily. They may have this kind of angina for a long time. This is called stable angina. When the pattern of angina changes a lot, it's called unstable angina. This is a sign of danger. Angina in someone who hasn't had it before, more episodes of angina with less exertion, and angina that comes on while you're resting are also danger signs.
Unstable angina may be the first sign of a heart attack. If you get angina, you should call your doctor or go to the nearest emergency room right away. Another sign of danger is chest pain that doesn't go away with rest or after taking medicine. If you have chest pain that doesn't go away, go to the emergency room right away.

What tests might my doctor do?
An electrocardiogram, sometimes called an EKG or ECG, is a simple test that can show if your heart or arteries have been damaged. If the EKG is done while you are having angina, it can also show if your pain is caused by a problem with your heart.
The next step after an EKG may be a stress test. Often, this test is done while you walk on a treadmill. Your doctor will look at your stress test to see if it's abnormal when you exercise. Your doctor may also have x-rays of the heart taken before and after you exercise. These pictures can show if an area of the heart is not getting enough blood during exercise. If this is
so, it may mean that the arteries supplying blood to your heart are blocked. Another important test is cardiac catheterization. In this test, a very long and very thin tube is inserted through an artery in the arm or leg and then guided into the heart. Dye is injected into the arteries around the heart. X-rays are taken. The x-rays will show if any of the arteries that supply the heart are blocked.

How can I prevent heart disease?
The best ways to prevent heart disease are to control high blood pressure, diabetes or a high cholesterol level and, if you smoke, to stop smoking. Maintaining a healthy diet, a healthy weight and a regular exercise program can help you avoid heart disease.
If you already have heart disease, the steps listed above are important to help keep the problem from getting worse.

How is heart disease treated?
Most people with heart disease take medicine to control their condition. Medicines called beta-blockers, calcium channel blockers and nitrates can help relieve angina. Taking low-dose aspirin every day can reduce the chance of a second heart attack in people who have already had one. Your doctor will tell you whether you should take any of these medicines.

What about surgery?
Angioplasty is a surgical treatment for heart disease. Angioplasty uses a tiny balloon to push open blocked arteries around the heart. The balloon is inserted in an artery in the arm or leg. A stent (a small metal rod) might be put into the artery where the blockage was to hold the artery open. Another surgical treatment for heart disease is bypass surgery. Pieces of veins or arteries are taken from the legs and sewn into the arteries of the heart to bring blood past a blockage and increase the blood flow to the heart. Bypass surgery is usually done when angioplasty isn't possible or when your doctor feels it's a better choice for you.

Are there side effects and other risks to the treatment of heart disease?
All medicines may have side effects. Aspirin may cause upset stomach. Nitrates may cause a flush (redness in the face) and headaches. Beta-blockers cause tiredness and sexual problems in some patients. Calcium channel blockers may cause constipation and leg swelling. Fortunately, most patients don't have side effects from these medicines. If you have side effects after taking a medicine, tell your doctor.
Surgery, such as angioplasty or bypass surgery, also has potential risks. The major risks can include heart attack, stroke or even death. These are rare and most patients do well. After angioplasty, you can probably expect to return to your previous activity level, or even a better activity level, within a few days. It takes longer (a few weeks or months) to recover from
bypass surgery.

How do I know which treatment is right for me?
Your doctor will help you decide which treatment is best for you.

Does heart disease ever go away?
Heart disease doesn't go away, but by working with your doctor, you can live longer and feel better.