Chest pain (Angina)

Description of Chest pain (Angina)

 
Definition
 
Angina is a medical term for pain or discomfort in the chest when there is decreased blood supply to the heart muscles. Angina is a symptom of an underlying blockage in the coronary arteries that supply blood to the heart.
 
Causes and Risk Factors
 
Common causes and risk factors are:
 
1. The commonest cause of poor blood supply to the heart muscles is accumulation of fat inside the coronaries called atherosclerosis.
2. Diseases of coronaries like embolus (an unattached blood clot causing blockage), inflammation of arteries, a spasm in the arteries, Kawasaki disease and congenital abnormalities can also cause angina pain.
3. Other heart diseases like hypertrophic cardiomyopathy (thickening and loosening of heart muscles), severe aortic valve disease, etc. are some of the rare causes.
4. Factors like emotional stress, cold weather, and obesity can act as a triggering factor.
5. Men have a higher risk than women.
6. Men older than 45 and women older than 55 years of age are at a high risk.
7. Modifiable risk factors include high blood pressure, high cholesterol levels in blood, type 2 diabetes, cigarette smoking, sedentary lifestyle, and stress.
 
Signs and Symptoms
 
There are many variants of angina.
 
1. Stable angina/angina pectoris: It is the most commonly occurring left sided or central chest pain. It is caused due to strenuous physical activity or stress and usually pain reduces when patient rests.
2. Unstable angina: It is an acute condition. It can occur even when you are resting or eating. The pain is more severe and often recurring.
3. Prinzmetal's angina: It is also referred as variant angina, angina inversa or Prinzmetal's variant angina. It is rare type of angina pain, which almost always occurs when a patient is at rest. It may be more painful and lasts longer than other types of angina. It usually occurs at night or early morning.
4. Microvascular angina: This type of angina is a symptom of coronary microvascular disease.

Patients describe angina pain as feeling of tightness or crushing weight in the central chest region radiating to arms, neck, jaw, back, or stomach region. Pain can also be accompanied by breathlessness, confusion, anxiety, profuse perspiration, and nausea. This pain usually lasts a few minutes, arises suddenly, and stops when you rest.
Chest pain that lasts only a few seconds is usually not angina, but you should visit the doctor as soon as possible as it may be a warning of heart attack.
 
Investigations
 
1. Doctor will be able to diagnose angina depending on the symptoms described by the patients.
2. They may carry out some basic investigations like resting electrocardiogram (ECG), chest x-ray, and blood test like troponin I or creatine phosphokinase-MB (CPK-MB). Further testing like echocardiography, coronary angiogram, stress ECG, CT-scan, or MRI of chest, CT angiography, etc. may also be advised as per patient’s condition.
 
Treatment
 
If the patient is diagnosed with angina, the doctor will start with initial drug therapy to stabilize the symptoms. Common line of treatment includes aspirin, beta blockers, nitroglycerin and morphine sulfate orally while maintaining oxygen saturation.
If the patient is not stabilized with medical therapy, surgical procedures like angioplasty or bypass operation [coronary artery bypass graft (CABG)] will be advised.
Lifestyle modifications like stop smoking, healthy diet and exercise will be advised by your doctor 
 
Did You Know?
 
Cardiovascular disease is the leading cause of death and is responsible for one of every three deaths in the world.
 
 
Content Details
Last updated on:
16 Jan 2019 | 12:17 PM (IST)
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Frequently Asked Questions about Chest pain (Angina)

By drinking moderate alcohol, i.e., two drinks a day for men and one drink a day for women, some people get beneficial effect against heart diseases like angina. Heavy drinking can badly damage your heart leading to heart diseases.
Nitroglycerine tablets to be kept under the tongue or used in the form of spray is very effective and most common way to rapidly treat anginal pain. Nitroglycerine expands blood vessels of the heart and increases the blood flow leading to reduction in chest pain.
Usually anginal pain is not affected by position of the patient, but it may become worse while lying down as in this position there is increased workload on heart. Hence, patient sometimes may prefer sitting than lying down.
Nausea and vomiting may occur in angina due to activation of autonomic nervous system that regulate various organs like heart, stomach, and intestine.
Anginal pain arises as a result of reduced blood supply to the heart. Due to same nerve supply of the heart and some structures in the body like jaws, neck, shoulder, and arms, anginal pain can be felt in these areas also.
Atherosclerosis means deposition of fatty material inside the arteries that leads to narrowing of arteries. Narrowing of arteries in the heart leads to reduced oxygenated blood supply to heart and can cause angina.
Out of various causes of anginal attacks, hereditary factor can also lead to angina. If someone in your family especially first degree relative like mother, father, brother are suffering from angina, then there are increased chances of you getting angina. Other risk factors of angina like high blood pressure, high cholesterol, etc. also runs in families.
When you feel squeezing or pressure in the center of chest, radiating pain in the back, neck, shoulders, jaw, and arms, with nausea, vomiting, and shortness of breath, then seek medical care at the earliest.
If you feel squeezing and pressure in the center of chest that may radiate to other body parts like arms, neck, or jaw, it is called angina. Palpitation is when you can feel your own heart beats that are rapid and fast.
In pneumonia, infection can spread to the layers covering lungs (pleurae) leading to irritation of these layers. These layers are pain sensitive and when irritated can give rise to chest pain. Usually you feel sudden and stabbing type of chest pain that becomes worse when you breathe or cough. In lung cancer, cancerous cells may spread to pleura and chest wall causing irritation to the nerves and chest pain.
At the time of delivery or c-section there is stretching of membrane that covers your abdomen and other organs leading to chest pain. Low blood pressure during c-section and use of oxytocin can also cause chest pain.
Yes, chest pain is a common problem in kids also. Chest pain in children is usually not serious, but when it is severe and continuous, you have to consult your physician for proper diagnosis and treatment.
You can get chest pain in any arm. Chest pain of heart attack usually radiates to the left arm, but can also radiate to right arm, back, shoulder, jaw, or neck. Hence, it is of utmost important to evaluate the cause of chest pain for proper treatment.
Chest pain during pregnancy is not uncommon and can have a number of causes like acid reflux, pressure from growing baby, stress, changes in breast during pregnancy, asthma and so on. More serious causes are rare like heart attack or amniotic fluid embolism. So, one should not wait to contact your physician whenever you feel chest pain during pregnancy.
Both back pain and chest pain can have some underlying cause that is to be evaluated by your physician. When there is severe chest pain which is radiating to the back, it usually occurs in diseases of heart like angina or heart attack.
Interestingly, there are no pain receptors in lungs but patients of asthma feel chest pain very commonly. This is because in asthma, one is using extra muscles for breathing which are not commonly used for normal breathing leading to muscle fatigue and soreness in those muscles.
Angina pain feels like any of the following - crushing, squeezing, burning, tightness, heaviness, pressure sensation, band-like feeling around the chest. It is a sensation of extreme discomfort in the central and left chest region.
Taking lower dose of Vitamin C is usually safe. After taking larger doses, i.e., more than 1000 mg, some people may experience heartburn or pain in the lower chest along with cramps in the stomach. Doses higher than 2000 mg must be avoided.
Myocardial infarction and angina lead to chest pain that radiates to jaw, neck, shoulder, arm, and back. As compared to angina, myocardial infraction is usually more severe with respect to chest pain which may last for about more than 30 min, associated with nausea, sweating, and does not get relieved by taking rest.
Fish (contains omega-3 fatty acids that are good for healthy heart), fruits, vegetables, and vitamins should be added to diet in patients of angina. Avoid oily foods like meat, dairy products, excessive salt, and frozen foods.
Physical activities like running, walking, and exercising increase the severity of chest pain in stable type of angina. Whereas in unstable form of angina, patient may get symptoms even at rest.
Pain in angina arises due to reduced supply of oxygenated blood to the heart. Heart is placed in the center, but slightly tilted to the left side. Nerves that supply blood to left arm and heart arises from a common location in the spinal cord. So, patient feels pain in the left arm.
Yes, chest pain may occur after stent placement or bypass surgery as a complication to these procedures. Pain is usually felt at left side of the chest. So, early diagnosis of such complication and its treatment is a must.
Yes, angina can be worsened after heavy eating and exercise. Chest pain or heartburn can also be a problem due to stomach upset and acid reflux. This should be differentiated from angina from heart disease.
Cold weather causes constriction of blood vessels. This leads to decreased blood supply to the heart. This, along with an increased demand of oxygenated blood by the body, puts pressure on the heart leading to worsening of angina.
Chest pain of angina and indigestion look similar. Many a time chest pain due to indigestion is bearable, burning, and get relieved after taking digestive pills. Whereas anginal pain is usually unbearable, radiate to arms, jaw, neck, and relieved by taking medications to cure angina like sorbitrate.
Yes, stress or anxiety can cause chest pain. Stress or anxiety results in increased sympathetic activity in the body. Due to which there is an increased work load on the heart. The increased heart rate associated with reduced blood supply leads to cardiac ischemia and associated chest pain.
Drinking heavy amount of alcohol can cause irritation of your stomach line. This can increase your acid reflux symptoms leading to chest pain.
Chest pain before period can be due to hormonal imbalance affecting the contractility of blood vessels of the heart. The exact reason is unclear. Hence, any type of chest pain should be evaluated and treated according to the cause.
Yes, sometimes excessive intake of coffee can cause chest pain due to acid reflux/heartburn. Coffee also increases heartbeat and can cause anxiety, mimicking chest discomfort. Such chest discomfort or pain must be evaluated by your physician.
Chest pain that is severe, crushing, or squeezing type in the center of chest that is radiating to left arm, jaw, neck, or left shoulder is usually serious and needs immediate consultation to your doctor for a timely management.
Nicotine, which is present in cigarettes, reduces oxygen supply to the heart leading to chest pain. Nicotine also increases chances of formation of blood clots which in turn leads to increased risk of heart attack and stroke.
Chest pain can last from few seconds to several minutes depending on the underlying cause. Severe, squeezing type of chest pain that lasts longer than 30 min and radiating to other parts of the body need consultation by your physician.
If the person is conscious: Make the person comfortable; loosen any clothing around the neck, chest and waist; call for help and rush to a hospital immediately. If the person is unconscious: Open the airway by tilting the person’s head backwards and check if he/she is breathing; if the person is breathing, make him/her lie on the left side in the recovery position; if there are no signs of breathing, start CPR (cardiopulmonary resuscitation) immediately; call for help and rush the person to a hospital immediately.