Introduction
Angina is a type of heart disorder in which a person may be lacking oxygen-rich blood flowing to the heart. As a result of the lack of blood, your heart may be beating faster in order to gain more blood, causing you chest pain or discomfort. It’s important to note that angina isn't a disease; it’s a symptom of some other form of heart disease (i.e., coronary microvascular disease, coronary artery spasm, coronary artery disease, etc.), and there are several types.
Types of Angina
There are four main types of angina.
Stable angina
Stable angina is also a discomfort or pain in your chest and a sign that you may have a form of heart disease. What differentiates it from other types of angina is that it’s caused by stress, over-exercising, or cold weather. At times when your heart needs more oxygen, heart disease limits how much oxygen-rich blood reaches your heart. Stable angina can feel like there’s pressure or indigestion happening in your chest, pain that shoots down your left shoulder/arm, shortness of breath, dizziness, nausea, and/or exhaustion.
Unstable angina
Unstable angina is a dangerous type of heart pain that signals an oncoming heart attack. Unstable angina is when your heart isn’t getting as much oxygenated blood because of a blood clot in one or more of the arteries that feed into your heart (coronary arteries). This type of angina has no pattern and usually takes a turn for the worse. It happens with only mild physical activity or may happen without warning (i.e. when you’re resting, relaxing, or even sleeping). The difference between stable angina and unstable angina is that stable angina usually involves some sort of exertion of physical activity or anger, anxiety, or stress. They usually last a short amount of time (a couple of minutes) and have a pattern - usually with the same stressor that caused the previous attack. Unstable angina occurs without warning, can happen even if you're at rest, doesn’t last the same amount of time (can last a long time), and the stressors can be different.
Microvascular angina
Microvascular angina occurs when small blood vessels that are bringing oxygenated blood to the heart are having problems, and this leads to the heart muscle getting damaged and starting to die due to a lack of oxygen. The small vessels (called the coronary microvasculature) are a big part of your heart’s blood supply, so when they start having problems, it takes a toll on your heart. Microvascular angina differs from other types because of the mechanism of the condition. While other types of angina might occur because of over-exertion in physical activity or when you're going through emotional problems, this type occurs because of functional issues with the vessels (i.e. endothelial dysfunction). The endothelium is the tissue lining your blood vessels, and spasms can occur due to functional issues. Symptoms can include heaviness, tightness, pressure, or squeezing in your chest; sweating; nausea and dizziness; stomach pain, difficulty breathing, fatigue, or just an overall lack of energy.
Variant angina
Variant angina is rare and can sometimes result in severe chest pain. It usually occurs from midnight to the morning when you’re asleep or resting. It also affects younger, healthier people, rather than other forms of angina. Chest pain or discomfort while resting, usually between midnight and 8 a.m. The pain may move to your arm, head, or shoulder. The recurrent episodes of pain last about five to 15 minutes per episode, possibly longer. The episodes tend to form a pattern. The symptoms include sweating, nausea, and/or dizziness.
Diagnosis
The diagnostic tests used to diagnose different types of angina differ from each other. Here are some of the tests for each type:
Stable angina
Electrocardiogram (EKG) - Records the electrical signal from the heart to check for different heart conditions.
A computed tomography (CT) scan - A technique medical professionals use to take internal images of the body.
Unstable angina
Echocardiogram - Uses sound waves to create pictures of the heart.
Blood tests - A laboratory analysis of things that may be found in your blood.
Microvascular angina
Magnetic Resonance Imaging (MRI) - A medical imaging technique used with radiology to give you clear images of organs and structures inside your body.
Positron Emission tomography (PET) scan - A technique that measures physiological function by looking at blood flow, metabolism, neurotransmitters, etc.
Variant angina
Coronary angiography - A procedure that uses a special dye and X-rays to see how blood flows through the arteries in your heart.
An ambulatory electrocardiogram - Records the electrical activity of your heart while you do your usual activities.
Risk Factors
Risk factors include:
Having an underlying heart disease (i.e. coronary heart disease, in which plaque builds up in your arteries)
Alcohol/drug use
Lack of physical activity
Stress
Genetic factors (if people in your family have a history of experiencing heart conditions, you may be at risk)
Prevention Methods
To prevent or lower your risk of angina, you should talk to your doctor about building heart-healthier habitats, as not taking care of it seems to be a common factor for angina. Heart-healthy habits include building a healthy eating pattern, remaining physically active, quitting smoking, managing stress, etc.
Fun Fact
Spending time with friends and family can lower your heart attack risk. Studies have found that people who live by themselves are 2x more likely to have a heart attack than people who live with a roommate or partner. Research has long suggested that regular social interactions play an important role in overall health, as well as heart health.
Conclusion
If you ever feel any sort of unusual pain or discomfort (no matter where in the body) it’s important to notify your doctor, or at least make a note of it. A lot of times we convince ourselves our pains are nothing serious, when they could, in fact, be your body signaling to you that something is wrong. You may not feel the need to bother someone, but it’s important to take care of yourself and make sure nothing serious happens.
Written By: Niral Jagadeesh
Edited By: Tarleen Chhatwal
Angina: Symptoms, Causes & Treatment. (2022, August 19). Cleveland Clinic. Retrieved September 21, 2023, from https://my.clevelandclinic.org/health/diseases/21489-angina
Microvascular Angina. (2022, December 6). American Heart Association. Retrieved September 21, 2023, from https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain/microvascular-angina
Rodriguez Ziccardi M, Hatcher JD. Prinzmetal Angina. [Updated 2023 July 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430776/
Goyal A, Zeltser R. Unstable Angina. [Updated 2022 Sep 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK442000/
Stable angina. (2023, January 1). MedlinePlus. Retrieved September 21, 2023, from https://medlineplus.gov/ency/article/000198.htm
Angina (Chest Pain) - Causes and Risk Factors. (2023, July 10). NHLBI. Retrieved September 26, 2023, from https://www.nhlbi.nih.gov/health/angina/causes
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