Angina – what is it, and what can be done?
Angina is a medical condition that typically causes symptoms of chest discomfort on exertion, relieved by rest. Chest pain can range from mild to severe, and may radiate to the neck, jaw and arms. Some people have less typical symptoms, such as breathlessness, indigestion-like discomfort or pain in less characteristic locations, and symptoms are not always entirely predictable.
It is caused by a supply and demand mismatch in the heart muscle, when the coronary arteries that supply the heart itself with blood and oxygen can’t meet its demands. Symptoms are usually exertional because it is during these times that the heart needs more oxygen. If the coronaries are unable to deliver that, for example because they’re narrowed, this can produce the symptoms we recognise as angina.
Prompt investigation and appropriate treatment are essential to reduce symptoms, improve quality of life and reduce risks of serious complications such as heart attacks. We begin with a detailed medical history and physical examination. An electrocardiogram (ECG) is performed to detect abnormalities in the heart’s electrical activity and blood tests help us to understand the contribution of underlying risk factors, like high cholesterol and diabetes. The next steps often involve CT coronary angiography, to image the coronary arteries non-invasively, before the patient and doctor can decide if further investigations like stress tests are required, or progression to invasive coronary angiography.
The aim of treatment in angina is to improve blood flow, relieve symptoms, and reduce cardiovascular risk. Lifestyle modifications are fundamental and include stopping smoking, maintaining a healthy weight, exercising as much as possible, and controlling associated risk factors.
Patients with coronary artery disease will often need preventative medication such as antiplatelets and statins, as well as anti-anginals – designed to improve symptoms. A short acting nitrate spray (GTN) is useful to help relieve angina attacks in the mean time.
People with obstructive coronary artery disease may need their arteries physically treated. After an invasive angiogram, the cardiologist can advise on the most appropriate strategy. This commonly includes stenting (also known as PCI which stands for percutaneous coronary intervention) or consideration of CABG for others (also known as coronary artery bypass grafting). Stents are inserted ‘keyhole’, through a small tube inserted through an artery in the wrist or groin, whilst bypass is a kind of open heart surgery.
In summary, angina is common and usually very treatable. The important first step is establishing whether symptoms are coming from the heart and understanding the state of the coronary arteries. Treatment can then be tailored to the individual, ranging from lifestyle changes and medication through to stenting or surgery where appropriate.
