Angina pectoris

Angina pectoris (also known as stenocardia) is what doctors call an attack in the heart region that is life-threatening. Call an ambulance immediate if you suspect a loved one is having such an attack.

People often experience pain, chest tightness, and fear of death. Angina pectoris is also known as chest tightness or painful tightness of the heart.
In most cases, the trigger for angina pectoris is so-called coronary heart disease (CHD). One or more coronary arteries constrict. These are the blood vessel that supply the heart muscles. The heart no longer receives enough oxygen due to the constriction . The disease often affects men over 55 years of age.

Experts define different forms of angina pectoris:

• Stable angina pectoris: Doctors refer to stable angina pectoris as seizures that occur during exertion and physical or emotional stress . In this case, the person concerned takes nitroglycerin as a spray or capsule (see section “Therapy”). The symptoms usually go aways after a few minutes.
• Unstable angina pectoris: Doctors speak of this in various cases: when the person concerned suffers angina pectoris for the first time, when the seizures worsen or occur even at rest. Unstable angina pectoris can herald a heart attack and is life-threatening. Relatives should call the emergency doctor immediately if they suspect anything.
• Prinzmetal angina : This special form is named after the American cardiologist Myron Prinzmetal. Doctors classify an attack as Prinzmetal's angina when cramps in the coronary arteries trigger the attack. The symptoms can appear suddenly and at rest and usually go away after a short time.
• Walk-through angina pectoris : This type occurs when the person begins to move. However, it disappears again with increasing exposure.
• Angina nocturna: This is what doctors talk about when angina pectoris develops during sleep at night.

Angina pectoris: symptoms

In most cases, angina pectoris is caused by arteriosclerosis . The coronary arteries thats supplies the heart with oxygen become calcified. Angina pectoris patients can have a seizure if they are exerting themselves, are stressed, have eaten a large meal, or are cold. Those affected usually feel the following signs of illness:

• Seizure-like, sudden pain behind the breastbone that may spread to the left arm, lower jaw, and spine
• A feeling of tightness or pressures in the chest
• Extreme fear and panic
• Shortness of breath

Angina pectoris in women and the elderly

Women and the elderly aged 75 and over with angina pectoris rarely show these typical symptoms. They are more likely to experience tiredness, abdominal pain , dizziness or nausea .

Strength of the complaints

How severe the symptoms of angina pectoris are varies greatly from person to person. Some patients have severe pain even though their cardiac arteries are only slightly damaged. Others have severely constricted blood vessels, but only mild symptoms.

Some people with heart problems have to cough heavily. However, this does not indicate angina pectoris, but rather heart failure . High blood pressure isn't necessarily a symptom of a seizure, either. However, high blood pressure is a risk factor: it increases the likelihood of developing angina pectoris.

Doctors divide the symptoms of the seizures into four stages:

• Severity level I: The attacks only occur with very high levels of stress - for example, when running endurance or doing heavy physical work.
• Severity II: Angina pectoris patients have seizures when they exert themselves heavily - for example, when walking uphill or climbing stairs.
• Severity III: Angina pectoris occurs with light exertion - for example when walking or climbing stairs to the first floor.
• Severity IV: Those affected experience attacks with the least amount of stress or at rest.

Angina pectoris: therapy

An angina attack is an emergency and should be treated immediately:

• Patients with stable angina pectoris should always carry nitroglycerin with them. The person concerned takes the medicine during an attack by either placing it as a capsule under the tongue or by spraying it under the tongue with a spray. Nitroglycerin dilates the blood vessels and usually allows the symptoms to subside after five minutes. If the symptoms do not improve, it may be a heart attack. Then relatives have to call an ambulance.
• An unstable angina occurs when pain and chest tightness occur suddenly without physical stress. Or if the usual angina symptoms are more severe than usual.

In the event of an attacks of unstable angina pectoris, outsiders must call an emergency doctor immediately. Relatives should provide first aid in the time until the ambulance arrives. This includes opening constricting clothing such as a collar or belt and raising your upper body. Try to calm the person down.

The emergency doctor usually treats the patient with various active ingredients. In addition to nitroglycerin, they use drugs such as heparin, beta-blockers and pain relievers. Heparin prevents the blood from clotting and the vessel from closing further. Beta blockers lower the heart rate and blood pressure. In some cases, the doctor will also gives you oxygen.

Healthy lifestyle for angina pectoris

To prevent further angina attacks, it is very important that the patient lead a healthy lifestyle . Above all, this includes quitting smoking, exercising regularly and eating a balanced, low-fat diet . The person concerned should aim for a normal weight . He also has to have other diseases such as diabetes or high blood pressure treated.

Medicines for angina pectoris

Those affected often have to take long-term medication to prevent further attacks. Acetylsalicylic acid thins the blood and prevents dangerous blood clots from clogging the blood vessel. So-called beta blockers reduce blood pressure and relieve the heart. As an emergency medication , patients must carry nitroglycerin with them as a spray or capsule. In the event of an acutes attack, the person affected sprays the spray or places the capsule under the tongue.

Surgical interventions on the heart

Surgery is useful in some patients with angina pectoris . Surgeons expand the coronary arteries with a catheter. They often then place a stent . This is a metal splint that prevents the vessel from narrowing again. Another option is bypass surgery . To do this, the surgeons removes a vein from another part of the body and puts a kind of diversion around the constriction of the coronary artery.

These measures can make the attacks less frequent and less violent. However, there is no cure for angina pectoris .

Alternative therapies

Some sufferers are looking for alternatives to therapy. Naturopaths often recommend arnica, skullcap or sage. However, there are no studies to show that the plants help with angina pectoris.
There is some evidence that accupuncture can help treat stable angina pectoris. Study participants who had their needles pricked regularly had fewer seizures than those who did not attend the sessions. The participants in the acupuncture groups were also more resilient and had less anxiety and depression. However, the study failed to show how long the effect lasted. The statutory health insurance companies do not cover the costs of acupuncture for angina pectoris.

Angina pectoris: causes

In most cases, the causes of angina pectoris is so-called coronary heart disease (CHD). The coronary arteries that supply the heart muscle with oxygen and nutrients become calcified. Doctors call this process arteriosclerosis. So-called plaques made of fats, blood clots, connective tissue and lime form in the vessels and constrict them. The bottlenecks form gradually over the years.

The vessels usually cope with the plaques for a long time. You can compensate for the danger by expanding. If the debris restricts the arteries by more than half their diameter, the heart can no longer get enough oxygen. Only now does the patient experience symptoms such as angina pectoris. This is the reason why those affected often notice the disease very late.

Doctors differentiate between various risk factors for coronary heart disease and thus for angina pectoris:

• High-fat and high-calorie diet: An unhealthy diet can lead to overweight , obesity ( obesity lead), diabetes and bad cholesterol. This increases the risk of arteriosclerosis and thus angina pectoris.
• Lack of exercise: too little sport and exercise can lead to diseases such as obesity and high blood pressure. This makes angina pectoris more likely.
• Smoking: Substances in tobacco smoke encourage plaques to form.
• High blood pressure : The disease damages the inner walls of the blood vessels.
• Diabetes: If the blood sugar is increased over a long period of time, the blood vessels suffer.
• Bad blood fat levels: An unfavorable cholesterol ratio causes plaques to form.
• Male sex: Women are less affected because the female sex hormone estrogen partially protects against arteriosclerosis. However, this protection is usually lost with the menopause.
• Older age: As a person ages, so do their blood vessels. That makes them more prone to plaques.
• Family (genetic) predisposition: Parents can pass on diseases such as high blood pressure and diabetes to their children. This also increases the risk of angina pectoris.

In the special form of Prinzmetal's angina, spasms of the coronary arteries trigger the attack. Medical professionals are not yet able to explain exactly how the cramps arise. This is probably due to smooth vascular muscle cells that contract too much. The cause of the phenomenon is unclear. 

Angina pectoris: diagnosis

If you suspect that you have an attack of angina pectoris, you should see a doctor. Even if you have chest pain without tightness or shortness of breath, you should have your symptoms checked by a health care professional .

Conversation and investigation

The doctors will ask about your symptoms and whether you smoke, how you eat and whether you exercise regularly. They will also make sure that you have other medical conditions such as diabetes. This is followed by a physical exam: the doctor will listen to your heartbeat with a stethoscope and measure your blood pressure. This is how the doctor can find out whether you have high blood pressure.

Imaging procedures

The doctor then usually arranges for an electrocardiography (EKG). He attaches electrodes to the patient's skin. These record the heart's electrical impulses. The doctor can use the electrocardiogram to see whether you have had angina pectoris or a heart attack.

As soon as the doctor has made the diagnosis, it usually makes sense to record an additional exercise ECG . The doctor registers the electrical impulses while you are moving on a stationary bike. On the sports equipment, the doctor can see how the heart reacts under stress. He checks the patient's blood pressure and pulse. In the case of very high blood pressure or severe angina pectoris (grade IV), the doctor does not perform a stress ECG in order not to endanger the patient.

In addition, the doctor can examine the heart with an ultrasound ( echocardiography ). This enables him to assess whether the heart valves and chambers are healthy.

In some cases it is also uses to check the coronary vessels with a so-called coronary angiography . This is a special form of X-ray examination in which the doctor injects a contrast medium through a tube (catheter). Then he recognizes on the X-ray where and how severely the vessels are restricted.

 

Angina pectoris: life expectancy

Life expectancy after the diagnosis of angina pectoris is very individual and in most cases cannot be calculated. The prognosis depends on many different factors:

• Time of diagnosis: How far has the angina pectoris progressed when the person concerned begins therapy
• Damage to the coronary arteries: where do the constrictions occur and how strong are they?
• Type: Does the patient suffer from stable angina pectoris that occurs during exertion or stress? Or does he have unstable angina pectoris that occurs suddenly and at rest? The latter can develop into a heart attack and worsen the prognosis.
• Medication: does the patient keep to taking the medication regularly?
• Lifestyle: is the person affected eating a balanced diet? Does he exercise regularly, avoid stress and refrain from cigarettes?
• Previous illnesses: Does the patient have other complaints such as high blood pressure or diabetes treated?
• Check-ups: Does the person concerned go to the doctor regularly to have their symptoms checked?

Patients with angina pectoris have a lower life expectancy than healthy people. However, if the patient adheres to the therapy and changes his lifestyle, he can usually assume a relatively good prognosis . The affected person usually has several years with a good quality of life.

Angina pectoris: duration

An attack of angina pectoris can last a few seconds to several minutes . The symptoms, such as a tightness in the chest, usually go away on their own after 15 to 20 minutes at the latest. Anyone who uses a nitro spray or capsules has no more symptoms after around five minutes. The nitroglycerin contained in the spray expands the blood vessels and allows the symptoms to subside.

How often the seizures occur varies greatly from person to person. They can occur up to several times a day or just every few months. If the person concerned exposes himself to triggers such as cold, stress and heavy loads and lets the therapy slip, he will have more frequent angina pectoris attacks. Avoiding the triggers, changing your lifestyle, and taking medication regularly can minimize the seizures.