Angina

Angina occurs when the heart doesn’t get enough oxygen during exertion or stress. Find out how to recognize and treat angina symptoms, such as chest pain, to prevent cardiovascular disease or a more serious event, like a heart attack.

What is angina?

The heart is a muscle that pumps blood throughout the body. Blood travels through the arteries to bring oxygen to the body’s organs so that they can function. Like all other organs, the heart also needs oxygen to do its job. 

When the body undergoes physical exertion or faces significant stress, the heart needs more oxygen to meet the body’s needs. When the heart doesn’t get enough oxygen, you’ll feel tightness, pain or a burning sensation in the centre of your chest. This is called an angina attack. 

In most cases, angina (or “angina pectoris”) is caused by a condition called atherosclerosis, which is when fatty deposits form on the wall of the arteries. These deposits restrict blood flow in the arteries, and the organs no longer get enough oxygen. When atherosclerosis forms in arteries that provide oxygen to the heart (coronary arteries), the heart doesn’t get enough oxygen, and angina symptoms appear.

Angina symptoms

Angina attacks generally have the following characteristics:

• They can come on during vigorous exertion, situations that cause stress or fear, exposure to cold or heat, or after a big meal.
• Angina symptoms cause tightness, pain or a burning sensation in the centre of the chest. The pain can spread to the neck, jaw, shoulders and back. You may also feel pressure, numbness in the arms (often the left arm), great fatigue, dizziness, or shortness of breath.
• An attack generally lasts about 3 to 5 minutes and rarely more than 15 minutes.
• Angina is relieved with rest or medication, such as nitroglycerin.

Angina or heart attack?

The main difference between an angina attack and a heart attack is that angina pain goes away with rest or medication. However, angina is a sign that you’re at risk of a heart attack. Chest pain should always be taken very seriously. See your doctor right away if you have untreated angina symptoms.

If your symptoms persist for 10 minutes after you rest or take your angina medication , call 9-1-1.

Angina or stomach problems? 

An angina attack can bring on symptoms that feel like those caused by heartburn, acid reflux or stomach ulcers. However, pain from stomach problems comes after a meal and generally disappears after you take an antacid.

See your pharmacist or doctor if these medications don’t relieve your symptoms.

How is angina diagnosed?

To confirm an angina diagnosis, your doctor will conduct a number of tests.

For example, an exercise electrocardiogram (a stress test on a treadmill) reveals whether exertion triggers an angina attack.  An angiogram, or an X-ray of the arteries after dye is injected into them, reveals whether the coronary arteries are blocked. These tests are done under a cardiologist’s supervision. If angina medication relieves symptoms, this confirms that the attack was indeed angina.

Angina treatment

Angina is a sign that the heart arteries are partially blocked and that the heart isn’t getting enough oxygen. Controlling your symptoms is critical, as is adopting a healthy lifestyle and taking medication, if you need to. When left untreated, angina can lead to myocardial infarction (heart attack), which often has more serious consequences.

A healthy lifestyle

Although angina can’t be cured, a healthy lifestyle is strongly recommended to help you prevent or control angina.

• Don’t smoke. Smoking contributes to clogged arteries and decreases blood oxygenation. If you need help quitting, don't hesitate to ask your pharmacist or doctor for help.
• Eat a healthy diet. Avoid eating big meals, and limit your intake of high-fat and salty foods. Consult Canada's Food Guide. For personalized recommendations, ask a nutritionist for advice.
• Aim to maintain a healthy weight. 
• Get 30 minutes of moderate physical activity every day. 
• Limit your intake of alcohol and caffeine.
• Learn to manage stress.
• Avoid exposure to very cold or very hot temperatures.
• Regularly check your cholesterol levels and your blood pressure. High cholesterol and blood pressure are risk factors for cardiovascular disease. If your doctor has prescribed medication to control your angina, you need to take it regularly.

Medication

If a healthy lifestyle isn’t enough to control your angina pain, your doctor may add one or multiple medications to your treatment. Several classes of drugs can help control or prevent angina attacks.

Nitroglycerin is the emergency drug most often prescribed. This drug decreases the heart’s need for oxygen, which quickly relieves angina. It comes in tablets that you take under the tongue or as an oral spray. Nitroglycerin must be used as soon as the symptoms of an angina attack appear. You need to keep this medication handy at all times and wherever you go so that you can treat an attack immediately.

If your angina symptoms don’t subside within 10 minutes after you take nitroglycerin, you must call 9-1-1 , as the pain may be due to a heart attack and not an angina attack.

As a preventive measure or if you’re using quick-acting nitroglycerin too often, your doctor may prescribe other medications in the form of patches or tablets with a very precise dosage that you can use or take  every day.

Medical procedures 

When an artery that provides blood to the heart becomes blocked, a percutaneous coronary intervention may have to be performed to dilate the blocked artery. This procedure consists of inserting a small balloon into the artery and inflating it. A stent is then inserted into the artery so that it stays open.

If your arteries are completely blocked or if you have multiple blockages, your doctor may then perform coronary bypass surgery. This procedure involves creating a new path for blood to flow to the heart. To make this path, a replacement blood vessel is created from a vein or artery taken from another part of the body.

 

If you want more information about angina or other cardiovascular diseases, your pharmacist is a valuable health care resource. Don’t hesitate to see your pharmacist for information!