Angina is a pain that comes from the heart. It is usually caused by narrowing of the coronary (heart) arteries. Usual treatment includes a statin medicine to lower your cholesterol level, low-dose aspirin to help prevent a heart attack, and a beta-blocker medicine to help protect the heart and to prevent angina pains. An angiotensin-converting enzyme (ACE) inhibitor medicine is advised in some cases. Sometimes angioplasty or surgery are options to widen, or to bypass, narrowed arteries.

What is angina?

Angina is a pain that comes from the heart. Each year about 20,000 people in the UK develop angina for the first time. It is more common in people over the age of 50 years. It is also more common in men than women. Sometimes it occurs in younger people. 

 

 

What are the symptoms of angina?

The common symptom is a pain, ache, discomfort or tightness that you feel across the front of the chest when you exert yourself. An angina pain does not usually last long. Some people with angina also become breathless when they exert themselves. Occasionally, this is the only symptom and there is no pain.

How do doctors know that I have angina?

In many cases the diagnosis is made by doctors based on the typical symptoms. No further tests may then be necessary. Tests are advised in some cases when the diagnosis is not clear, or sometimes to assess the severity of the condition. The test or tests that you have will depend on what is available locally and whether the test is suitable for you. One or more of these may be advised:

Echocardiography is an ultrasound of the heart. During this test you may be asked to exert yourself or be given an injection to make your heart work harder. The operator will then be able to see your heart working under stress.

An MRI scan can also show how your heart works under stress, as above. Some people may find MRI scans difficult. You need to lie very still in a confined space.

An angiogram may be recommended for some people. In this test a dye is injected into the coronary arteries. The dye can be seen by special X-ray equipment. This shows up the structure of the arteries (like a road map) and can show the location and severity of any narrowing. 

 

 

Briefly, risk factors that can be modified and may help to prevent angina from getting worse include:

Smoking. If you smoke, you should make every effort to stop.

High blood pressure. Your blood pressure should be checked regularly, at least once a year, if you have angina. If it is high, it can be treated.

If you are overweight, losing some weight is advised. Losing weight will reduce the amount of workload on your heart and also help to lower your blood pressure.

High cholesterol. This should be treated if it is high.

Inactivity. You should aim to do some moderate physical activity on most days of the week for at least 30 minutes. For example, brisk walking, swimming, cycling, dancing, gardening, etc. (Occasionally, angina is due to a heart valve problem where physical activity may not be so good. Ask your doctor to confirm that you can undertake regular physical activity.)

Diet. You should aim to eat a healthy diet. A healthy diet means:

At least five portions (and ideally 7-9 portions) of a variety of fruit and vegetables per day.

You should not eat much fatty food such as fatty meats, cheeses, full-cream milk, fried food, butter, etc. Ideally you should use low-fat, monounsaturated or polyunsaturated spreads.

Try to include 2-3 portions of fish per week, at least one of which should be oily (such as herring, mackerel, sardines, kippers, salmon, or fresh tuna).

If you eat red meat, it is best to eat lean red meat, or eat poultry such as chicken.

If you do fry, choose a vegetable oil such as sunflower, rapeseed or olive.

Try not to add salt to food, and limit foods which are salty.

Alcohol. Some research suggests that drinking a small amount of alcohol may be beneficial for the heart. The exact amount is not clear, but it is a small amount. So, do not exceed the recommended amount of alcohol as more than the recommended upper limits can be harmful. That is, men should drink no more than 21 units of alcohol per week, no more than four units in any one day, and have at least two alcohol-free days a week. Women should drink no more than 14 units of alcohol per week, no more than three units in any one day, and have at least two alcohol-free days a week. One unit is in about half a pint of normal strength beer, or two thirds of a small glass of wine, or one small pub measure of spirits.

The main aims of treatment are:

To prevent angina pains as much as possible and to ease pain quickly if it occurs.

To limit further deposits of atheroma as much as possible. This prevents or delays the condition from worsening.

To reduce the risk of having a heart attack.

 

 

Treatments that are advised in most cases

Lifestyle changes as discussed above

Glyceryl trinitrate (GTN)

This medicine comes as tablets or sprays. You take a dose under your tongue as required when your angina pain develops. GTN is absorbed quickly into the bloodstream, from under the tongue. A dose works to ease the pain within a minute or so. 

 

You should always carry your GTN spray or tablets with you. Some people take a GTN tablet or a spray before any exercise – for example, before climbing stairs. If the first dose does not work, take a second dose after five minutes. If the pain persists for 10 minutes despite taking GTN, then call an ambulance. 

 

GTN works by relaxing the blood vessels. This reduces the workload on the heart, and also helps to widen the coronary arteries and increase the flow of blood to the heart muscle.

A statin medicine to lower your cholesterol level

Cholesterol is a chemical that is made in the liver from fatty foods that you eat. Cholesterol is involved in forming atheroma. As a rule, the higher the blood cholesterol level, the greater the risk of developing atheroma. However, whatever your cholesterol level, a reduction in the level is usually advised if you have angina. 

 

Statin medicines lower the blood cholesterol level by blocking an enzyme which is needed to make cholesterol in the liver. There are several different statin medicines to choose from.

Aspirin or another antiplatelet medicine

Aspirin reduces the stickiness of platelets. Platelets are tiny particles in the blood that help the blood to clot after cuts. If lots of platelets become stuck on to a patch of atheroma inside an artery they can form a clot (thrombosis). Therefore, taking aspirin reduces the risk of a heart attack, which is caused by a blood clot forming in a coronary artery. 

For more information on angina screening, diagnosis and treatment or any other heart related problems contact Phyathai Sriracha Heart Center on International direct line no: 087 – 1000990 Email: [email protected]  www.phyathai-sriracha.com