Angina – Complete Guide: Diagnosis, Treatment, and Management

 

What is Angina?

Angina is a type of chest pain caused by reduced blood flow to the heart muscle. It occurs when the heart’s oxygen demand exceeds its supply, usually due to coronary artery disease (CAD). Angina is a symptom of an underlying heart condition, often related to atherosclerosis, and should be evaluated and treated promptly.

Types of Angina

Stable Angina

• Definition: Predictable chest pain triggered by physical exertion or emotional stress, relieved by rest or nitroglycerin
• Cause: Fixed atherosclerotic plaques that partially block coronary arteries
• Duration: Usually lasts 1–5 minutes

Unstable Angina

• Definition: Unpredictable chest pain that occurs at rest or with minimal exertion
• Cause: Often due to rupture of an atherosclerotic plaque and blood clot formation
• Duration: Can last longer than stable angina (may indicate heart attack risk)

Variant (Prinzmetal’s) Angina

• Definition: Rare form caused by coronary artery spasm
• Cause: Temporary blockage from artery spasm
• Duration: Brief episodes, often at rest

 

Microvascular Angina (INOCA)

• Definition: Angina without visible coronary blockages Cause: Dysfunction of small coronary vessels
• Duration: Similar to stable angina but harder to diagnose

 

Diagnosis of Angina

Initial Evaluation

• Medical history: Detailed assessment of chest pain characteristics
• Physical exam: May detect signs of heart failure or arrhythmias Risk
• assessment: Using tools like Framingham or ASCVD score

 

Diagnostic Procedures for Angina

1. Electrocardiogram (ECG)

• What happens: You lie still while small electrodes are attached to your chest, arms, and legs. The machine records your heart’s electrical activity for 5–10 minutes.
• Purpose: Detects abnormal heart rhythms or signs of reduced blood flow (like ST-segment changes).
• Duration: 5–15 minutes

2. Stress Test (Treadmill Test or Pharmacologic Stress Test)

• What happens: You walk on a treadmill or receive medication (if you can’t exercise) to make your heart work harder. Your heart rate, blood pressure, and ECG are monitored throughout.
• Purpose: Checks if physical exertion triggers angina or ECG changes.
• Duration: 30–60 minutes

3. Coronary Angiography (Invasive)

• What happens: A thin tube (catheter) is inserted into an artery (usually in the wrist or groin). Contrast dye is injected, and X-rays show blockages in coronary arteries.
• Purpose: Confirms the location and severity of artery blockages.
• Duration: 30–60 minutes (requires local anesthesia)

 

Medical and Surgical Treatment of Angina

Medical Management of Angina

Angina is primarily managed through medications that improve blood flow and reduce the heart’s workload. Doctors prescribe different classes of drugs depending on the type and severity of angina:

• Nitrates (e.g., nitroglycerin): Provide quick relief during angina attacks by dilating coronary arteries.
• Beta-blockers (e.g., metoprolol): Reduce heart rate and blood pressure, decreasing the heart’s oxygen demand.
• Calcium channel blockers (e.g., amlodipine): Relax blood vessels and improve coronary blood flow, especially for variant angina.

Additional Medications

• Statins to lower cholesterol and stabilize plaques Antiplatelet drugs (aspirin, clopidogrel) to prevent blood clots
• ACE inhibitors/ARBs for patients with high blood pressure or diabetes

 

Surgical and Interventional Procedures

1. Percutaneous Coronary Intervention (PCI / Stenting)

Minimally invasive Balloon inflation opens the blocked artery Stent placement keeps the artery open Recovery: 1–2 days of hospitalization

2. Coronary Artery Bypass Grafting (CABG)

Open-heart surgery Uses healthy blood vessels to bypass blocked arteries Ideal for multiple or complex blockages Recovery: 5–7 days hospitalization, with longer healing

3. Enhanced External Counterpulsation (EECP)

Non-surgical treatment Leg cuffs rhythmically inflate to increase blood flow Best for inoperable patients Requires: 35 outpatient sessions

 

Choosing the Right Treatment

Mild angina: Often well-managed with lifestyle changes and medications

Single artery blockages: Treated with PCI/stents

Multiple/severe blockages: Require CABG

Non-surgical candidates: May benefit from EECP therapy Regular follow-ups with a cardiologist are essential

 

Patient Experience

“At first, I thought it was just indigestion. But when the pain started spreading to my shoulder and jaw, I went to the ER. It turned out to be angina. A stent was placed the next day—and now, with medications and walking every morning, I feel stronger than ever.”

—Asif , 52, Accountant

 

Case Study: Microvascular Angina in a Young Woman

Patient: 35-year-old non-smoking female, no visible coronary blockages, but severe chest pain on exertion.

Diagnosis: Microvascular angina confirmed via stress test and advanced imaging.

Treatment: Calcium channel blockers and lifestyle changes (yoga, diet modification).

Outcome: Symptoms reduced significantly within 3 months.

 

Frequently Asked Questions (FAQ)

 

1. Is angina a heart attack?

No. Angina is chest pain due to reduced blood flow, but it does not cause heart muscle death like a heart attack. However, unstable angina can lead to a heart attack if not treated.

 

2. Can angina be cured permanently?

Angina can’t always be cured, but it can be effectively managed with medication, lifestyle changes, and procedures like stenting or bypass surgery.

 

3. What are the warning signs of unstable angina?

Chest pain at rest, pain that lasts longer than usual, and pain that doesn’t improve with medication—seek immediate help if these occur.

 

4. Can young people have angina?

Yes. Microvascular angina can affect younger individuals, especially women, even without major artery blockages.

 

5. What lifestyle changes help angina?

Quit smoking, eat a heart-healthy diet, exercise regularly, manage stress, and control diabetes and blood pressure.