Angina, also known as angina pectoris, is a type of chest pain caused by reduced blood flow to the heart. It is a symptom of coronary artery disease, the most common type of heart disease. Recognizing and understanding angina is crucial for preventing serious heart conditions, such as heart attacks.

What is Angina?

Angina manifests as a discomfort or pain in the chest, often described as squeezing, pressure, heaviness, or tightness. This pain can also radiate to the shoulders, arms, neck, jaw, or back. There are two primary types of angina:

1.  Stable Angina happens predictably with physical exertion or emotional stress and is relieved by rest or medication.
2.  Unstable Angina: This is more severe and unpredictable, occurring at rest or with very little exertion. It is a medical emergency and requires immediate attention as it can precede a heart attack. Unstable angina is an emergency. If you have unstable angina you should dial 999 and seek urgent medical help.

Symptoms of Angina

Common symptoms of angina include:

• Chest pain or discomfort
• Pain in the arms, neck, jaw, shoulder, or back accompanying chest pain
• Nausea
• Fatigue
• Shortness of breath
• Sweating
• Dizziness

Diagnosis of Angina

Diagnosing angina involves a combination of patient history, physical examination, and diagnostic tests. Here are key steps in the diagnostic process:

1. Medical History and Physical Exam: A detailed medical history and physical exam help in understanding the symptoms and risk factors, such as high blood pressure, high cholesterol, diabetes and smoking.
2. Electrocardiogram (ECG): An ECG records the electrical activity of the heart and helps identify signs of coronary artery disease or heart rhythm.
3. Blood Tests: Blood tests can check blood cholesterol and glucose (sugar) levels. These are important risk factors for coronary artery disease.
4. Exercise Stress Test: This test monitors the heart while the patient exercises, helping to reveal issues that occur during physical activity.
5. Echocardiogram: An ultrasound of the heart, this test shows the heart’s structure and function, identifying areas of damage to the heart or problems with the heart valves.
6. Coronary Angiography: This test uses dye and X-rays to visualize the coronary arteries, identifying blockages or narrowing.

Treatment Options for Angina

The treatment of angina focuses on reducing symptoms and preventing future heart problems. Treatment strategies include lifestyle changes, medications, and medical procedures.

Lifestyle Changes

Adopting a heart-healthy lifestyle is crucial in managing angina:

• Healthy Diet: A Mediterranean style diet is recommended. Emphasise fruits, vegetables, whole grains, and lean proteins. Limit saturated fats, cholesterol, and salt.
• Exercise: Regular physical activity helps improve heart health. Always consult a doctor before starting a new exercise regimen.
• Quit Smoking: Smoking cessation significantly reduces heart disease risk.
• Weight Management: Maintaining a healthy weight reduces the strain on the heart.
• Stress Management: Techniques such as meditation, yoga, and deep breathing exercises can help manage stress.

Medications

Various medications are used to treat angina:

• Antiplatelet Agents: Drugs like aspirin, clopidogrel, ticagrelor and prasugrel prevent blood clots, reducing the risk of heart attack.
• Statins: These lower cholesterol levels, reducing plaque buildup in arteries.
• Antianginals: Drugs such as beta-blockers which reduce the heart’s demand for oxygen by reducing the heart rate and blood pressure. Calcium channel blockers and nitrates work by relaxing and widening the blood vessels, improving the blood flow.

Medical Procedures

For severe cases of angina, medical procedures might be necessary:

• Angioplasty and Stenting: A balloon is used to open up a blocked artery, and a stent is placed to keep it open.
• Coronary Artery Bypass Surgery (CABG): This surgery involves grafting arteries or veins from elsewhere in the body to bypass blocked coronary arteries.

Research and Future Perspectives

Ongoing research aims to improve the diagnosis, treatment, and prevention of angina. Emerging areas of research include:

• Coronary Microvascular Function: The impact of the smaller heart arteries (coronary microvascular system) on how patients experience angina
• Extrinsic Compression of the Coronary Arteries: Angina caused due to compression of the artery such as due to an anomalous course or due to squeezing by the heart muscle itself (bridging).
• New Medications: The role of new medication options such as GLP-1 inhibitors in reducing the risk of heart attacks.
• Genetic Studies: Investigating genetic factors that contribute to CAD to develop personalized treatment strategies.
• Artificial Intelligence: Utilizing AI and machine learning to enhance diagnostic accuracy and predict patient outcomes.

Conclusion

Angina is a serious condition that requires prompt attention and comprehensive management. With advances in medical research and technology, the future holds promise for more effective treatments and improved patient outcomes. If you experience symptoms of angina, consult with a healthcare provider to develop a personalized treatment plan. Early diagnosis and lifestyle changes are key to managing angina and maintaining heart health.