1. My father has just been diagnosed with chronic angina. What exactly is angina?
Your father has a serious heart condition that occurs when the heart does not receive all the oxygen-rich blood it needs to function well. He may feel pain or discomfort in the center of the chest behind the breastbone. He may also have what is called "radiating pain" in the jaw, shoulder, back, or arms. Angina pain can be triggered by physical activity, such as climbing stairs, or by emotional stress, such as frustration or anger. The pain can last anywhere from two to 10 minutes, and usually subsides with rest or short-acting nitroglycerin. Read more in Angina Defined.

2. Do many people have chronic angina?
According to the American Heart Association's 2002 Heart and Stroke Statistical Update, more than 6.6 million people in the United States are currently diagnosed with angina. Of those, 4.1 million are women and 2.5 million are men. In addition, more than 400,000 people are newly diagnosed with angina each year. Read more about who gets angina and why in Risk Factors.

3. Is angina a condition associated with aging, or can you get it at any age?
Since angina is associated with coronary artery disease (CAD), the condition usually shows up in people ages 55 and older. But younger people can have CAD and angina attacks as well. Read Coronary Artery Disease for more.

4. I'm worried about the pain affecting my mother's active lifestyle. How will angina change her everyday activities?
Your mother may find that anticipating and dealing with angina attacks limit her daily activities. Sometimes people with chronic angina avoid certain actions they think will trigger an attack. These include: increased physical activity; stressful or emotional situations; eating too much, too often, or too late; air pollution; and cold temperatures.

A person's efforts to avoid the pain and discomfort of angina can alter daily living to the extent that patients no longer feel good about their health and ability to stay active. You and your mother should work with her doctor to determine any physical limitations. Then ask the doctor to suggest ways your mother can modify—rather than halt—her daily activities, and what medicines might be necessary so she can lead the fullest life possible. Read Living Longer, Living Better for more.

5. I sometimes feel different sensations of pressure and pain. What is an angina attack supposed to feel like and how often do the attacks occur?
The strength, frequency, and duration of an angina attack can vary from person to person. Mild symptoms include feeling faint and/or nauseous or breaking out in a cold sweat. You may feel severe pain or chest pressure, or a vise-like, crushing, or squeezing sensation behind the breastbone (or sternum). Pain can also radiate to the jaw, teeth, shoulders or back.

Attacks can happen anytime a trigger—such as physical exertion or a stressful situation—sets one off. The discomfort can last from two to 10 minutes and usually goes away with rest or short-acting nitroglycerin. Read Diagnosing Angina for more.

6. I'm worried about confusing the pain of an angina attack with the pain of a heart attack. What is the difference?
Angina pain does not always mean a heart attack is happening. Rather, the pain you feel indicates the heart muscle is not receiving enough oxygen-rich blood to work efficiently.

With a heart attack, blood supply to the heart is completely blocked, causing permanent and irreversible damage to the heart muscle. The pain is more severe, lasts longer, and is not relieved with short-acting nitroglycerin or rest. If you think you are having more severe pain than usual or the pain is not going away, don't delay—call 911 or your local emergency number. Read more about How the Heart Works.

7. If I have angina, am I at risk for having a heart attack?
Yes, because people with angina usually have coronary artery disease, they are at an increased risk for a heart attack. If angina episodes start happening more often, lasting longer, or occurring even when you're at rest (known as unstable angina), a heart attack may be about to happen. Studies indicate that every year, 3% to 3.5% of angina patients have heart attacks. If you feel you might be having a heart attack, call 911 or your local emergency number right away. Make sure those around you know how to help if you do have a heart attack; read You and Your Family for more.

8. Besides chronic angina, what other types and how are they different?
Less common types of angina are unstable angina, Syndrome X, and silent ischemia.

• Unstable angina. People with coronary artery disease may develop unstable angina, meaning pain and discomfort can happen unpredictably, even during rest. The pain is generally more severe and frequent than that of chronic angina. New or more severe symptoms of unstable angina require medical help right away, since a heart attack may be about to happen. Chronic angina patients may develop unstable angina as their condition progresses.
• Syndrome X. Syndrome X (also called microvascular angina) is a less common form of angina that mostly affects women. Patients have chest pain but they appear to have normal, unblocked coronary arteries. Researchers believe the discomfort comes instead from a malfunction in the tiny arteries that supply blood to the heart.

Silent ischemia. Angina attacks without pain are called silent ischemia. Ischemia means the heart or other organs do not receive enough oxygen-rich blood to work well. Despite this, the patient does not have chest pain or discomfort, even though tests reveal the same abnormal electrocardiogram (EKG or ECG) changes as with chronic angina. An EKG is a device that records the electrical activity of the heart on a moving strip of paper to determine how well and how fast the heart is working. Read more in Other Types of Angina.

9. What drugs are used to treat angina?
Currently, three drug classes are used to treat chronic angina: nitrates, calcium channel blockers, and beta-blockers.

• Nitrates help blood vessels relax, thereby increasing oxygen-rich blood flow to the heart.
• Beta-blockers stop the action of a substance in the nervous system (adrenaline) that stimulates the heart to work harder and faster. By reducing the heart's workload (by reducing blood pressure, heart rate, and the strength of the pumping force of the heart), beta-blockers decrease the amount of oxygen that the heart requires to perform.
• Calcium channel blockers block calcium from reaching the body's cells. Calcium normally enters the cells through special openings called calcium channels. Calcium causes arteries to tighten or narrow, increasing the heart's workload by boosting blood pressure and reducing blood flow. By keeping extra calcium out of cells, calcium channel blockers help lower blood pressure, decrease heart muscle pumping force and heart rate, and lower the heart's demand for oxygen.

Note that everyone responds to medications differently. A drug that works for one person may not be completely effective for another. Though angina patients may take one or more of these medications, about two-thirds still have angina attacks. Research suggests that some patients on more than one type of drug continue to have more than two attacks per week. Other studies show that some angina drugs may cause unwanted side effects such as dizziness, sexual problems, fatigue, and headaches in some people.

Always, if side effects become worse or don't go away, report them to your doctor, and ask if a change in your treatment may be better for you. Read more in Angina Medications.

10. Can surgery or other procedures help angina?
Yes, they might. Your doctor may recommend a surgical procedure if your medications no longer help control your angina pain. The goal of these procedures is to allow an increased flow of blood to the oxygen-deprived heart. The four primary procedure options are percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), enhanced external counterpulsation (EECP), and transmyocardial revascularization (TMR).

• PCI. A balloon is inserted into a narrowed artery and then inflated, pressing fatty plaque against the wall of the artery (thus the common name for this procedure: balloon angioplasty). This helps increase the size of the artery and improve blood flow to the heart. Sometimes a tiny wire frame called a stent is left in the artery to help keep the artery open.
• CABG. A type of open heart surgery, this procedure involves taking a blood vessel from another part of the body, such as the leg, and connecting it to the heart, making a detour around a blockage in the coronary artery. With the new detour in place, the heart once again begins to receive an adequate flow of oxygen-rich blood.
• EECP. Sometimes referred to as a "natural bypass," EECP is a procedure that may increase blood flow through the heart by stimulating new blood vessel growth (called angiogenesis). Cuffs are placed around the legs and are rhythmically inflated and deflated for one hour based on signals from electrocardiogram monitoring. Patients must commit to EECP sessions five days per week for seven weeks. EECP may reduce the frequency of angina attacks and also the depression associated with having angina.
• TMR. This procedure uses lasers to make small channels in the wall of the heart into the pumping chamber. The increased flow of oxygen-rich blood through the channels helps new vessels grow (angiogenesis). More vessels mean increased blood flow to the heart tissue, bypassing the clogged coronary arteries. Patients may also have less angina pain because the procedure eliminates some of the nerves in the area of the ischemic tissue.
  
  TMR is approved for use in patients with severe angina who have had no benefit from other treatment options. However, recent research indicates that TMR may not work as well as originally believed.

For more, read Surgery and Related Therapies, Potential Therapies, and Alternative Treatment Options.

11. Are potential new treatments for chronic angina in development?
Scientists are working on several potential new treatment options for chronic angina patients.

• Gene therapy for angiogenesis. To grow new vessels, the body produces a protein called VEGF. A new procedure enables physicians to inject the gene for VEGF directly into the patient's heart muscle. Researchers hope the gene will become a part of the heart muscle cells and help grow new blood vessels, which will provide other pathways for oxygen-rich blood to move around clogged coronary arteries and reach the heart.
• Drug-coated stents. Stents are small wire mesh cages inserted into a coronary artery after it has been opened by a balloon angioplasty. Stents act as a scaffold for the artery, propping it up and open for improved blood flow. They help prevent the artery from closing up again, a condition called restenosis. Unfortunately, stents aren't foolproof—restenosis can still occur.
  
  Researchers are testing drug-coated stents to see if they can prevent restenosis. These stents are coated with a small amount of a drug that works only in that specific area. A variety of drugs are being tested. They range from drugs that help prevent rejection of transplanted kidneys to anti-cancer drugs to medications that help break down or prevent blood clots from forming. The FDA has not approved any of these therapies and research is continuing.

Read more in Potential Therapies.

12. Is it true that being female helps to protect me from heart disease?
Heart disease is the leading cause of death among men, but it's the leading cause of death for women, too. More women die from heart disease than from cancer, chronic lung disease, and accidents combined. But being female does have advantages. Heart disease tends to develop about 10 years later in women, and females lag behind males by about 20 years when it comes to increased risk of heart attack or sudden death. The protective effects are probably due to the female hormone estrogen. Read more in Women and Heart Disease.

13. Are there other gender differences when it comes to heart disease?
Yes, many. Women who have heart attacks are more likely to die from them. New research suggests that having diabetes is a much stronger risk factor for heart disease among women than men. Also, women get Syndrome X more often, a type of angina in which chest pain occurs, but heart arteries appear normal on X-rays. Such factors lead some doctors to advocate taking female physiology and symptoms into account in research, prevention and treatment. Visit Women and Heart Disease for more information.

14. My mother has angina and seems sad much of the time. How can I watch for symptoms of depression?
You're wise to be concerned. Heart patients, including those with angina, are at greater risk for depression, including major (or clinical) depression. Look for warning signs such as despair, apathy, trouble concentrating, fatigue, sleep or eating problems, low self-esteem, sloppy appearance, or persistent headaches or digestive problems. If some of these symptoms apply, urge your mother to talk to her doctor or a mental health professional about how she has been feeling. Learn more in Depression and Heart Disease.

15. How is depression treated?
Today, the standard treatment consists of antidepressant drugs, psychotherapy, or both. Fortunately, most depressed people can be treated effectively, but too often, depression is left unrecognized and untreated. For angina patients, depression, anxiety, and stress make the heart work harder, which in turn can worsen angina pain or discomfort. That's why it's especially important for patients and their caregivers to remain alert for the warning signs above. Read more in Depression and Heart Disease.

16. I know that stress can worsen my angina pain, but what exactly happens to my heart when I feel anxious or pressured?
Stress, anxiety or fear—because of a family argument, traffic accident, or other reason—causes your brain to signal the adrenal glands to release a hormone that triggers the "fight-or-flight" response. Heart rate and blood pressure rise, and your heart beats faster and harder. As a result, your heart requires more oxygen to do its work. But if your arteries are narrowed by coronary artery disease, they can't deliver enough oxygen-rich blood. Therefore, angina may strike. Visit Managing Stress for more information.

17. How can I cope better with stress?
Some angina patients find simple measures helpful, such as listening to soothing music, soaking in a warm bath, taking a walk, or exercising. Talking with a friend or loved one may work wonders, too. For more structured ways to reduce stress, consider counseling, meditation or spiritual practice, disciplines such as t'ai chi or yoga, or a stress-management program. For the latter, ask your doctor, religious leader, or hospital social worker for a referral. See Managing Stress for more information.

18. I'm frustrated that I've had to give up so many activities to prevent angina attacks. Do other angina patients commonly feel this way, too?
You're not alone. In one study, 82% of angina patients reported altering daily routines to prevent angina attacks, for example, by shying way from activities that require exertion or by resting more. When angina prevents you from functioning at your desired level, you may feel that your quality of life has been compromised. Doctors define "quality of life" as your overall satisfaction with life—how you feel, as well as your ability to function physically and socially. Learn more in Living Longer, Living Better.

19. I feel that my doctor doesn't truly understand how much angina affects my daily life. Should I bring this up during my next visit?
Yes. It may feel uncomfortable to tell your doctor that your treatment may not be working, or perhaps you believe that no more can be done to improve your angina. However, most doctors want to hear such concerns. Ask about changes that may help, including treatments as well as lifestyle changes (diet, exercise, stress management, and other measures). These actions may go far to help improve your quality of life. Read Living Longer, Living Better for more information, and visit LifeHeart's Talk to Your Doctor for suggested questions to ask your doctor about angina.

20. My angina attacks are very painful and uncomfortable. Can they damage my heart?
Angina usually doesn't damage the heart like a heart attack, in which part of the heart muscle may die from lack of oxygen-rich blood. Instead, angina can take its toll by causing ongoing physical and emotional pain or discomfort. Besides enduring painful and frightening attacks, angina patients often feel depressed and anxious about future attacks. Although angina isn't normally considered "chronic pain," some experts believe it should be categorized this way. Visit Understanding Chronic Pain for additional information.

21. What is chronic pain?
Chronic pain may be continuous, or it may come and go, but its hallmark is that it lasts for months or years. Such pain is commonly associated with a chronic condition, such as migraines, arthritis, or ischemia. More than 6 million Americans experience repeated angina attacks, which means that they, too, may struggle with chronic pain. Chronic pain can lead to enormous costs physically, emotionally, and financially, for example, if pain causes you to take sick days or go on disability. See Understanding Chronic Pain for more.

22. I heard about a promising "Mediterranean diet." What is it?
The "Mediterranean diet" centers around fruits, vegetables, starches, beans, nuts, seeds, and low to moderate amounts of dairy products, poultry, and fish. Olive oil is used for cooking, and modest amounts of wine are included. The consumption of red meat and eggs are limited. One study found that heart attack survivors who followed a Mediterranean diet were 50% to 70% less likely to have a repeat heart attack than survivors who ate a typical Western diet. Lean more in Nutrition Matters.

23. Can a drink or two each day help my arteries?
New studies hint that modest alcohol drinking may slow artery stiffening that happens with age. But doctors aren't yet giving the thumbs-up to drinking for heart health because of the risk of addiction, liver damage, and accidental injury or death. Ask your doctor for advice, and if you decide to drink, limit yourself to no more than one alcoholic drink per day if you're a woman, and no more than two per day if you're a man. Read more in Nutrition Matters.

24. My doctor suggests that I exercise, but it's never been a habit. How do I get started?
First, choose an enjoyable activity—otherwise, you won't stick with it. Exercising with a friend or relative keeps motivation up, too. If your life feels busy, don't attempt to cram a continuous 30 minutes of exercise into the day. Instead, take a 10-minute walk three times a day. And when you honor your exercise commitments, occasionally indulge in a special reward to keep yourself going, such as a massage or a fun night out. Read Exercise for Heart Health for additional information.

25. What should I do if I feel angina pain during exercise (or at any other time)?
Stop right away, rest, and take short-acting nitroglycerin, if your doctor has prescribed it. Ask your doctor if you should make changes in your exercise routine to prevent future attacks. He or she may refer you to a cardiac rehabilitation program, which can run tests to find the right level of activity for you. If your angina becomes more painful or starts after very mild physical activity, see your doctor immediately. Visit Exercise for Heart Health for additional information.

26. My husband has angina and seems unmotivated to follow treatment or take care of his health. What might be going on?
The reasons may be many, but don't overlook the possibility of depression, especially if your husband seems unhappy or expresses feelings of hopelessness. When angina patients are depressed, they may be less likely to comply with medical treatment or to make healthy lifestyle changes, such as exercising and eating well. To worsen matters, they may turn to overeating or smoking to cope with emotional pain. And by not following treatment plans, they won't get the full benefit of their medications. For the sake of your husband's health and well-being, talk with him and his doctor about whether he needs to be checked for depression.

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