What is angina pectoris?
		Angina - what happens in the heart?
		What causes an angina attack?
		Are chronic angina attacks predictable?

1. Angina pectoris is a serious and disabling heart condition that causes a feeling of crushing or squeezing behind the breastbone. Some people may feel pressure or pain in the chest, jaw, teeth, shoulder, back, or arm.



2. Angina attacks happen when your heart is not receiving enough oxygen, a condition called ischemia.



3. Ischemia occurs when the coronary arteries are not supplying enough oxygen-rich blood to the heart.



4. Angina attacks can be triggered by exercise, eating a big meal, emotional stress, extreme weather, chills, fever, or low blood sugar.

You've never had a problem climbing upstairs with the groceries. You could always keep up with your children or grandchildren with little effort. But recently you've noticed a pressure, a suffocating or squeezing pain, or discomfort in your chest that seems to be triggered by certain activities or emotions. You know that stopping to rest helps the pain or discomfort go away. If you have mentioned these attacks to your doctor, she or he may have told you that you have angina. And, if that is the case, you know you may also need to take short-acting nitroglycerin under the tongue or as a spray to help relieve attacks. In fact, nitroglycerin is the drug that is used most often to relieve angina.¹

This section of LifeHeart.com explains what angina is, what causes it, and how it is diagnosed. Angina is serious. Some people with angina may discover that they are unable to participate fully in activities they enjoy. Others may find that they are unable to continue working on a regular basis. Your doctor will help you find the best treatment plan available to help you control your angina attacks. With your treatment plan in hand, you can take steps to begin regaining control of your life. Learning more about angina is an important part of this process.

What is angina pectoris?

The word "angina" comes from the Greek word for "strangling"; "pectoris" is Latin for "of the chest."² Angina pectoris (called angina for short) can be a serious and debilitating heart condition, marked by repeated and sometimes unpredictable attacks of pain or discomfort. Many people describe angina as a vise-like, crushing, or squeezing sensation behind the breastbone, also called the sternum. Others may admit that their angina is more difficult to describe and feels like a mild type of chest pressure or as if they are suffocating. Some people may also feel symptoms in the jaw, teeth, shoulder, back, or shooting down the arm. Still others may experience numbness or feel like they're having indigestion.

You should be aware that if this type of pain is more severe than you've ever felt before, if it makes you feel faint or nauseated, causes you to break out in a cold sweat, or is unrelieved by the short-acting nitroglycerin your doctor may have prescribed, you might be having a heart attack. Call 911 or your local emergency number right away.

Angina pectoris was well known by doctors of the late 1700s.³ Yet angina seems to be more a product of the 20th century when Americans started driving more, walking less, and eating more food than they needed for survival. In addition, people began living longer in the 20th century than ever before. As people aged and lifestyles changed, doctors began seeing angina in their patients more often.⁴

Your doctor may have told you that your angina is "stable angina," "chronic stable angina," or "chronic angina." Chronic means that you've had angina for a long time. Some doctors use the term stable angina to indicate that the number of attacks you have on a regular basis hasn't changed in the past 60 days. Chronic angina is just one type of angina. See Other Types of Angina for more information.

Angina - what happens in the heart?

Angina attacks occur when your heart is not receiving all the oxygen it needs. This is called ischemia, and it can happen one of two ways.

The amount of blood flowing through the heart may be less than before because the arteries of the heart have become partially blocked. Blockages are often a result of plaque buildup (atherosclerosis), the usual cause of coronary artery disease. (See Coronary Artery Disease for more information.) This means less oxygen-rich blood—therefore, less oxygen for making energy—reaches the heart. The result is sometimes called supply angina.

Rarely, even though the usual amount of blood may be flowing through the coronary arteries, the blood may not have enough oxygen to support the extra work the heart is doing during exercise or emotional stress. The result is sometimes called demand angina. For example, anemia, a shortage of red blood cells, can result in a shortage of oxygen in the blood.

What causes an angina attack?

Angina attacks can be triggered by physical activity such as exercising at the gym or walking up a hill. Emotional tension, such as frustration or anger, as well as chills, fever, low blood sugar, and abnormally fast heartbeats can also bring on an angina attack. Eating (big meals in particular) can cause an angina attack. It has been suggested that this is a result of an increase in the heart's demand for oxygen. However, new evidence has shown that angina might also occur after a meal because there may be less blood flowing through arteries in the heart that may already have a partial blockage.⁵

The connection between extra physical work and angina attacks is fairly obvious. But how does stress or anger cause angina?

When you are mentally stressed, a nerve signal from your brain tells your heart and the rest of your body to prepare for immediate action. This is the fight-or-flight response, the split-second reaction to either stand your ground or leave the situation behind. Your heart beats faster and your blood pressure rises. Both make your heart work harder to keep the same amount of blood flowing through the body. If you have plaque buildup in your coronary arteries, this increased demand on the heart can bring on angina even though the amount of oxygen in the blood is the same.

Simply put, emotional stress, anger, and worry can increase the number and severity of angina attacks because of the heart's increased need for oxygen-rich blood. Since anger increases heart rate and blood pressure, blood vessels may tighten and can cause ischemia. In fact, these types of emotions may sometimes be more of a problem for people with chronic angina than physical effort is, because their effects can last for hours.⁶ Doctors do not fully understand how the heart muscle sends pain messages to the brain, but chemical messengers in the body's nervous system may be sending the alert.

Yet not everyone will feel angina pain or discomfort in the same way. Some people may recognize the pain or discomfort sooner, while others may describe very different symptoms of the attack.

Angina pain or discomfort can take a few minutes to build up, and can last anywhere from two to 10 minutes. The pain usually goes away once you stop to rest. In addition to any daily angina medicines your doctor may have prescribed, people with angina usually receive a prescription from their doctor for a medication called short-acting nitroglycerin, to be taken when angina strikes. The tablet is placed under the tongue and allowed to dissolve when signs of angina first appear. Some doctors may prescribe a short-acting nitroglycerin spray instead of tablets. Relief provided by short-acting nitroglycerin may occur within seconds to minutes. Learn more in Angina Medications.

Are chronic angina attacks predictable?

Your attacks seem somewhat predictable, you know what usually triggers an attack, and they don't occur when you are resting or relaxed. You know which activities or types of stress will start an attack. In fact, you may have adjusted your daily schedule to avoid these attacks, perhaps including some of the activities you enjoy.

How could angina be called "stable" as long as you continue to have even one angina attack a week? Actually, many people with stable angina may still have unpredictable angina attacks. You could have an angina attack one day going up the stairs, but not on the next day under the very same conditions.

	What is ischemia? Click here.

Sources

1. American Heart Association. Angina Pectoris Treatments. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4496. Accessed March 6, 2004.

2. "Angina" and "Pectoris." Merriam-Webster's Online Collegiate Dictionary. 2004. Available at: http://www.m-w.com. Accessed June 24, 2004.

3. Leibowitz, J.O. The History of Coronary Heart Disease. London: Wellcome Institute of the History of Medicine, 1970. 1.

4. O'Rourke, R.A., R.C. Schlant, and J.S. Douglas. "Diagnosis and Management of Patients with Chronic Ischemic Heart Disease." Hurst's The Heart. 10th ed. Ed. V. Fuster, et al. New York: McGraw-Hill, 2000. 1208.

5. Chung W-Y, Sohn D-W, Kim Y-J, et al. Absence of postprandial surge in coronary blood flow distal to significant stenosis: A possible mechanism of postprandial angina. J Am Coll Cardiol. 2002;40:1976-1983. PubMed

6. Futterman LG and Lemberg L. Anger and Acute Coronary Events. Am J Crit Care. 2002;6;574-576. PubMed