Angina

Diagnosis

Your doctor will do a physical examination and question you about your symptoms in order to identify angina. Additionally, any risk factors, such as a family history of heart disease, will be discussed with you.

The following tests are used to identify and confirm angina:

• Electrocardiogram. The electrical activity of the heart is measured by this rapid and painless examination. Electrodes are applied to the chest, and occasionally the arms and legs in the form of sticky patches. The electrodes are connected by wires to a computer, which shows the test findings. If the heart is beating too quickly, too slowly, or not at all, an ECG might reveal this. In order to determine whether blood flow through the heart has been slowed down or interrupted, your healthcare professional may also look for patterns in cardiac rhythm.
• Chest X-ray. The health of the heart and lungs can be seen on a chest X-ray. To find out if other illnesses are causing chest pain symptoms and to check for an enlarged heart, a chest X-ray may be performed.
• Blood tests. When the heart muscle is harmed, as in a heart attack, certain heart enzymes enter the bloodstream. These chemicals can be found via a blood test for cardiac enzymes.
• Stress test. When the heart is working harder, diagnosing angina might occasionally be simpler. Usually, a stress test entails using a treadmill or stationary cycle while having the heart rate monitored. A stress test could be conducted concurrently with another test. In situations where physical exercise is not feasible, healthcare providers may opt to prescribe medications that replicate the effects of exercise on the heart.
• Echocardiogram. In an echocardiogram, sound waves are used to produce images of the beating heart. The blood flow through the heart can be seen in these pictures. A stress test could include an echocardiography.
• Nuclear stress test. Blood flow to the heart muscle is measured during a nuclear stress test both at rest and under stress. Similar to a standard stress test, a nuclear stress test involves injecting a radioactive tracer into the patient’s blood. How the tracer travels via the cardiac arteries is visible with a specialized scanner. Low or absent tracers in certain areas imply inadequate blood flow.
• Cardiac Computerized Tomography (CT). You normally recline on a table within a doughnut-shaped machine for this test. The device’s internal X-ray tube spins around the body to gather images of the chest and heart. A cardiac CT scan might reveal any heart enlargement or narrowing of any heart arteries.
• Cardiac Magnetic Resonance Imaging (MRI). This examination produces detailed pictures of the heart using radio waves and magnetic fields. Usually, you will be lying on a table within a long, tube-like machine that creates precise images of the blood vessels and the structure of the heart.
• Coronary angiography. X-ray imaging is used in coronary angiography to look within the heart’s blood arteries. It belongs to the broader category of operations known as cardiac catheterization.

In order to inject dye into a cardiac artery, a doctor threads a thin tube (catheter) through a blood vessel in the arm or groin. The dye enhances the visibility of the cardiac arteries on an X-ray. Your doctor may refer to this kind of X-ray as an angiogram.

Treatment

Treatment options for angina include:

• Medications
• Modification of lifestyle
• Angioplasty and stenting
• Coronary bypass surgery

The treatment objectives for angina are to reduce its frequency and severity, while also minimizing the risk of mortality and heart attack.

If you encounter unstable angina or experience angina pain that is different from your typical pain, it is essential to seek immediate emergency medical attention.

Medications

Medication may be required if lifestyle modifications, such as eating well and exercising, fail to improve heart health and reduce angina pain. Among the medications used to treat angina:

• Nitrates. Angina is frequently treated with nitrates. So that more blood can flow to the heart, nitrates relax and widen the blood vessels. Nitroglycerin is the kind of nitrate that is most frequently used to treat angina. Under the tongue is where the nitroglycerin tablet is put. Your doctor may advise taking a nitrate as a long-term prophylactic measure or before to activities that frequently cause angina (such as exercise).
• Aspirin. Because aspirin lessens blood clotting, blood can flow more easily through constricted heart arteries. Blood clot avoidance can lower the risk of a heart attack. Never begin taking an aspirin everyday without first consulting your doctor.
• Blood thinners. Blood doesn’t clot because certain drugs, including clopidogrel, prasugrel, and ticagrelor, reduce the likelihood that blood platelets will adhere to one another. If you can’t take aspirin, one of these medicines might be advised.
• Beta blockers. Beta blockers effectively reduce blood pressure by inducing a decrease in both the heart rate and the force of each heartbeat. Additionally, these drugs relax blood vessels which help increase the blood flow.
• Statins. Drugs known as statins are used to decrease blood cholesterol. A risk factor for heart disease and angina is high cholesterol. The chemical the body requires to produce cholesterol is blocked by statins. They aid in preventing blood vessel obstructions.
• Calcium channel blockers. Calcium antagonists, also known as calcium channel blockers, relax blood vessels and increase blood vessel width to promote blood flow.
• Other blood pressure medications. Angiotensin-Converting Enzyme (ACE) inhibitors and Angiotensin II Receptor Blockers (ARBs) are additional medications for lowering blood pressure. Your doctor could advise one of these medications if you have high blood pressure, diabetes, heart failure signs, or chronic renal disease.
• Ranolazine. For chronic stable angina that doesn’t improve with other drugs, this medicine may be administered. It can be taken either by alone or in combination with other angina drugs such calcium channel blockers, beta blockers, or nitroglycerin.

Therapies

To improve blood flow to the heart, a non-drug approach termed Enhanced External Counterpulsation (EECP) may occasionally be suggested. Cuffs that resemble blood pressure monitors are wrapped around the pelvis, thighs, and calves during EECP. Multiple treatment sessions are necessary for EECP. People who experience frequent, uncontrolled angina (refractory angina) may find relief from their symptoms with EECP.

Surgery and other procedures

To address angina pain and coronary artery disease, medical professionals may consider catheter procedures or open-heart surgery when lifestyle modifications, medications, or other treatments prove insufficient. The following surgeries and methods are utilized for treatment:

• Angioplasty with stenting. A very small balloon is put into the constricted artery during an angioplasty, also known as a Percutaneous Coronary Intervention (PCI). A small wire mesh coil (stent) is typically introduced after the balloon has been inflated to expand the artery in order to keep it open.

Angina is lessened or completely eliminated after an angioplasty with stenting. If lifestyle modifications and medicines are ineffective at treating chronic, stable angina, angioplasty with stenting may be a useful alternative.

• Open-heart surgery (coronary artery bypass surgery). A blocked or narrowed heart artery is bypassed during coronary artery bypass surgery using a vein or artery from another part of the body. The heart receives more blood after bypass surgery. It can be used to treat stable angina as well as unstable angina that has not responded to conventional therapies.