Angina 

A consultant cardiologist explains angina, a syndrome caused by a restriction in the supply of oxygen-rich blood to the heart. He explains the risks, symptoms and treatment, and who is most likely to develop angina.

Find out how to prevent angina

Transcript of Angina

Angina is normally described as a form of chest pain,

but rather than being a severe pain,

it's a feeling of cramping and constriction in the middle of the chest.

This lasts a few minutes and typically happens when people begin to exercise.

It can go down the arm, into the shoulders and neck and so on.

It can be associated with things like sweatiness and shortness of breath.

The usual cause is narrowings in the arteries

that provide blood to the heart.

Angina happens when the heart is trying to do extra work,

and the oxygen it gets from the narrowed blood vessels is insufficient

to provide for its needs.

It's almost a stitch-like symptom that the heart develops.

Angina is usually classified into two categories, stable and unstable.

Stable will typically come on when somebody walks a particular distance,

it lasts a short period of time and goes very quickly with medication.

Unstable angina tends to last longer and happens at rest or on little exertion.

That should be regarded as an emergency and the patient should go to hospital.

A proportion of people will present with stable angina

that is due to Atherosclerosis, narrowing in the arteries,

and that progresses and develops over many years, perhaps 20 or 30 years.

It's a very slow-changing process which is the reason why many of these patients

can be managed with tablets and are not at high risk.

However, the unstable population might present for the first time

with a heart attack. Obviously that is a much higher risk situation.

Currently it's impossible to accurately predict who is going to become unstable

from the stable population.

The sort of people who get angina, it's more common in men

and in some ethnic groups, particularly Asians,

and it becomes much more common as people get older.

There is a variety of risk factors that make people more likely to have it,

such as smoking, high cholesterol, high blood pressure.

Angina is extremely common, it gets more common with age

and it's estimated that perhaps as many as 1 in 5 people over the age of 65

has some degree of angina.

A lot of those people will have relatively mild symptoms

and will be controlled on tablets, but some obviously will be much more unwell.

In younger populations it is much less common,

and in women before the menopause it's much less common.

In terms of medication, the treatment for angina is in three groups.

One is to stop the symptoms when they occur,

typically in the form of a spray

or a small nitrate tablet that goes under the tongue.

The next is to prevent symptoms occurring,

which will be with medication such as beta-blockers which slow the heart down

and reduce the oxygen demand for the heart and prevent it happening.

There are alternatives for beta-blockers which not everybody can use.

The final part is to try and prevent progression of the existing disease.

That includes tablets such as aspirin, something to reduce cholesterol,

which is usually a statin, and various other medication too.

Following diagnosis, many patients are advised to have further investigations

which might be a test like an angiogram,

which specifically looks at the inside of the arteries,

to decide whether or not further treatment is necessary,

such as angioplasty or bypass surgery.

An angiogram is a test which looks at the inside of the arteries

by putting a tube either in the top of the leg or the wrist

and take a fine catheter up to the heart and put dye around the heart

to outline the arteries.

X-rays are taken and that shows you where the narrowings are.

Then, there are several possibilities,

one is that you will be recommended to carry on with tablets,

the next possibility is an angioplasty will be done,

which is done through the same tube,

but involves putting in a balloon and a stent, a wire mesh,

to keep the artery open.

That is put in the narrowed area and blown up to keep the artery open.

If there are a lot of narrowings, or in certain circumstance,

a bypass operation may be recommended.

This is a surgical option

which involves putting grafts beyond the narrowings to improve the blood flow.

There are a lot of things that people can do throughout their lives

to try and reduce their chances of getting heart disease.

Not smoking, having a good diet, exercise.

Drinking is acceptable, but in modest amounts.

We're all aware that the diet should be high in fruit and vegetables,

relatively low in saturated fat and low in salt.

Stable angina itself does not carry a very huge risk.

People shouldn't worry if they have stable symptoms

and the pain lasts a short time.

They will be given medication, which is life-long.

That reduces the risk of anything further happening quite substantially.

Unstable angina is a very different category,

and should be regarded as an emergency.

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