ANGINA
What is angina?
Angina is the common name for the pain felt when the heart muscle does not
get enough oxygen. The muscles in your heart are telling you they need more
oxygen by cramping and causing pain. The pain is the heart's way of warning you
it cannot cope. In angina, the pain is often described as a 'tightness,
heaviness or an ache' across the chest. The pain may also be felt in the arms
(particularly the left arm), shoulder, wrist, jaw or in the back. The pain can
last for a few minutes or much longer. You may also feel breathless. If you pay
attention to the warnings and go to your doctor, modern investigations and
treatments mean that most people can continue to live a full and active life.
Ignoring the warnings could mean a heart attack in the future.
Why isn't the heart getting enough oxygen?
Like every muscle, the heart has a blood supply.
The blood supply is carried to the muscle by two coronary arteries. The blood
supply takes oxygen and nutrients into the heart muscle which gives it energy
to work. The harder a muscle has to work, the more oxygen and nutrients it
needs. In people with angina, the arteries are narrowed and therefore not
enough blood can get through to supply the muscle with oxygen and nutrients.
This means that whilst there may be no problem for the heart when you are doing
normal activities, when you ask the heart to work a bit harder (e.g. run for
the bus or walk up a hill), it can't get enough oxygen and it complains. Your
heart also has to work harder when you are stressed or excited.
Why have my blood vessels developed narrowings?
Your blood vessels are narrowed with a build-up of fatty tissue called
atheroma in the vessel lining. The fatty build-up can develop into hardened
areas called plaques. As these gradually become bigger and thicker, the surface
of the plaque eventually becomes quite rough. This can cause your blood cells
to stick to the plaques on their way past, eventually causing a clot to form.
Angina becomes a heart attack when the clot finally blocks the artery.
This is why it is so important not to ignore the warning signs - the blockage
may be prevented.
Why me?
It may be that the problem tends to 'run in families' and this can mean you
are more likely to develop the problem. However, there are several other
reasons which might make you more prone to develop angina. Things such as
smoking, high blood pressure, high sugar levels in the blood (diabetes) or high
fat content in the blood (cholesterol). Being overweight and unfit will not
help either.
How does the doctor know it's angina?
Usually, the doctor will be able to listen to your story and decide if it is
angina and not heartburn, indigestion or anything else. However, your doctor
may want to do a few tests to see if there are any other problems.
The most common test is an ECG (electrocardiogram).
This is a recording of your heart beating and is completely painless. It can
show if you have had any heart attacks in the past or if the heart beat is out
of rhythm. You may be asked to do some exercise (on a treadmill or exercise
bike) so that the doctor can assess how your heart is working during exercise.
A blood test can measure the level of fats in your blood (cholesterol
level).
A heart scan is another painless investigation that shows your heart
actually working on a TV screen (echocardiogram).
A coronary angiogram is a special x-ray which has to be done by a specialist
in a hospital. A fine tube is put into an artery in the leg or the arm until it
reaches the arteries of the heart. A dye is then injected and this can show
where the narrowings are in the arteries of the heart.
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