Why People get Angina?

1. Angina is caused by narrowing or blockages in the arteries supplying blood to the heart muscles. The narrowing is caused by deposition of Cholesterol or Fats in the walls of arteries. This is called Atherosclerosis.
2. Might be caused by increase in the sensitivity of the arteries of the heart usually in cold weather or during exercise. This is called spasm of the heart arteries. Common in female and Smokers.

Risks for Angina

1. Smokers
2. Diabetes
3. High blood pressure
4. High blood cholesterol or triglyceride levels
5. Unhealthy diet and Lack of exercise
6. Increasing age
7. Family history of heart problems
8. Stressful Life

Types of Angina

1. There are two main types of angina you can get including:
1. Stable Angina: This is the most common type of angina. The attacks of angina is triggered by either exertion or stress. The pain usually improves within few minutes of rest or by using a spray under the tongue.
2. Unstable angina: This is less common but more serious. The attacks are more unpredictable and may be with or without any triggers. It may occur at rest.

How to Diagnosis Angina?

A medical doctor diagnoses angina. He will take a detailed history of the symptoms of chest pains and do physical examination. This is usually followed by various tests.

Symptoms of Angina

1. The symptoms of angina includes:
1. Chest pain or chest discomfort, possibly described as pressure, squeezing, burning or fullness ( usually on the left side of upper chest/left arm or neck/jaw)
2. May be associated with Nausea, Shortness of breath, Sweating or Dizziness.

Tests for Angina

The doctor may request from a list of tests below, in order to confirm and treat angina.

Symptoms of Angina

1. Electrocardiogram (ECG or EKG)
2. Blood tests
3. Echocardiogram
4. Stress test ( one from the list below as per your doctor advice)
1. Exercise treadmill test
2. Nuclear stress test
3. Stress Echocardiogram
5. Coronary angiography
6. Cardiac computerized tomography (CT) scan

How to live with angina?

During acute attack of Angina

1. Stop what you are doing and rest.
2. Use your GTN medicine (spray or tablet): you must sit before you use. You may feel lightheaded or dizzy
3. Take another dose of GTN after 5 minutes if the first one does not help.
4. If no improvement in 5-10 minutes, call your emergency services.

Medications

Your doctor will prescribe various medications based on your individual needs and your underlying other conditions and risk factors. The drugs used in angina are as follows:

1. Aspirin
1. Prescribed as soon as your doctor diagnose you with angina.
2. Aspirin increases the blood flow through the narrowed heart arteries. In addition, reduces the ability of your blood to clot and reduce your risk of a heart attack.
2. Beta-blockers
1. Beta-blockers reduces the heartbeats and reduces blood pressure.
2. Beta-blockers also help blood vessels relax and improve blood flow to heart muscle, thus reducing or preventing angina.
3. Nitrates
1. Nitrates relax and widen your blood vessels, which leads to increase blood to flow to your heart muscle
2. The doctor may prescribe for long-term and available in various doses.
3. This can be used under your tongue in the form of spray or tablet.
4. Statins
1. Statins are drugs used to lower blood cholesterol, which helps in reabsorbing cholesterol that has accumulated in plaques in your artery walls
5. Calcium channel blockers
2. Calcium channel blockers relax and relaxes blood vessels by affecting the muscle cells in the arterial walls. This increases blood flow in your heart, reducing or preventing angina.
6. Clot-Preventing Drugs
1. Some medications such as clopidogrel (Plavix), prasugrel (Effient) and ticagrelor (Brilinta) can used to help prevent blood clots from forming.
2. One of the above medications are used, if you are cannot take aspirin ( allergy).
3. You would need one of the above medications in ADDITION to aspirin if you were treated with a STENT in your narrowed or blocked heart arteries. The doctor will decide the duration of medications.
7. Ranolazine (Ranexa)
1. This can be used alone or with other angina medications in patients who angina is not very well controlled on above-mentioned medications.
8. Blood Pressure-Lowering Medications
1. Your doctor may prescribe blood pressure medications such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) in order to help relax your arteries and lowers the blood pressure.
2. Other Medications: You may be need to be treated with medications if you suffers from diabetes, heart failure or chronic kidney disease.

1. • In addition to above, medications and further investigations you have narrowing or blockages of your heart arteries may need treatment with the following procedures.
1. Coronary angioplasty OR Percutaneous Coronary Interventions (PCI)
2. Coronary Artery Bypass Graft (CABG) surgery

1. Diet and Life style changes
1. If you are diagnosed with angina, you must work on your lifestyle changes: these changes include:
1. Stop smoking and avoid exposure to passive smoking.
2. Regular exercise (discuss with your doctor about a safe exercise plan).
3. Eat a healthy diet with limited amounts of saturated fat; eat whole grains, and many fruits and vegetables.
4. Treat diseases or conditions that can increase your risk of angina, such as diabetes, high blood pressure and high blood cholesterol and stress.
5. Avoid large meals.
6. Limit alcohol consumption to one to two drinks or fewer a day.
7. Get an annual flu shot to avoid heart complications from the virus
2. Driving and Angina
1. If your angina is control, then you can keep driving.
2. If you gets frequent angina, attacks occur at rest, while driving, or triggered by emotion then you need to stop driving until your symptoms are well controlled.
3. You must inform your licensing authority and get advice if hold heavy vehicles license
3. Work and Angina
1. You can continue your routine activities
2. You should keep your GTN medicine with you just in case you have an attack at work.
3. If your job involves heavy lifting or manual labour, discuss with your employer
4. Sexual Life
1. Sexual activities can be continued if angina is control
2. You should NOT use Viagra if you are on regular nitrates tablets.
5. Exercise and sports
1. You should do routine exercise as It is important to stay active.
2. If you are worried and thinking that you might trigger your symptoms or cause a heart attack, but actually the risk is low if you if build up your activity level gradually and take regular breaks.
3. Aim for 150 minutes of moderate activity each week. Plus, it's recommended that you get 10 minutes of strength training twice a week and to stretch three times a week for 5 to 10 minutes each time.
4. Speak to your doctor if you are not sure about the safety of your exercise.