Angina Pectoris: Symptoms, Types

Brief overview

  • Symptoms: pain behind the sternum, radiation to other areas possible, tightness and/or shortness of breath often with fear of death, unstable form: life-threatening, in women/older people/diabetes atypical symptoms such as dizziness, nausea
  • Causes and risk factors: oxygen deficiency of the heart usually due to coronary artery disease, risk factors: smoking, high blood pressure, diabetes mellitus, older age
  • Treatment: Medications: Nitro preparations as well as others against the underlying disease, possibly (surgical) interventions such as balloon dilatation or bypass surgery, lifestyle changes: refrain from smoking, healthy diet, physical activity.
  • Course and prognosis: Fast help is very important for course and prognosis, since life-threatening course with heart attack is possible, depending on the severity of the underlying disease and lifestyle.
  • Prevention: Smoking cessation, exercise and healthy diet

Angina pectoris (chest tightness, heart tightness, stenocardia) is the term doctors use to describe an attack-like pain behind the breastbone. It is usually the main symptom of arteriosclerosis of the coronary arteries (coronary heart disease = CHD). Angina pectoris is therefore actually a symptom and not a disease.

  1. Pain behind the breastbone
  2. Trigger is a physical or emotional stress
  3. Complaints decrease by physical rest and/or by nitro spray/capsule

In atypical angina, only two of the three criteria are met. It is also possible that there is no pain in the heart area or only one criterion is met.

What are the symptoms?

Affected people often describe a feeling of heaviness and numbness in the arm, shoulder, elbow or hand. This usually affects the left side of the body. In addition, symptoms such as sudden shortness of breath, nausea, vomiting, sweating and/or an oppressive, choking feeling in the throat occur. Often, these signs accompany feelings of anxiety that go as far as fear of death and suffocation.

Special features in women

Special features in older people

Elderly people (especially those over 75 years of age) often show similar angina pectoris symptoms as women. During an attack, they often complain only of shortness of breath and a drop in performance.

Special features in diabetes

What are the different forms?

Depending on the course of the disease, doctors distinguish between different forms of angina pectoris: stable and unstable angina pectoris.

Stable angina pectoris: symptoms

At rest, the symptoms usually subside within 15 to 20 minutes. When a nitro spray is used to combat the signs of angina pectoris, they usually subside after about five minutes.

Doctors divide stable angina into five stages, according to the Canadian Cardiovascular Society:

Stage

Complaints

0

None Symptoms

I

No complaints with everyday stress such as walking or climbing stairs, but with sudden or prolonged stress

II

III

Discomfort during light physical exertion such as normal walking or dressing

IV

Rest complaints and discomfort at the slightest physical exertion

Unstable angina pectoris: symptoms

A special form of unstable angina pectoris is the rare Prinzmetal angina. In this case, the vessels of the heart become tense (coronary vasospasm). It occurs at rest, for example, during sleep.

Unstable angina develops from stable chest tightness or occurs out of nowhere.

Doctors divide unstable angina into three degrees of severity:

Grade

Severity

I

New onset of severe or worsening angina pectoris

II

III

Angina pectoris at rest within the last 48 hours

With unstable angina pectoris, there is a high risk of heart attack (20 percent). Therefore, it is absolutely necessary to call the emergency doctor immediately in case of an attack! Doctors speak of acute coronary syndrome when unstable angina pectoris turns into a heart attack.

How does angina pectoris develop?

In arteriosclerosis – the main cause of angina pectoris – the blood vessels are narrowed by deposited fats, platelets, connective tissue and calcium. If the coronary vessels are affected, the heart receives too little oxygen and nutrients. Doctors then speak of coronary heart disease (CHD) with the main symptom of angina pectoris.

Risk factors promote the deposition of blood fats on the arterial walls. These risk factors are:

  • Smoking
  • Elevated blood pressure
  • High age

Inflammatory processes transform the wall of the blood vessel – a so-called arteriosclerotic plaque develops. This is colloquially referred to as arteriosclerosis. Over many years, the vessels harden and their diameter decreases. If such a plaque tears, a blood clot forms at the site. Sometimes this completely blocks the artery.

The following factors increase the risk of atherosclerosis of the coronary arteries:

  • Unhealthy diet and obesity: High-fat and high-calorie diets lead to obesity and high cholesterol levels in the long term.
  • Lack of exercise: sometimes raises blood pressure and worsens cholesterol metabolism
  • Genetic predisposition: Cardiovascular disease is clustered in some families, so genes appear to play a role. The risk is increased if first-degree relatives have developed CHD before the age of 55 (women) or 65 (men).
  • Smoking: Substances in tobacco smoke promote, among other things, the formation of unstable plaques in the vessels.
  • High blood pressure: Elevated blood pressure levels directly damage the inner walls of the blood vessels.
  • Diabetes mellitus: In poorly controlled diabetes, blood sugar is permanently too high, which damages the vessels.
  • Elevated inflammation levels: For example, if the protein CRP is elevated in the blood, this makes the plaques unstable.
  • Higher age: With increasing age, the risk of arteriosclerosis of the coronary vessels increases.

How is angina pectoris diagnosed?

Conversation and physical examination

First of all, the physician talks to the patient and takes his or her medical history (anamnesis). He asks, for example, how long the symptoms of cardiac arrest have existed, how they manifest themselves exactly, and what causes them or in what situation they arise. The doctor also asks whether you are already using a nitro spray and whether the symptoms can be alleviated with it.

The next step is a physical examination. Among other things, the doctor listens to the heart and lungs and taps the chest. A blood pressure and pulse measurement are also part of this examination. In this way, the doctor checks whether the patient has high blood pressure (hypertension). A blood test provides information, particularly in the case of unstable angina pectoris, as to whether a heart attack may have occurred.

Imaging procedures

Ultrasound of the heart: During a heart ultrasound (echocardiography), the doctor examines whether the heart muscle is altered. This enables him to assess the heart chambers and heart valves and their function. The doctor usually performs this ultrasound through the esophagus. The patient is usually unaware of the examination because he or she is given anesthesia.

Stress ECG: Physicians perform the stress ECG in the clinic or practice with so-called bicycle ergometry. In this process, the patient rides a stationary bicycle with a gradual increase in the load. If the strain causes insufficient blood flow to the heart muscle, the connected devices record this. If angina pectoris occurs and the ECG changes, this is important for the diagnosis.

Cardiac scintigraphy: Cardiac or myocardial scintigraphy depicts the blood flow to the heart muscle at rest and under stress. To do this, the doctor first injects the patient with a weakly radioactive substance that absorbs the muscle tissue of the heart. The so-called gamma camera then images the radioactive rays and shows which areas of the heart are poorly supplied.

How is angina pectoris treated?

The first goal of angina pectoris treatment is to prevent severe attacks as well as a heart attack. The danger of a heart attack exists primarily in the case of unstable angina pectoris. This can be recognized, for example, by sudden pain and a feeling of tightness in the chest when the patient is at rest, or by the unusual severity of the usual angina pectoris symptoms.

The victim absolutely needs first aid until the arrival of the emergency physician. The following simple measures will help in such a situation:

  • Loosen clothing that constricts the victim, such as collars or belts.
  • Keep his upper body elevated.
  • Try to stay with the patient and reassure him.
  • Provide fresh air: If the seizure happens in a room, it helps to open the window. Many sufferers find this soothing.

Angina pectoris: Medications

Nitro preparations must never be taken together with potency drugs (phosphodiesterase-5 inhibitors)! This is life-threatening, as both drugs lower blood pressure. As a result, it is possible for blood pressure to drop so low that life is in danger.

Other drugs that doctors prescribe as part of angina pectoris therapy, even long-term, are:

  • Blood thinners such as platelet aggregation inhibitors, acetylsalicylic acid or clopidogrel
  • Vasodilators for vasodilatation with various nitrates
  • Statins for elevated cholesterol levels

Angina pectoris: interventions on the heart

Doctors dilate the narrowed section of blood vessel that causes angina using balloon dilation. Here’s how it works: They insert a small balloon into the narrowed section of the vessel through a thin plastic tube (catheter). They inflate this balloon on the spot so that it expands the constriction.

Angina pectoris: Healthy lifestyle

Successful angina pectoris treatment requires the patient’s cooperation. As a sufferer, it is advisable to adopt a healthy lifestyle that avoids or at least reduces risk factors of chest tightness. You can achieve this, for example, by:

  • A healthy diet
  • Regular exercise
  • Refraining from nicotine
  • Losing weight if you are overweight

What is the course of angina pectoris?

The prognosis and life expectancy of angina pectoris depend on the underlying disease. Angina pectoris is actually a symptom by definition and not a disease in its own right, but it should always be considered a warning signal.

Angina pectoris attacks lead to decreased exercise capacity and, overall, a reduced quality of life for many sufferers.

Can angina pectoris be prevented?

If you want to prevent angina pectoris, the same tips apply in principle as for people who already suffer from chest tightness: Lead a healthy lifestyle to keep your heart and blood vessels healthy. This includes:

  • Eating a healthy diet
  • @ Ensure regular physical activity
  • Reducing excess weight
  • To give up smoking
  • To avoid stress and find rest

It is also important to have regular preventive checkups. Only in this way is it possible for the doctor to detect and treat diseases such as diabetes, high blood pressure or elevated blood cholesterol levels, which damage the blood vessels, in good time. If the doctor prescribes appropriate medication for you, it is necessary that you take it regularly – even if you feel well at the moment.