ANGINA

Possible Cause

Angina is caused by reduced blood flow to your heart muscle. Your blood carries oxygen, which your heart muscle needs to survive. When your heart muscle isn't getting enough oxygen, it causes a condition called ischemia.

The most common cause of reduced blood flow to your heart muscle is coronary artery disease (CAD). Your heart (coronary) arteries can become narrowed by deposits called plaques. This is called atherosclerosis.

This reduced blood flow is a supply problem — your heart is not getting enough oxygen-rich blood. You may wonder why you don't always have angina if your heart arteries are narrowed due to fat buildup. This is because during times of low oxygen demand — when you're resting, for example — your heart muscle may be able to get by on the reduced amount of blood flow without triggering angina symptoms. But when you increase the demand for oxygen, such as when you exercise, this can cause angina.

• Stable angina. Stable angina is usually triggered by physical exertion. When you climb stairs, exercise or walk, your heart demands more blood, but it's harder for the muscle to get enough blood when your arteries are narrowed. Besides physical activity, other factors, such as emotional stress, cold temperatures, heavy meals and smoking, also can narrow arteries and trigger angina.
• Unstable angina. If fat-containing deposits (plaques) in a blood vessel rupture and a blood clot forms, it can quickly block or reduce flow through a narrowed artery, suddenly and severely decreasing blood flow to your heart muscle. Unstable angina can also be caused by blood clots that block or partially block your heart's blood vessels. Unstable angina worsens and is not relieved by rest or your usual medications. If the blood flow doesn't improve, heart muscle deprived of oxygen die which is called as a heart attack.
• Variant angina. Also called Prinzmetal's angina, is caused by spasm of the coronary artery in which the artery temporarily narrows. This narrowing reduces blood flow to your heart, causing chest pain. Variant angina can occur even when you're at rest, and is often severe. It can be relieved with medications.

The following Factors increase your risk of coronary artery disease and angina:

• Tobacco use. Chewing tobacco, smoking and long-term exposure to secondhand smoke damage the interior walls of arteries — including arteries to your heart — allowing cholesterol to collect and block blood flow.
• Diabetes. Diabetes is the inability of your body to produce enough insulin. It is a hormone secreted by your pancreas, allows your body to use glucose.
• High blood pressure. Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries.
• High blood cholesterol or triglyceride levels. Cholesterol is a major part of the deposits that can narrow arteries throughout your body. A high level of low-density lipoprotein (LDL) cholesterol (the "bad" cholesterol), increases your risk of angina and heart attacks. A high level of triglycerides, a type of blood fat related to your diet, also is undesirable.
• History of heart disease. If you have coronary artery disease or if you've had a heart attack, you're at a greater risk of developing angina.
• Older age. Men older than 45 and women older than 55 are at a greater risk.
• Lack of exercise. An inactive lifestyle contributes to high cholesterol, high blood pressure, type 2 diabetes and obesity. However, it is important to talk with your doctor before starting an exercise program.
• Obesity. Obesity raises the risk of angina and heart disease because it's associated with high blood cholesterol levels, high blood pressure and diabetes. Also, your heart has to work harder to supply blood to the excess tissue.
• Stress can increase your risk of angina and heart attacks. Too much stress, as well as anger, can also raise your blood pressure. Surges of hormones produced during stress can narrow your arteries and worsen angina.

Complications

The chest pain that can occur with angina can make some normal activities, such as walking, uncomfortable. However, the most dangerous complication to be concerned about with angina is a heart attack.

Common signs and symptoms of a heart attack include:

• Pressure, fullness or a squeezing pain in the center of your chest that lasts for more than a few minutes
• Pain extending beyond your chest to your shoulder, arm, back, or even to your teeth and jaw
• Increasing episodes of chest pain
• Prolonged pain in the upper abdomen
• Shortness of breath
• Sweating
• Impending sense of doom
• Fainting
• Nausea and vomiting

Care and Treatment

You can help prevent angina by making the same lifestyle changes that might improve your symptoms if you already have angina. These include:

• Quitting smoking
• Monitoring and controlling other health conditions, such as high blood pressure, high cholesterol and diabetes
• Eating a healthy diet
• Increasing your physical activity after you get your doctor's OK
• Maintaining a healthy weight
• Reducing your stress level.

When to Call the Doctor

If your chest pain lasts longer than a few minutes and doesn't go away when you rest or take your angina medications, it may be a sign you're having a heart attack. Call 911 or emergency medical help. Arrange for transportation. Only drive yourself to the hospital as a last resort.