YOUR GUIDE TO Understanding Your Angina Diagnosis and Treatment
Our goal at the Mercy Health Heart Institute is to help you be well. Our experienced team includes cardiologists, cardiovascular surgeons, electrophysiologists, registered nurses, physical therapists and registered dietitians. And all of us have one goal: making sure your heart is healthy. It s important that you understand what angina is, your treatment options and how you can help yourself be well. WHAT IS ANGINA? Angina is defined as chest pain or discomfort caused by heart disease. According to the American Heart Association (AHA), it is a symptom of the condition known as myocardial ischemia. Pain occurs when the myocardia (the heart muscle) gets insufficient blood and oxygen (ischemia). It is often the first sign of heart disease. Usually, angina signals that you have narrowing in one, or possibly more, of your coronary arteries (the large blood vessels that carry oxygen-rich blood to your heart). Angina is a warning signal that your heart isn t getting enough blood. WHAT CAUSES ANGINA? The chief cause of angina (reduced blood and oxygen flow) is atherosclerosis, the build-up of cholesterol-laden plaques on the interior walls of your arteries. As plaques grow, they restrict blood flow, causing pain. If a plaque tears or ruptures, a blood clot can form that completely blocks blood flow. This causes a heart attack and usually irreversible damage to your heart muscle. WHAT ARE MY RISK FACTORS FOR ANGINA? There are some risk factors out of your control: a family history of heart disease and your age. The older you are, the longer time you ve had to have plaque build-up. Risk factors that are within your control include smoking, being overweight and eating a diet high in salt which can contribute to high blood pressure, which damages the thin layer of protective cells that line the interior surface of blood vessels.
WHAT ARE THE EARLY WARNING SIGNS OF ANGINA? Tightness and pressure in your chest (right below the breastbone) are classic angina symptoms. Pain, tingling or numbness in your jaw, shoulders arms or fingers, sweating, breathlessness, nausea and fatigue are all classic signs especially in women. WHEN SHOULD I SEEK MEDICAL ATTENTION? Angina symptoms can be very vague and be interpreted as indigestion. It is best to err on the side of visiting your doctor if you have any signs of angina. WHAT IS STABLE ANGINA? Stable angina is characterized by symptoms that come on only when your heart has to work harder than usual, during exercise or stress, for example. Stable angina that is triggered by activity and goes away with rest generally signals that your heart is getting enough oxygenated blood, so you don t experience symptoms during leisurely activities. Often, when symptoms do arise, the triggers are predictable and easily manageable. Over time, it will become easy for you to gauge the level of exertion that triggers symptoms. You can be active enough to get close to but not beyond this level, and use medication to stop pain if you overdo it. If angina is coming on in new situations, however, call your doctor. For example, you notice that walking across the room causes pain when it didn t two months ago means your blockage is probably getting worse. If you have any doubt about why pain is occurring, call 911 and take emergency steps. WHAT IS UNSTABLE ANGINA? Unstable angina may be a signal that a heart attack is imminent. Due to the blockage of a coronary artery causing severe narrowing, your heart is not getting enough blood even when oxygen demand is low. The three key signs of unstable angina are: Symptoms that follow no pattern and occur at rest and with exertion, An episode that lasts longer than 20 minutes, and Pain that is not relieved by rest or fast-acting nitrates. If you experience any of these symptoms, call 911 immediately. Other times to call 911 or have someone take you to the emergency room: If you re experiencing chest discomfort for the first time If an episode of angina is accompanied by sweating, dizziness, nausea, vomiting or difficulty breathing If something seems very different or intense about your angina. All of these symptoms can signal a heart attack.
IS THERE ANYTHING I CAN DO WHILE WAITING FOR MEDICAL HELP? Take one or two full-strength aspirins or four 81 mg children s aspirins, but don t swallow them. Chew the tablets for 30 seconds, which gets the aspirin into your bloodstream quickly. If you have been prescribed a fast-acting nitrate, take one to help widen a blocked artery. If it doesn t ease pain immediately, you can take up to two more, with five minutes between each dose. Lie down (on the floor, which is the best surface to be on if CPR is needed), breathe deeply and slowly, and try to relax until help arrives. 8 CONTROLLABLE ANGINA RISK FACTORS Cigarette smoking High blood pressure Cholesterol (high LDL, low HDL) Diabetes Abdominal obesity Depression and anxiety Sedentary lifestyle Fruit and vegetable intake WHAT SHOULD I EXPECT AFTER BEING DIAGNOSED WITH ANGINA? After being diagnosed with angina, your doctor will want more information in order to prescribe treatment. Your physician will talk to you about you family history, measure your blood pressure and order a blood test. In addition he will order the following tests: A resting electrocardiogram (EKG), placing small sensors on your chest to detect patterns of electrical activity from your heart Exercise stress test in which you ll walk on a treadmill or ride a stationary bike while your EKG, blood pressure and heart rate are monitored. In some cases, more testing may be required: 24-hour Holter Monitor: wearing a small, portable EKG device Pharmacological stress test: injection of a drug to mimic the effect of exercise Nuclear medicine stress test: injection of a mildly radioactive substance during a stress test to allow monitoring of it through your coronary arteries Coronary angiography: insertion of a tiny tube (catheter) into a vein usually in the groin and threaded up to the coronary arteries, where a contrast material is released and X-rays taken to show the location and severity of any obstructions CT angiography: an alternative to coronary angiography, a CT scanner takes highly detailed images of your heart Cardiac MRI: in this test, you will lie in a long tube while powerful agents and radio-frequency waves construct detailed images of your heart.
7 QUESTIONS YOUR DOCTOR MAY ASK YOU Can you describe the pain? Do you have any chronic health conditions? Are you physically active? How s your diet? What s your stress level? Do you smoke? Are you taking any medications? HOW DO I REDUCE MY SYMPTOMS AND CUT THE RISK OF HEART ATTACK? Although there is no cure for heart disease, taking medication correctly, following a heart-healthy lifestyle and getting cholesterol, blood pressure, diabetes and other risk factors under control will help manage your condition. 4600 McAuley Place Cincinnati, Ohio 45242 www.e-mercy.com 4/2012 1,000 MD DG