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Dealing with the discomfort of angina

The word angina comes from the Latin word angere, meaning “to choke or strangle.” To doctors, angina almost always means angina pectoris, or chest pain due to an inadequate supply of oxygen to the heart muscle (pectoris refers to the chest). But the neck, jaw, shoulders, and even the arm may also hurt during an angina attack.

In fact, many people who have angina don’t describe the sensation as pain, says . Discomfort is probably a better word than pain.

It is often the first warning sign of coronary artery disease, in which fatty plaque narrowing the heart’s arteries slows down blood flow to the heart muscle. At rest, the blood supply to the heart muscle may be sufficient. But during exercise or periods of emotional stress, the increased demand for blood may outpace the heart’s supply.

The resulting dip in oxygen and buildup of waste products stimulates nerves in the heart, causing the discomfort.

What triggers angina?

Anything that make your heart beat faster than normal — including exercise and intense emotions — can set off an angina attack. There’s even a phenomenon known as “Monday morning angina.” Angina tends to peak around holidays, underscoring the role of stress on the heart. What’s more, heavy meals and cold weather can also provoke the problem. “I always say that the worst day of the year for your heart is a Monday holiday in December,” says Dr. C. Michael Gibson, professor of medicine at Harvard Medical School.

Dealing with the discomfort of angina

Easing angina

When angina quickly and consistently subsides after you rest or calm down, it’s known as stable angina. Several different types of medications can help prevent the problem, including beta blockers (which slow down the heart, lowering its demand for blood) and calcium-channel blockers and nitrates (which relax and widen blood vessels).

Ranolazine (Ranexa), which appears to increase the blood supply to areas of the heart muscle, is another option. These are all taken daily in pill form.

Nitrates also can be taken on an as-needed basis; under-the-tongue nitroglycerin tablets or sprays often provide relief within minutes. Longer-acting versions are available as pills, ointments, or patches. Because you can develop resistance to nitrates (which renders them less effective), you’re better off taking them only when you need them, if possible.

A more serious form, unstable angina, occurs at rest or with only slight exertion. If symptoms are brand new, occur at rest, build in intensity, don’t respond to medication, or last more than a few minutes, call 911, because you may be having a heart attack caused by a clot blocking a narrowed heart artery.

Microvascular angina

Although angina often stems from plaque buildup in the heart’s main arteries, that’s not always the case. Sometimes, a coronary angiogram (a special x-ray of the heart’s arteries) reveals completely or mostly clear arteries.

We’re finally starting to recognize that a fair amount is caused by microvascular disease.

As the name suggests, this affects the tiny arteries that branch off from the larger ones. These vessels may be narrowed by plaque that isn’t visible on an angiogram.

Microvascular angina, which appears to be more common in women, may be treated with calcium-channel blockers.

Vasospastic angina

Another variant of the problem, known as vasospastic angina, also occurs in people with unobstructed arteries. The muscles within the heart’s arteries suddenly clamp down, causing a coronary spasm.

These brief, temporary spasms block blood flow to heart muscle, triggering symptoms. Also called Prinzmetal angina, it can occur out of the blue — even in the middle of the night, waking the person from sleep.

About one in 300 people is thought to have this condition, which is also treated with nitrates and calcium-channel blockers.

If you have it, work with your physician to find a medication and exercise regimen that works for you. “Be careful, but don’t let it cripple your life and prevent you from doing the things you enjoy” .


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