Angina – The Most Common Symptom of Coronary Artery Disease

More commonly known as chest pain, angina can be experienced by sufferers of CAD as a discomfort, a pressure or heaviness on the chest. For me, this was the most significant symptom that warned me I was on the verge again of having another heart attack. Sometimes it was an aching, burning sensation, or a feeling of fullness that often times, I attributed to indigestion.

It was mostly chest pain, but sometimes also, the pain would radiate towards my left arm and back. Other sufferers may experience the pain going through their shoulders, neck, jaw or throat.

If there is one advice I could share with you is to take note of these symptoms and never ignore them. I did once and it replied to a heart attack when I was just 44 years old. Even if you have never been diagnosed with any heart problem, please seek treatment as soon as possible – no, immediately. And if you know you have angina, you must take your anti angina medicines as prescribed by your doctor. Make sure you tell the doctor the precise nature of the pain, when it happened and what you exactly you were doing. With the doctor's help, you can determine if the pain you have experienced were regularly occurring or if the pain is becoming worse and more frequent, even if you are at rest and not doing any physical efforts.

Causes of Angina

It starts with the decrease of blood flow to the heart. When this happens, oxygen and vital nutrients do not reach the heart muscles. The heart of them must use another type of fuel, but a less efficient one so it can continue to pump blood to the rest of the body. This use of another less efficient fuel leads to the production of lactic acid. Lactic acid builds up in the muscles and its accumulation cause pain. The same thing happens with muscles in the legs or arms when you work out too much. The pain in the muscles of the arms and legs is caused by lactic acid also. There are drugs that are used to counteract this tension of the heart to use an inefficient fuel.

Types of Angina

There are three types of angina, namely:

1. Stable angina – pain is experienced only while doing physical activities or during intense emotional episodes. Taking a rest will usually make the pain disappear.

2. Unstable angina – chest pain experienced from this type may occur more frequently and even while resting or doing minimal activity. Oral medications can usually relieve symptoms but because the pain is unstable, it may be a precursor to a heart attack.

3. Prinzmetal's angina – pain comes even if you are at rest, sleeping or just being exposed to cold temperatures. Pain is caused by diminished blood flow to the heart's muscle or due to spasms of the coronary artery very near the blockage.

A doctor can make a diagnosis of angina after asking the patient a series of questions to find out what the symptoms are and under what circumstances pain appears. The doctor will ask you the intensity of the pain, what part of your body experienced the worst pain and what you were doing when the pain came. In my case, I vaguely remember now (it was 9 years ago when I first experienced angina) the chest pain and shortness of breath that followed. I remember becoming nervous and afraid since it was the first time I experienced such pain. I thought then that I was already having a heart attack. I went to a hospital near where I was working at the time. The doctor had me put on a nitroglycerin patch which immediately gave me a terrible headache and advised me to see a cardiologist the next day. You guessed it, I posted the visit but only for three days. The first episode of pain occurred on a Monday and I went the next Thursday. The cardiologist told me that indeed it was possible that I have blockage on my heart arteries so he told me to stay in the hospital to have my heart examined. I went to the hospital that weekend to undergo a series of test: exercise stress test, ECK, and echo cardiogram. They all pointed to the potential of coronary artery disease. What remained for me to go was angiogram. It was impossible for me to have that then for financial reasons. I asked the doctor to honestly tell me my chances and he told me we could still try to control the progress of my disease through medication.

Angina treatment

Aside from regularly taking drugs to lower blood pressure and control diabetes, the most significant part of my treatment was a radical lifestyle change. Since I was also diagnosed with diabetes, the change included dieting. That means exercising regularly and eating a heart friendly diet, including avoiding sweets and high cholesterol foods. Back then, I had stopped smoking two years earlier but the doctor told me that the damage smoking has done to my body is still fresh and has definitely contributed to my present condition then.

Some drugs used to treat angina function in two ways:

1. Increasing the amount of oxygen that is brought to the heart muscle

2. Reducing the heart's need for oxygen.

These type of medications include:

* Beta blockers

* Calcium channel blockers

* Nitrates

* Angiotensin-converting enzyme inhibitors (ACE inhibitors)

Other medicines function by preventing the formation of blood clots. Included in this type are:

* Antiplatelet medications

* Anticoagulants

* Blood thinners.

In my case, I think I went through all these medications in the hope of controlling the advance of my coronary artery disease.

Your doctor may recommend a more radical and invasive treatment to open up a blocked artery if you have a more serious case or worse case of angina. These include:

* Angioplasty

* Stenting

* Coronary artery bypass grafting (CABG) surgery

Transmyocardial revascularization (TMR)

* External counterpulsation (EECP)

It was only after my first heart attack (August 2004) that an angiogram was performed on me. And this was because I had medical insurance which I did not have when I was first diagnosed with CAD. The cardiologist told me to have angioplasty but again, I was not able to have one because of financial reasons. He then prescribed an aggressive regimen of medications to help me manage my condition.

My condition worsened at the latter part of 2005 and I decided to seek the help of relatives to pay for my angioplasty. It was finally done on January 17, 2006 the day of my son's birthday. The intervening cardiologist inserted a stent in my heart.

I continued to take my medicines regularly, stick to a meatless diet and avoid high cholesterol food and most of all, I started to bike to work. I did this for two years.

In November of 2008, I again started to have chest pain and experienced shortness of breath when climbing stairs. My cardiologist ordered nuclear imaging tests. Because this was covered by my insurance, I went to the hospital to have them during the first week of December. I underwent the tests for two days. They told me that the images did not come out right the first time, so they had to do it again. I remember that injured me with a radioactive liquid and they warned to stay away from children and pregnant women for a minimum of three days. I was radioactive!

The results were disheartening. The doctor recommended that I go another angiogram to see if I have another blockage developing in my heart. He suggested that if the results of the angiogram prove that there are blockages, I should have angioplasty right there and then. It turned out that indeed I had two blockages this time. The first one was already partially blocked. He described it to me as "70% to 80% stenosis", which I came to understand as significantly blocked. He inserted two stents in my heart this time.

What you should do if you are experiencing angina

1. Stop whatever it is you are doing and get rest immediately.

2. You would have been prescribed with nitroglycerin to treat angina so take it and wait.

3. If after five minutes you still have chest pain, take another dose of nitroglycerin.

4. Wait for another 5 minutes and if the pain persist, take a third dose of the medicine.

5. If after resting, 3 doses of nitroglycerin and 15 minutes of waiting and you still have angina, call for emergency help or have someone bring you to the emergency room of a hospital near you.

6. If you think that the pain is more than angina and you are having a heart attack, do not delay and call for emergency help. Take an aspirin too. The key to surviving is a quick treatment to less the amount of damage to your heart muscles.