How to Deal With Angina Pain

Three Parts:Recognizing AnginaGetting Medical TreatmentLowering Your Risk Through Diet and Lifestyle

Angina is chest pain that occurs when your heart doesn’t get enough oxygenated blood. It is also a very serious warning signal that you are at risk of having heart attack. If you have chest pain, seek medical attention immediately and talk to your doctor about ways of reducing your pain and risk of a heart attack.[1]

Part 1
Recognizing Angina

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    Call emergency responders if you could be having a heart attack. Angina itself can be a symptom or precursor to a heart attack. If you are unsure about whether the chest pain you are experiencing could be a heart attack, call emergency responders immediately. Symptoms of angina include:[2][3]
    • Pain in your chest
    • A squeezing feeling in your chest
    • Pain in your arms, neck, jaw, shoulder, or back
    • Nausea
    • Fatigue
    • Shortness of breath
    • Sweating
    • Dizziness or lightheadedness
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    Call emergency responders if you are a woman with abnormal symptoms. Women’s symptoms during heart attacks often differ from those of men. They may not have chest pain. However, it is still a medical emergency. Women are more likely to have:[4]
    • Nausea
    • Difficulty breathing
    • Abdominal discomfort
    • Exhaustion
    • Pain in the neck, jaw, or back with or without chest pain
    • A stabbing pain instead of a squeezing feeling
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    Call emergency medical responders if you are having an unstable angina. An unstable angina is often a sign of a heart attack. You may need immediate treatment to avert a heart attack. Signs of an unstable angina include:[5][6]
    • Pain that is not alleviated by angina medication. If medication does not alleviate the angina within five minutes, call an ambulance.[7]
    • Pain that is more severe or different from your previous episodes
    • Pain that gets worse as it continues
    • Pain that continues for up to 30 minutes
    • Pain that occurs when you are not exercising, even possibly when you are asleep.
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    Ask your doctor if you have a stable angina. This is the most frequent type of angina. Your doctor may diagnose you with a stable angina if your angina:[8][9][10]
    • Is triggered by exercise, emotional stress, cold, smoking, or eating a heavy meal
    • Feels like gas or indigestion
    • Lasts only 5 minutes or less
    • Is similar to other angina attacks you have had
    • Includes pain that radiates to your arms or back
    • Is alleviated by medication
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    Discuss less common anginas with your doctor. Determining whether you have these anginas may help your doctor to determine what the underlying cause of your angina is. Tell your doctor before hand if you are pregnant, nursing, or think you could be pregnant, as this might affect your doctor's choices of which tests to give you.[11][12][13]
    • Variant angina or Prinzmetal’s angina occurs when your coronary artery spasms and constricts. This reduces blood flow to your heart causing the angina. It usually causes severe pain and may happen even when you are inactive. It can usually be helped by medications.
    • Microvascular angina is often an indication of coronary microvascular disease. It occurs when the small coronary arteries spasm and restrict blood flow to the heart. The pain is generally severe and does not go away quickly. You may also feel tired, have difficulty breathing, and have problems sleeping. It may be triggered by stress.
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    Get additional tests if your doctor suggests it. Depending on your particular symptoms and medical history, your doctor may request one or more of the following tests:[14][15]
    • Electrocardiogram (ECG). In this test your doctor will attach metal electrodes to your arms, legs, and chest. The electrodes will be attached to a machine that will measure the electrical pulses of your heartbeat. This test is noninvasive and does not hurt.
    • A stress test. During this test, you will exercise on a treadmill or bike while connected to an ECG machine. This tells the doctor how much exercise your heart can handle before you have an angina episode. If your health condition makes you unable to exercise, you may be given a medication that will make your heart beat faster instead.
    • A nuclear stress test. This is similar to a stress test except that the doctor will also give you a radioactive substance into your blood stream. This enables the doctor to then use a scanner to take pictures of your heart as you exercise. It can be used to determine what areas of your heart are not getting enough blood.
    • An echocardiogram. This test uses sound waves that are above our hearing range to create an image of your heart. It can detect damaged areas. Your doctor may also do this during a stress test.
    • An x-ray. An x-ray produces an image of your heart and lungs. It allows the doctor to study the size and shape of your organs. It does not hurt. You may be asked to wear a lead apron to protect your reproductive organs.
    • Blood tests. Your doctor may want to take blood and test it to see if it contains enzymes that enter your blood stream after your heart has been injured due to a heart attack.
    • Cardiac CT scan. This test involves using X-rays to take images of your heart. It enables the doctor to see if parts of your heart are enlarged or if you have constricted arteries that might be reducing the blood flow to your heart. During this test, you would be on a table inside the scanner.
    • Coronary angiography. This test would involve the doctor using a cardiac catheter. This is a small tube that would be inserted into your body through a vein or artery in your groin or arm. The catheter would them be moved through the vein or artery to your heart. A dye would be put into the catheter which would enable the doctor to use x-rays to see where you might have blocked arteries. Because this test is more invasive, it is likely to be used as a last resort. Your doctor may suggest it if other tests have not be successful at diagnosing you or your angina is not responding to treatment.

Part 2
Getting Medical Treatment

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    Ask your doctor about using medications for symptom relief. One commonly prescribed medication is glyceryl trinitrate. It causes your blood vessels to relax and widen. This increases the blood flow to your heart immediately and should relieve your pain within three minutes.[16]
    • This medication is taken to stop an angina episode or prevent it if you are about to do something that may trigger it, like exercise.
    • It may cause headaches, flushing, and dizziness. You should not drink alcohol with it. If it makes you dizzy you should not drive or operate machinery.
    • You can take it as a pill or a spray.
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    Use medications to prevent future episodes. There are many different possibilities for medications that your doctor may prescribe, depending on your symptoms and medical history. These medications are designed to prevent attacks over the long-term, rather than deal with an occurring or oncoming attack. Because some of these medications may interact with other prescription medicines, over-the-counter medications, herbal remedies, or supplements, it is important to tell your doctor about everything that you take. Possible medicines include:[17]
    • Beta-blockers. These medications make your heart beat slower and weaker, reducing the amount of blood and oxygen it requires. Side effects include fatigue, cold hands and feet, diarrhea, and feeling unwell. These medications may interact with other medications, including over-the-counter medications.
    • Calcium channel blockers. These medications relax your arteries and increase the blood flow to your heart. Side effects include flushing, headaches, dizziness, exhaustion, and rashes, but they usually stop after a few days. Grape fruit juice can cause you blood pressure to drop, so you should never drink grape fruit juice while on these medications.
    • Long-acting nitrates. These medications relax your blood vessels and increase the blood flow to your heart. Side effects include headaches and flushing. These medications cannot be taken with sildenafil (Viagra) because they may lower your blood pressure too much.
    • Ivabradine. This medication slows your heartbeat. It is often given to people who cannot take beta-blockers. A side effect is that it may disturb your vision by causing you to see bright flashes. This can make driving at night dangerous.
    • Nocorandil. This medication widens your coronary arteries and increases blood flow to your heart. They are often prescribed for people who can’t take calcium channel blockers. Side effects include dizziness, headaches, and feeling unwell.
    • Ranolazine. This medication relaxes the heart without affecting the rhythm of your heart beat. It is often given to people with heart failure or arrhythmias. Side effects include constipation, dizziness, and weakness.
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    Use medications to reduce your risks of heart attacks and strokes. People with angina are often at a high risk for a heart attack or stroke. If this is the case for you, your doctor may suggest the following medications:[18]
    • Statins. These medications prevent your body from making cholesterol. This can reduce your blood cholesterol, prevent additional blockages in your arteries, and reduce your risk of heart attacks and strokes. Side effects include constipation, diarrhea, and abdominal discomfort.
    • Aspirin. Aspirin can prevent the platelets in your blood from sticking together and forming clots. This reduces your risk of heart attacks and strokes. Aspirin may not be suitable for people with stomach ulcers. Side effects include irritation to your digestive tract, indigestion, and feeling unwell.
    • Angiotensin-converting enzyme inhibitors (ACE). These medications lower your blood pressure. This means that your heart doesn’t have to work as hard. However it can reduce the blood flow to your kidneys, so this medication may not be suitable for people with kidney problems. Side effects include dizziness, exhaustion, weakness, and coughing.
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    Talk to your doctor about surgery. If medication does not alleviate your symptoms, your doctor may recommend surgery in addition to medication. One of two procedures is generally used to treat angina:[19][20]
    • Coronary artery bypass graft. This procedure takes a piece of another blood vessel elsewhere in the body and uses it to route the blood around a blocked artery. This option is often the most likely to be recommended if you have diabetes, are over 65, or have blockages in at least 3 arteries. It is used for both stable and unstable anginas. Recovery usually takes three months.
    • Angioplasty and stenting. The doctor puts a balloon tipped catheter into the artery that is too narrow. The balloon is expanded at the narrow point to stretch the artery open. A stent, or wire mesh, is put in to hold the artery open. This is often used for stable anginas. It is less invasive because the catheter may be inserted through your groin or arm, making recovery easier. Recovery is usually two weeks or less. However, it has a higher likelihood of the artery becoming blocked again, relative to coronary artery bypass surgery.

Part 3
Lowering Your Risk Through Diet and Lifestyle

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    Keep your arteries clear with a low-fat diet. Saturated and trans fats are particularly bad for your heart. Keep your fat intake down to 3 servings per day. A serving is actually a very small amount, like a tablespoon of butter. You can reduce your fat intake by:[21]
    • Checking the labels on food to see what types of fat they contain. Limit yourself to 14 grams of saturated fat and 2 grams of trans fat each day. This will help prevent your arteries from clogging. Some packages may not say they have trans fats. If it says “partially hydrogenated,” those fats are likely to be trans fats.[22][23]
    • Healthier fat sources include: Olive, canola, vegetable, and nut oils, avocados, nuts, seeds, trans fat free margarine, cholesterol lowering margarines like Benecol, Promise Activ, and Smart Balance. Fat sources to avoid include: Butter, lard, bacon fat, gravy, cream sauces, nondairy creamers, hydrogenated margarine, hydrogenated shortening, cocoa butter, chocolate, coconut, palm, cottonseed, and palm kernel oils.[24]
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    Lower the burden on your heart with a low salt diet. Eating too much salt contributes to hypertension, or high blood pressure. You lower your salt intake by:[25][26]
    • Not adding table salt to your food. At first, you may miss the salt, but after a while, your body will readjust and you won’t crave the salt.
    • Avoid pre-packaged or canned foods that have salt added. This includes many snacks like chips, pretzels, and salted nuts. You can replace these snacks with an apple or carrot.
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    Satisfy your hunger with fruits and vegetables. Fruits and vegetables are low in fat and high in fiber and vitamins. A heart healthy diet should include 2 to 3 cups of fruit and 2 to 3 cups of vegetables each day.[27][28]
    • Fresh or frozen vegetables are generally healthier than canned items. In particular avoid canned vegetables that have salt added or fruits that have sugary syrups. Don’t eat vegetables that are fried, breaded, or have fatty cream sauces.
    • Many fruits and vegetables make simple, quick snacks. Try eating an apple, banana, cucumber, carrot or pepper when you get hungry between meals.
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    Swap fatty meats for lean meats. Red meats like steaks and pork chops are often very fatty. Healthier alternatives are poultry and fish. You should eat no more than 6 ounces of meat per day.[29][30]
    • Trim off any fat you see and remove the skin.
    • Change your cooking techniques. Try baking or grilling instead of frying.
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    Cut calories from alcohol. Drinking too much can increase your risk for obesity and burden your heart. If you drink a lot, you may find that quitting causes you to lose weight. When you do drink, try to stick to these guidelines.[31][32]
    • Only one drink per day for women and men over 65.
    • One to two drinks per day for men under 65.
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    Don’t harden or narrow your arteries through smoking. Smoking and chewing tobacco can damage your arteries making you more prone to angina, high blood pressure, heart attacks, and strokes. You can get help quitting by:[33][34]
    • Talking to your doctor or seeing a counselor
    • Joining support groups or calling hotlines
    • Using medications or nicotine replacement therapy
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    Exercise if your doctor says it is ok. Do not start a new exercise program without talking to your doctor to see if your heart can handle it. However, if your doctor gives you the go ahead, it can help you to lower your blood pressure, reduce your cholesterol, and help keep your arteries clear.[35][36][37]
    • If exercise is an angina trigger for you, talk to your doctor before starting. Your doctor may recommend you take medications before exercising and keep the exercise mild enough that you don’t trigger an attack. Overtime you may find that you can increase the intensity of your workouts without having an episode.
    • You may want to start with mild, low impact exercise like walking, swimming, or biking. Then as you start to get in shape, talk to your doctor about increasing your exercise program. However, because angina can indicate a vulnerability to heart attacks, you should carefully discuss your plans with your doctor so that you don’t over stress your heart.
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    Don't use dangerous or ineffective alternative medicine treatments. The National Institute for Health and Care Excellence (NICE) in Britain recommends against using the following alternative therapies. These treatments have not been shown to be safe or effective for people with angina:[38]
    • Acupuncture
    • Transcutaneous Electrical Nerve Stimulation (TENS). This technique uses small electrical pulses to stimulate the nerves and reduce pain.
    • Enhanced external counterpulsation (EECP). During this treatment you put inflatable cuffs around parts of your body like your legs. These cuffs are inflated in the rhythm of your heart beat with the goal of improving the blood flow.

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Categories: Cardiovascular Health and Blood Pressure