As many of you are probably aware that the prevalence of cardiovascular disease is increasing world-wide despite sophisticated advances in cardiac investigations and treatment strategies. Where the introduction of life-saving drugs, state-of-the-art imaging modalities and a quantum-leap in cardiovascular intervention has probably saved countless lives and influenced many more, there is still much more to be done.
Over the years I have learnt (through shared experience and patient feedback) that patient education is a key factor which is not well-addressed during medical consults. This might include the possible symptoms that one can experience during a heart attack, importance of cardiac medications or the relevance of key modifications in one’s daily activities. I feel as doctors, practitioners and healthcare providers it is the single-most important duty that we can perhaps never fulfill enough. We conveniently forget that the ‘treatment’ of patients does not stop within hospitals, theatres, catheter labs or coronary care units but also extends into the realms of their homes and day-to-day lives.
What is angina?
Angina is an uncomfortable sensation, ache or pain in the chest. Some people describe it as indigestion or ‘heart-burn’. Most patients will experience this in the central part of their chest. The pain can stay in the chest or spread across to either arm (more commonly the left arm), lower jaw or teeth. It is commonly brought on by physical exertion, however, patients can experience this at rest, during emotional stress or cold weather. It can occur during sleep and may wake people up. Typically, the symptoms fade away within 10-15 minutes of resting.
What causes angina?
The heart comprises of muscle which requires its own blood supply to provide nutrients and oxygen. There are two main coronary arteries which divide into several branches to allow a balanced blood supply to all parts of the heart’s muscular wall.
The coronary arteries can become gradually narrowed due to a build-up of fatty material within the walls of the blood vessels. This process is known as atherosclerosis and the fatty deposit is called atheroma or plaque (Figure 1). When this narrowing is severe enough to restrict blood supply, it can lead to a demand and supply mismatch resulting in pain which is known as angina.
The treatment options may include angioplasty and stent insertion or coronary artery bypass grafting (CABG). These treatments are available at Omar Hospital & Cardiac Centre which is a state-of-the-art cardiac centre.
What is the difference between angina and a heart attack?
A heart attack may occur if the narrowed artery becomes completely blocked due to a blood clot. This causes a complete cessation of blood supply to the heart muscle leads to permanent tissue damage if not treated quickly. The pain usually does not go away at rest and the symptoms can be much more severe in comparison to angina.
What do I do if I get angina?
- Stop what you are doing.
- Sit down and rest.
- Chew 300 milligrams of aspirin once only (if you are not allergic to aspirin).
- Use a nitrate spray under your tongue (if you have been prescribed one)
- Spray once and wait for 5 minutes.
- Spray again and wait for 5 minutes.
- Spray for the third time and if the pain persists for another 5 minutes then call the ambulance.
- If you do not have a nitrate spray then call the ambulance if the pain persists for more than 15 minutes.
Figure 1 Mechanism of Angina
Normal unobstructed blood supply (A), Atherosclerosis leading to plaque formation and decreased blood supply causing angina (B).