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What is Angina and Causes of Angina

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Angina (an-JI-nuh or AN-juh-nuh) is chest pain or discomfort that occurs when an area of your heart muscle doesn't get enough oxygen-rich blood. Angina may feel like pressure or squeezing in your chest. The pain also may occur in your shoulders, arms, neck, jaw, or back. It can feel like indigestion.

It is common to equate severity of angina with risk of fatal cardiac events. There is a weak relationship between severity of pain and degree of oxygen deprivation in the heart muscle (i.e. there can be severe pain with little or no risk of a heart attack, and a heart attack can occur without pain).

Angina also can occur in people with valvular heart disease, hypertrophic cardiomyopathy (this is an enlarged heart due to disease) or uncontrolled high blood pressure. These cases are rare, though.

What causes angina?

Coronary artery disease

Coronary arteries supply oxygenated blood to the heart muscle. Coronary artery disease develops as cholesterol is deposited in the artery wall, causing the formation of a hard, thick substance called cholesterol plaque.

Research suggests that damage to the inner layers of the coronary arteries causes CAD. Smoking, high levels of fat and cholesterol in the blood, high blood pressure, and a high level of sugar in the blood (due to insulin resistance or diabetes) can damage the coronary arteries.

Increased extravascular forces, such as severe LV hypertrophy caused by hypertension, aortic stenosis, or hypertrophic cardiomyopathy, or increased LV diastolic pressures
Reduction in the oxygen-carrying capacity of blood, such as elevated carboxyhemoglobin or severe anemia (hemoglobin, <8 g/dL)

Congenital anomalies of the origin and/or course of the major epicardial coronary arteries

Symptoms of Angina

Classic or typical angina occurs predictably with physical exertion or strong emotional reactions, and goes away just as predictably with rest. Starting immediately behind the sternum (breast bone), the pain may radiate to the left arm and shoulder or up to the jaw.

The pain isn't a sudden, shooting, stabbing, or burning type. It's often described as either a dull ache, pressure, heaviness, or a crushing sensation. Pain that comes and goes over a few seconds is also unlikely to be angina, which is steady and often predictable.

Treatment of Angina

Nitroglycerin and long acting nitrates: Nitroglycerin (NTG) tablets placed under the tongue (known as sublingual; sub=under and lingua=tongue), is a very effective means of treating angina. The tablet dissolves under the tongue and may have a slightly sharp, burning or tingling taste. Tablets which have this taste when fresh but subsequently become tasteless may indicate loss of effectiveness and potency. They need to be replaced by a fresh supply when they pass the expiration date printed on the bottle label; usually a few months after purchase.

Attend regular check-ups with your doctor to monitor your blood pressure and get advice on how to reduce it if necessary.
If you have diabetes, you should aim to closely control your blood sugar levels, as advised by your nurse or doctor.
Your doctor will also monitor your cholesterol level - if it's too high, your doctor can advise you about your options for reducing it.

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