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Angina

Angina is the primary symptom of coronary artery disease and in severe cases of myocardial infarction. Usually experienced chest pain. Is often referred to as stable angina (predictable) or unstable (less predictable and a sign of a more serious situation). Angina itself is not a disease.

There is ample evidence that, in fact, the onset of angina within 48 hours before myocardial infarction may be protective, possibly conditioning the heart to resist damage resulting from attack.

Angina can be experienced in different ways and can be mild, moderate or severe:

- Usually defined as an oppressive feeling, but mild, which may seem to an object that presses on the chest.
- The pain often radiates to the neck, jaw or to the left arm and shoulder.
- More unusual is that patients explain burning sensation in the chest, stinging, or pain spreading to the right arm or back.
- Sometimes the patient experiences shortness of breath, fatigue, or palpitations instead of pain.
- The intensity of pain is not always related to the severity of the medical problem. Some people may feel severe pain due to weak ischemia, while others may experience only mild discomfort from severe ischemia.
- Some people have also reported increased sensitivity to heat in the skin with the onset of angina.
- Angina may be precipitated by large meals that require an immediate demand for more oxygen to the heart.

Stable angina. In the stable angina is predictable chest pain. Although less serious than unstable angina, can be extremely painful. Usually improves with rest and responds well to medical treatment (typically nitroglycerin).

Any event that increases oxygen demand can cause an attack of angina. Some typical triggers include:

- Exercise
- Cold weather
- Emotional stress
- Large meals
- Episodes of angina may occur at any time during the day, but a large proportion appears to occur between the hours of 6:00 AM and noon.

Unstable angina. Unstable angina is a much more serious and is often an intermediate stage between stable angina and heart attack. Unstable angina is usually diagnosed when a patient has the following symptoms:

- The pain wakes the patient or occurs at rest.
- The patient had never before experienced angina feel a strong or moderate pain while performing mild exercise (climbing a flight of stairs or walking two blocks).
- Stable angina has progressed in severity and frequency over a period of two months and the pain-killing drugs are less effective.
- Prinzmetal angina. A third type of angina called variant or Prinzmetal angina is caused by a spasm of the coronary arteries. Almost always when the patient is resting, and often that go along with irregular heartbeats. Irregular heartbeats are common, but the pain is usually relieved with treatment.

Silent ischemia. Some people with severe coronary artery disease do not experience angina pain, a condition known as silent ischemia, which some experts attribute to abnormal processing by the brain of heartache. This is a dangerous condition because patients have no warning signs of heart disease. In one study, people who had silent ischemia had higher rates of complications and mortality than those who suffered pain. (Anginal pain may actually protect the heart conditions before a heart attack). [For more information, see the chapter on Angina egalenia encyclopedia].