A feeling of tightness in the chest during exercise is one of the warning symptoms of an angina pectoris attack also called “angina”. Be careful, the symptoms are sometimes more atypical in women.
Angina pectoris or “angor” causes pain in the chest behind the sternum. This symptom can occur at times when the heart needs more oxygen (effort, emotion such as stress, digestion etc). Stable angina attacks are distinguished from unstable angina attacks. The diagnosis is made by the attending physician and a cardiologist. Treatment will depend on the cause.
Definition: what is angina pectoris?
Angina, also called “angina pectoris” is a damage to the coronary arteries of the heart which do not bring it the necessary oxygen to function properly. This lack of essential contribution is at the origin of a heart pain. It can lead to heart attack. We distinguish :
► thestable angina (or stable angina or coronary disease) for which the characteristics do not change over time (same cause, same intensity, same duration). It occurs during an effort and disappears when it stops.
► and I’unstable anginaworse. She corresponds to a more advanced stage with seizures occurring even at rest, often more frequent and longer. The electrocardiogram, ultrasound, scintigraphy and coronary angiography confirm the diagnosis. This unstable angina pectoris is considered a threat of myocardial infarction (we speak of acute coronary syndrome) and requires emergency hospitalization in a unit cardiology.
What are the symptoms of angina pectoris?
In the early stages, a chest pain behind the breastbone appears only during effort, digestion or an emotion, times when the heart needs more oxygen. The pain is called “anginal”, i.e. it corresponds to a vice-like tightness at the back of the sternum with some possible radiation in the arm or in the shoulder, sometimes accompanied by cough. If the obstruction of the coronaries increases, the symptoms can occur at rest, it is unstable angina which can be a warning sign of a myocardial infarction.
What symptoms in women?
Symptoms of an angina attack differ from person to person. In women in particular, they can be “atypical” and result in respiratory and/or digestive symptoms in the foreground.
Left unchecked, angina pectoris leads to myocardial infarction.
What are the causes of angina pectoris?
Angina pectoris is caused by a narrowing of the caliber of the arteries which will slow down the blood flow that reaches the heart. The most common cause is atherosclerosis, that is to say the formation of atheroma plaques inside the coronary arteries because of cardiovascular risk factors: tobacco, overweight, sedentary lifestyle, arterial hypertension, diabetes, hypercholesterolemia and family history. However, some angina attacks can also be related to coronary artery spasms which cause sufficient constriction to decrease blood flow in these vessels as in the case of Prinzmetal’s angina whose origin is unknown.
Can you live long with angina pectoris?
Yes, but provided you are regularly monitored by the doctor and monitor your lifestyle. Without it, angina pectoris leads to myocardial infarction. This risk is increased if it is “unstable” angina (see below). In this case, hospitalization must be done urgently. To prevent the attack of angina, it is necessary to counter atherosclerosis (phenomenon which clogs the arteries and deprives the heart of its good oxygenation). So :
- Reduce your weight if you are overweight (to see with the doctor)
- Eliminate tobacco
- Treat high blood pressure if present
- Correct your cholesterol level if it is too high – Quitting smoking – Correction of hypertension – Maintenance of cholesterol
“Thanks to the various treatments (control of risk factors, medication, bypass…), the pain of angina pectoris can disappear and a completely normal life – active or even sporty (but not just any sport or just any old how) –is possible“ inform the French Federation of Cardiology.
Diagnosis: what tests to do in case of angina pectoris?
The assessment of chest pain is carried out by the attending physician, in coordination with a cardiologist. Typical exams include:
- a blood test (hemogram, ionogram, glycaemia, lipid and renal assessment);
- an electrocardiogram (ECG) at restperformed if possible during or just after a painful episode of angina pectoris;
- resting transthoracic echocardiography or MRI if ultrasound is not feasible. It eliminates other causes of pain (anomaly of a valve, disease of the heart muscle, pericarditis, fissure of the aorta), analyzes the movements of the heart and calculates the ejection fraction of the left ventricle (search for heart failure ).
Sometimes a chest x-ray is prescribed if the doctor suspects a lung disease that may explain the symptoms (pneumonia for example). Specific examinations, called ischemia testsare carried out in a manner adapted to each case:
- a stress test : stress ECG, stress or stress echocardiography;
- a stress scintigraphy or MRI…
In an emergency, a coronary angiography can be carried out. This examination may be necessary to directly identify coronary artery stenoses (restricted areas).
At what age are you most at risk of getting angina pectoris?
The risk of angina pectoris gradually increases in frequency with age. It concerns more men over 50, especially smokers, suffering from diabetes, excess cholesterol, high blood pressure or obesity.
Treatments for angina may be initially medicatedbut in advanced stages, angioplasty or coronary bypass becomes essential. The treatment consists of the administration of nitrates (Lenitral or trinitrin). It is important to distinguish anginal pain from the pain encountered in the event of myocardial infarction which does not yield to the administration of trinitrine and which requires emergency treatment. In case of unstable angina, the basic treatment is known by the acronym BASIC : Beta blockers, Antiplatelet agents, Statins, Inhibitors of the converting enzyme and Correction (diet, reduction of risk factors).
Source: French Cardiology Federation.