Angina: Heed its warning

         It can happen after you’ve run to catch a bus, after you’ve eaten a large meal or after you’ve had an argument. Sometimes it even happens when you’re at rest. Known as angina pectoris—or angina, for short—it’s a chest pain or tightness that affects more than 9 million Americans.

      Angina usually occurs when fatty deposits clog the coronary arteries, causing the heart to receive less oxygen and blood than it needs—a condition called atherosclerosis. The attacks are triggered when exercise, stress, cold exposure, digestion or some other activity places an extra demand on the heart.

A common symptom
      The most common symptom of heart disease, angina causes a dull, aching or burning feeling; tightness; pressure; or a feeling of heaviness. The pain most often occurs on the left side but may also spread to the arms, the neck, the jaw, the lower chest or the abdomen. Women, however, frequently do not experience the typical left-side pain but instead have jaw or abdominal discomfort, shortness of breath, extreme fatigue, nausea, sweating or irregular heartbeat. (Women should be on the lookout for such symptoms particularly after menopause, when their risk for heart disease slowly rises.)
      In any case, the pain usually lasts only a few minutes and is relieved by rest or medication—such as nitroglycerin tablets placed under the tongue.
      Those with angina should be alert for any changes in pattern. If it takes longer for the pain to subside or if an attack occurs after less exertion than before, call your doctor.

Who gets angina?
      You’re at higher risk of developing angina if you have high cholesterol or high blood pressure, you smoke or it runs in your family. One of the biggest mistakes those taking medication to control high cholesterol make is not sticking to a low-cholesterol diet. If you’re taking cholesterol-lowering medication, keep in mind that it doesn’t give you the freedom to eat whatever you like. Rather, it must be used in combination with a careful diet.

Pain at rest
      While the most common form of angina occurs after physical exertion or emotional upset, some people experience attacks even when they’re resting. This kind of angina is called unstable angina because the pain strikes without warning. It should be treated as a medical emergency.
      One form of unstable angina is variant angina pectoris, or Prinzmetal’s angina. Variant angina occurs when a spasm of a coronary artery blocks blood flow to the heart. About two-thirds of people with variant angina have severe atherosclerosis in at least one major vessel.
      The most important thing to remember about angina is that it’s a warning sign. Respect it as a friend telling you that something is wrong. If you heed its warning, it could save your life.

What you can do

      Taking the steps below can prevent angina and dramatically cut your risk of heart disease.
      • Stop smoking. This may well be the most effective way to prevent angina and heart disease. Not only does smoking promote the accumulation of blood-clogging deposits in the arteries, it also robs the heart of oxygen, causes blood vessels to constrict and raises blood pressure.
      • Lose the fat. A diet rich in saturated fat causes artery-blocking deposits to form, preventing sufficient blood and oxygen from reaching the heart.
      • Drop extra pounds. The heavier you are, the harder your heart has to work. Being overweight also contributes to the development of other cardiovascular risk factors such as high blood pressure, high cholesterol and diabetes.
      • Get moving. Exercise helps keep weight in check and promotes cardiovascular fitness. Walking is a safe, effective way to begin. Start out on a flat surface and walk five to 10 minutes a day. Gradually increase the duration and incline. If you suffer from angina, check with your doctor before beginning an exercise program.

Medications at a glance

• Coronary vasodilators. Nitroglycerin and other nitrates provide temporary relief from angina by dilating the blood vessels, allowing blood to flow freely to the heart. Vasodilators—available in pill, patch and ointment form—can be used to prevent an angina attack. And slipping two nitroglycerin tablets under the tongue is the primary way to relieve pain during an attack.
• Beta blockers. By interfering with the way adrenaline (a stress hormone) primes your system, beta blockers help lower your heart rate, decrease blood pressure and reduce the heart’s demand for oxygen.
• Calcium channel blockers. Used to treat angina triggered by coronary artery spasms, calcium channel blockers help vessels relax and help lower blood pressure.