Going After Your Own Heart: Here’s Why Anginas Matter in Heart Health

Angina isn’t a disease on its own but a warning sign of an impending heart issue like a heart attack or stroke. A recent study of 2024 showed that angina affects almost 6% of the Indian population above 45 years of age. It affects almost 30000 to 40000 per million people in Western countries. Like many other warning signals that the body gives, understanding angina ensures that you take a proactive approach to restore cardiac health.

Chest pain or an uncomfortable sensation triggered by a decrease in blood flow to the heart muscles is called angina. It is a classical sign of coronary artery disease (CAD) due to the clogging of the blood vessels by cholesterol deposits. Angina can also have non-cardiac causes like chest and gut problems. Identifying the root cause of angina is instrumental in resolving frequent angina episodes.

Anginas are divided into four types:

• Stable angina: It is the most common type; attacks are triggered by stress or exercise and typically go away after a few minutes of rest.
• Unstable angina: Attacks are more severe and unpredictable, potentially occur without a trigger, and can persist even after rest.
• Microvascular angina: It is the angina caused by coronary microvascular disease (MVD) — issues of the smallest coronary arteries in the heart. 
• Vasospastic or variant angina: Also known as Prinzmetal’s angina, this attack happens between midnight and early morning while resting.

Angina can be due to cardiac issues and non-cardiac causes.

The cardiac causes of angina are:

• Coronary artery disease (CAD): Angina arises from atherosclerosis, a condition in which the arteries that provide blood to the heart muscles become narrowed due to the accumulation of cholesterol.
• Coronary Microvascular Disease (MVD): As discussed, the condition, more prevalent in women, damages the walls of tiny blood vessels branching from coronary arteries, which are not visible on typical CAD testing.
• Coronary artery spasms: These are temporary restrictions on blood flow to the heart caused by the opening and closure of coronary arteries. These spasms can occur without coronary artery disease and may demand added investigations.

The non-cardiac causes of angina:

• Gastro-oesophageal reflux disease (GERD)
• Lung disease
• Musculoskeletal pains in the chest
• Anxiety/panic attacks. 

Risk factors that increase the chances of an angina episode are:

• Stress and anxiety
• Smoking
• Obesity
• Hypertension (high blood pressure)
• Diabetes
• Age (45+ for men and 55+ for women)

What happens when you experience angina or chest pain and discomfort?

When the heart doesn’t get enough oxygen supply, it switches to a backup energy process that doesn’t need oxygen. This backup method produces by-products — hydrogen, potassium, and lactate — in the blood around the affected areas of the heart.

The extra hydrogen ions then compete with calcium, which is critical to the contraction of the heart muscles. Thus, the heart may not pump blood properly or may stop contractions altogether. For stable angina, this lack of oxygen usually needs a trigger, like exercise, stress, cold temperatures, etc.

You typically experience:

• Tightness and pressure in the chest
• Severe discomfort
• Burning and aches in the middle of the chest
• Pain and burning in the neck, jaw, and shoulders (typically left)
• Uneasiness and anxiety 

Living with angina is fairly common. It is best managed by lifestyle modifications such as: 

• Losing weight with diet and regular physical training
• Quitting smoking and the consumption of alcohol
• Being consistent with medications and cutting back on high-salt diets like packaged and processed foods
• The diet must be low in unhealthy fats and sugars
• Stress management with breathing techniques and yoga
• Working closely with one’s doctor for underlying health conditions and prescribed medications

Dr Monteiro Grancy Vijayraj, a consultant surgeon at St Joseph's Mission Hospital Mananthavady, adds, “Angina pectoris can feel like pressure, tightness, or squeezing in the chest, sometimes radiating to the shoulders, arms, neck, or back. It commonly happens during times of physical activity or under stress.”

“It's easily mistaken for gastritis, muscle cramps, and generalised tiredness. Vomiting, which is sometimes associated with angina, is attributed to some form of gastrointestinal discomfort. The primary risk factors include diabetes, dyslipidemia, and hypertension. A primary risk factor that causes atherosclerosis and, in turn, causes angina is smoking, which is on the rise,” Dr Vijayraj adds.

It is imperative that you log your episodes of angina in case there are more than one and report it to your doctor early on. Angina is just your body telling you in advance about heart-related and other pathologies that need immediate attention. 

Angina is caused by heart-related issues like coronary artery disease (CAD), coronary microvascular disease (MVD), or noncardiac causes like gastro-oesophageal reflux disease (GERD), lung issues, panic attacks, etc.

Angina can be stopped immediately by taking medication that dilates the blood vessels and supplies enough oxygen to the heart immediately. 

Angina is one of the first symptoms of a heart attack but not necessarily the first stage. It is a precursor to heart attacks.

Depending on the type, anginas can be effectively managed with your doctor’s advice and lifestyle modifications. 

Angina is a serious warning signal of an ongoing heart problem or more.