Severe chest pain with a characteristic feeling of tightness in the chest is an indication of angina pectoris. They can be the harbinger or symptom of a heart attack. Get to know symptoms, causes, and therapy. Angina pectoris (or stenocardia) literally means “tightness in the chest”. That also describes the complaints. Those affected report a seizure-like, sometimes violent, feeling of tightness in the heart or chest area. These pain attacks indicate a circulatory disorder of the coronary arteries and an insufficient supply of the heart muscle. Thus, they are an important and typical symptom of coronary heart disease (CHD). However, every attack of angina pectoris can also be a heart attack.
Chest tightness, tightness of the heart, stenocardia
Forms Of Angina Pectoris
Doctors differentiate between stable and unstable angina pectoris and the special form of Prinzmetal’s angina.
- Stable angina pectoris: Stable angina pectoris occurs depending on the load and is triggered by various factors. These include physical activities, emotional stress, stress, cold or even lavish meals. The intensity of the complaints remains almost the same with every attack.
- Unstable angina pectoris: The unstable angina pectoris occurs independently of stress and is also known as resting angina. Any new chest tightness or chest tightness with variable symptoms is also unstable angina pectoris. Angina nocturna is a special form. The symptoms mainly occur at night. When lying down, more blood flows back into the heart. This represents a higher requirement for the previously damaged heart muscles. This additional stress manifests itself as angina pectoris.
- Prinzmetal angina: Prinzmetal angina (also called vasospastic angina) is a special form of angina pectoris. The chest complaints are felt independently of stress, often at night, and are caused by vascular spasms.
Symptoms of angina are the most characteristic. A rather dull pain begins behind the breastbone and spreads over the chest in the shape of a tire. Often these pains are perceived as extremely strong, oppressive, and threatening. They typically radiate into the left arm, upper abdomen, neck, or lower jaw. Radiation to other areas of the body is also possible. In addition, there is often shortness of breath and cold sweat, blood pressure soars, and the pulse races. Some patients are scared to death. Sometimes angina pectoris is misinterpreted as heartburn or heartburn is mistaken for angina pectoris. In English, heartburn is therefore also referred to as heartburn.
An attack of angina pectoris can pass within seconds, but it can also last for minutes, less often for hours. If an attack lasts more than 15 minutes, a heart attack is suspected.
Most angina is caused by Coronary Artery Disease (CHD). The coronary arteries are narrowed as a result of arteriosclerosis. As a result, the heart muscle is only insufficiently supplied with oxygen, especially when it is exerted. This reduced blood flow and insufficient oxygen supply cause the symptoms.
Angina pectoris is not only triggered by physical activities such as climbing stairs or jogging. Cold or heavy meals can also provoke an angina pectoris attack. When it is cold, for example, the resistance in the blood vessels increases. This reduces the blood flow to the heart muscle, and chest problems occur.
Lush meals stimulate digestive activity, the stomach and intestines have to be supplied with more blood. The heart muscle then has less blood available, which leads to an attack of angina pectoris.
Vascular Spasms Lead To Prinzmetal’s Angina
An exception to angina pectoris is Prinzmetal’s angina. In this form, the insufficient supply of myocardium is triggered by vascular spasms in the coronary arteries. These vascular cramps (spasms) occur mainly at night and at rest.
Angina pectoris is diagnosed based on the typical symptoms. For further clarification, a blood test, an electrocardiogram (EKG), and an image of the coronary vessels (coronary angiography) can follow.
The therapy for angina pectoris is different. Depending on the severity of the symptoms and the condition of the coronary arteries and the heart muscle, medicinal or surgical measures are initiated.
Medicines For Angina Pectoris
Various active ingredients are available to the doctor for the drug treatment of angina pectoris:
- The narrowed coronary arteries are usually dilated with nitro-based vasodilators (such as isosorbide mononitrate and isosorbide dinitrate) or molsidomine.
- In addition, beta-blockers (e.g. atenolol, bisoprolol, carvedilol, and metoprolol), calcium antagonists (such as verapamil or diltiazem), and dihydropyridines (such as amlodipine and nifedipine) are often used to lower blood pressure and heart rate.
- If beta-blockers are not tolerated or must not be taken, the relatively new active ingredient ivabradine can help. Ivabradine lowers the heart rate without affecting blood pressure or the strength of the muscles in the heart.
- The active ingredient Trapidil can improve the blood flow to the heart muscle.
- In order to reduce the risk of a vascular occlusion and thus the risk of a heart attack, low doses of acetylsalicylic acid and anticoagulant agents such as phenprocoumon are used.
- Cholesterol-lowering drugs from the group of statins, for example, atorvastatin, simvastatin, lovastatin, or pravastatin, help to lower the risk of atherosclerosis or to stop the course of atherosclerosis.
Occasionally, narrowed coronary arteries are surgically widened or renewed. The methods of choice for the surgical treatment of angina pectoris are so-called percutaneous coronary intervention (PCI) and bypass surgery. PCI is performed using a cardiac catheter. The doctor pushes a folded balloon up to the coronary arteries – usually through the inguinal artery. The balloon unfolds at the narrowed point (balloon dilatation) and holds the vessel open. A small lattice frame made of stainless steel (so-called stent) around the balloon sometimes secures this method.
In a bypass operation, a vascular blockage is bridged with another blood vessel.
Even if an attack of angina pectoris feels threatening: keep calm. Sit up straight and try to breathe calmly and evenly. Usually, the pain goes away within a short time.
Patients with angina pectoris have spray or bite capsules with glycerol trinitrate (nitro spray, microcapsules) as emergency medication. After the application, the blood vessels dilate and breast problems usually improve quickly. If this is not the case, there could be a heart attack. In this case, please call the emergency doctor immediately.
Pay attention to the duration of the complaints. If the pain persists for more than 15 minutes, you should definitely alert the emergency services. Medical professionals refer to this condition as an acute coronary syndrome.
Regular medical check-ups provide information on possible risk factors for angina pectoris (e.g. arteriosclerosis). If you are legally insured, you can have a check-up every two years from the age of 35 at Check-up 35. Above all, patients with diabetes and overweight as well as smokers should take advantage of this offer.
Smokers are also advised to stop using the vice. You can obtain information on this from your family doctor, health center or your health insurance company. Furthermore, you should pay attention to normal body weight and a healthy, varied diet. Patients with lipid metabolism disorders, high blood pressure values , and diabetics should ensure normal blood values and carefully follow their therapies.