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Five things to know about angina

Angina occurs when the heart does not receive enough oxygen-rich blood flow, and is often a symptom of another heart condition, like coronary artery disease. Cardiologist David Laxson, MD, shares five things you should know.
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Do you feel like someone is squeezing your heart when you get stressed? Perhaps you feel pain in your left arm? Or experience indigestion when you exercise?

You could be experiencing angina, or the symptoms people feel when part of the heart muscle is not getting enough oxygen-rich blood flow.

“The heart is essentially saying ‘Ouch, I need more blood flow,’” said Cardiologist David Laxson, MD, with University of Minnesota Health Heart Care.

Angina, which becomes more common as people age, can be a sign of other significant health issues, like coronary artery disease. The majority of people who experience angina do so because of plaque build-up on the wall of one or more coronary arteries that slowly and steadily constricts blood flow to the heart. If that artery suddenly becomes completely blocked, a heart attack occurs.

If you’re experiencing angina, it’s important to understand the patterns—for example, what causes it, what relieves it (or makes it better) and how long it lasts—and know how to react appropriately. We caught up with Laxson to talk about five things we should know about angina.

There is more than one kind of angina.

There are two major types of angina: stable angina and unstable angina. Other variations of angina exist, but are rare.

  • Stable angina keeps a reliable pattern. That is, the symptoms only happen under certain, often predictable, circumstances and usually last less than 10 minutes—but always less than 20 minutes—before they go away. Often, exercise, emotional stress or large meals trigger this kind of angina, Laxson said.

  • Unstable angina means the pattern is changing or getting worse. In this case, the symptoms may come on more frequently or easily, such as with less exertion. They may also be more severe and they may last longer, Laxson said. They can also occur with little to no stress or activity. Sometimes, unstable angina is triggered by blood clots.

If the angina continues for more than 20 minutes, the health risks increase significantly. “A heart attack is basically when angina doesn’t go away after 20 minutes,” Laxson said. “Once it goes on for 30 minutes or more, you start to see permanent heart damage happening.”

Learn more about University of Minnesota Health Heart Care services.

Angina is not just chest pain.

Angina is commonly associated with chest pain—but that’s not the whole story. The spectrum of symptoms that occur when the heart itself doesn’t get enough blood is broad, Laxson said. Angina symptoms may also include chest tightness, burning or other discomfort, shortness of breath, discomfort in other areas of the body (including the shoulders, between the shoulder blades or down an arm), unusual numbness and other associated symptoms.

“People are used to thinking it’ll be pain in their chest that radiates down their left arm,” Laxson said. “Some people with angina experience that—but many people do not.”

Unsure if you’re experiencing angina? Watch for patterns.

Are you unsure whether you’re experiencing angina? If so, take note of repeating patterns. How long do the symptoms last? Do the symptoms start because of exercise, eating or stress? Do they stop if you stop exercising? Where does the pain occur? Does a change in your position trigger the symptoms? Does deep breathing or coughing affect the symptoms?

If you’re regularly experiencing symptoms that fit some of these patterns, then it may be time to meet with your primary care physician. If the pattern grows less predictable, you could be experiencing unstable angina. It’s always better to err on the side of caution, but Laxson shared this general rule: “As long as it goes away and stays away, you can predict when it’s going to come and it doesn’t last longer than 20 minutes—then you don’t have to go to the emergency room or call the paramedics,” he said.

Under 35? You’re probably fine.

Angina is rare in people under 35 years of age—unless that person has a history of diabetes. Besides age and diabetes, risk factors include: a history of hypertension, smoking or high cholesterol. If an immediate family member was diagnosed with heart disease at a young age, you may have a higher risk of angina and heart disease as well.

Angina is a symptom, not a condition.

Don’t forget: Angina is not a disease. Instead, it is most often symptom of other heart conditions, including coronary artery disease. Angina most often occurs when coronary artery disease causes plaque to build up in arteries supplying the heart and limits sufficient blood flow to the heart.

If it is a partial obstruction, treatment may include medication, surgery or placement stent. A total obstruction may lead to a heart attack.

In some cases, the body may create small blood vessels to reroute blood flow around a blocked artery—but only if the blockage builds slowly, allowing the body time to adapt. This is known as chronic total occlusion (CTO).

These reroutes provide enough blood flow to the heart to prevent a heart attack, even though there is 100 percent blockage. Historically, the main treatment for a total occlusion has been medication or bypass surgery. Now, however, University of Minnesota Health cardiologists very often use a less-invasive catheter method to navigate through the blockage and place a stent in the blood vessel that can relieve even a chronic total blockage.

 “Many patients with CTO may have been told by doctors that medical therapy is the only option, but often we are now able to correct an occlusion with a successful stent procedure,” Laxson said.

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