Angina Cardiac Chest Pain

20-12-2006Back to Article

Angina Fact Sheet

Angina is a symptom of coronary artery disease (CAD), and is typically a recurring feeling of pain or discomfort in the chest due to myocardial ischemia, i.e. an inadequate supply of blood and oxygen to the heart muscle resulting from narrowing or blockages in the coronary arteries

Symptoms of Angina

Common symptoms include an uncomfortable pressure, fullness, squeezing or pain in the center of the chest under the breastbone. This discomfort also may be felt in the neck, jaw, shoulder, back or arm. Angina symptoms in women may present differently than those in men. Angina may be less intense or last longer, or it may be experienced as nausea, difficulty breathing or an extreme feeling of tiredness.

Quick Facts

• Approximately 6.8 million Americans suffer from angina (4.2 million women and 2.6 million men), Roughly 1 in 44 people in the U.S. have angina.
• An estimated 400,000 new cases of stable angina occur each year.

• Angina typically affects men older than 60 years and women older than 70 years in USA largely, But in India increasing number of men above 40 years and women above 50 years experience angina.

• Approximately 150,000 angina patients annually are considered refractory to medical, Interventional (Angioplasty) and/or surgical therapy.

Types of Angina

The three types of angina are stable, unstable, and variant (Prinzmetal's). It is very important to know the differences among the types.

• Stable angina. Stable angina is the most predictable and prevalent form of angina. Physical exertion is the most common trigger although emotional stress and exposure to extreme temperatures also may lead to anginal episodes. Angina attacks typically last no more than five minutes and are usually relieved by rest and/or nitroglycerin.

• Unstable angina. Unstable Angina is unpredictable. Patients experience symptoms without an obvious trigger, often while they are at rest. The discomfort may be more severe, prolonged (as long as 30 minutes) and different in character than stable angina symptoms.. 

• Canadian Cardiovascular Society Angina Classification System.
  Class I Ordinary physical activity does not cause angina, such as walking or climbing stairs. Angina occurs with strenuous, rapid or prolonged exertion at work or recreation.
  Class II Slight limitation of ordinary activity. Angina occurs on walking or climbing stairs rapidly, walking uphill, walking or stair climbing after meals, or in cold, in wind, under emotional stress or only during the few hours after awakening. Angina occurs on walking more than two blocks on the level and climbing more than one flight of ordinary stairs at a normal pace and in normal condition.
  Class III Marked limitation of ordinary physical activity. Angina occurs on walking one to two blocks on the level and climbing one flight of stairs in normal conditions and at a normal pace. Class IV Inability to carry on any physical activity without discomfort – anginal symptoms may be present at rest.

  EECP is a registered trademark of Vasomedical, Inc.
  © 2005 Vasomedical, Inc. V15-0053 Rev.1

Treatment Options

The first line of treatment for patients is medication that helps increase the supply of oxygen to the oxygen-deprived heart muscle by dilating coronary vessels or decreasing the demand for oxygen. Unfortunately, for most patients with angina, medication becomes less effective over time. More invasive options include angioplasty and coronary stent placements, as well as coronary artery bypass grafting (CABG). However, these procedures sometimes fail, pose risks and are expensive. There are many factors that increase the risk of these invasive procedures, including:

• Age

• The existence of comorbid conditions, such as diabetes or renal insufficiency

• Small blood vessels, frequently seen in women

• Coronary anatomy that is not suited for surgical intervention

• Prior failed interventional procedures

• Previous CABG

While some patients with more extensive disease or who have disease of the left main coronary artery may require bypass surgery, there is a new option for patients who cannot be treated effectively with medication or who are unsuitable for or unwilling to undergo invasive procedures. This treatment is called EECP® external counterpulsation therapy.

EECP® Therapy

EECP therapy is a non-invasive outpatient treatment that is used to relieve or eliminate angina. It is believed to create new pathways around blocked arteries in the heart by expanding networks of tiny blood vessels that help increase blood flow to the heart muscle. EECP treatment can reduce or eliminate the frequency and intensity of chest pain, decrease the need for medication and greatly improve the ability to participate in activities of daily living. After receiving EECP treatment, patients often are able to enjoy moderate exercise for the first time since developing angina.
EECP therapy is typically given in 35 one-hour-sessions over seven weeks. Patients lie down on a padded table and have their calves and lower and upper thighs wrapped in blood pressure-like cuffs. The system, which is synchronized to the individual patient’s cardiac cycle, inflates the cuffs with air to create external pressure when the heart is resting (diastole) and deflates the cuffs just before the heart beats (systole). The system’s action, which pulses counter to the heart's beating, increases blood flow to the heart muscle, decreases the heart’s workload and creates a greater oxygen supply for the heart muscle while lowering the heart's need for oxygen.

Sources

American Heart Association. Heart and Stroke Facts; National Heart, Lung, and Blood Institute. Diseases and Conditions Index: Angina; American Heart Association. Angina Pectoris Treatment; Patient Health International. Angina Fact and Figures;American Heart Association. Transmyocardial Revascularization (TMR); American Heart Association. Heart Disease and Stroke Statistics-2004 Update. Dallas,Tex. American Heart Association;2003.