Chest pain or angina

Angina is a type of chest pain brought on by decreased blood flow to the heart (pronounced either an-JIE-nuh or AN-juh-nuh). A sign of coronary artery disease is angina.
Angina pectoris is another name for angina.
Squeezing, pressure, heaviness, tightness, or discomfort in the chest are common angina pain adjectives. It may feel like there is a significant weight on your chest. Angina can cause either a fresh discomfort that has to be checked out by a doctor or a persistent pain that gets better with treatment.
The discomfort of indigestion, for example, can be challenging to distinguish from angina, even though it is a relatively common type of chest pain. Seek immediate medical attention if you experience inexplicable chest pain. 
Types of angina:
There are various varieties of angina. Whether relaxation or medication relieves symptoms depends on the cause.

• Stable angina:

The most typical type of angina is stable angina. Exertion usually triggers it, and it subsides typically with rest or angina medicine. Angina, for instance, may cause pain while walking uphill or in chilly weather.
Discomfort from stable angina is predictable and frequently comparable to chest pain from earlier bouts. The average duration of chest pain is five minutes or less.

• Unstable angina:

Unpredictable and occurring while at rest is unstable angina. Or the angina discomfort is getting worse and requires less exertion. It usually lasts for at least 20 minutes and is more severe than stable angina. Neither relaxation nor the typical angina drugs relieve the agony. If the blood flow doesn’t improve, the heart becomes oxygen-starved and suffers a heart attack. An urgent medical response is necessary for unstable angina.

• Variant angina:

Prinzmetal angina, another variant of angina, doesn’t result from coronary artery disease. A spasm brings it on in the heart’s arteries, which momentarily lowers the blood flow. The primary symptom of variant angina is severe chest discomfort. It usually happens in cycles while you’re sleeping or resting. Medication for angina may be able to reduce the pain.

• Refractory angina:

Despite a mix of drugs and lifestyle modifications, angina attacks are frequent.
Causes of angina:
Reduced blood supply to the heart muscle is what causes angina. The blood carries the oxygen that the heart muscle requires to survive. Ischemia is the medical term for the disorder that results from the heart muscle not receiving enough oxygen.
Coronary artery disease is the most typical cause of decreased blood flow to the heart muscle (CAD). The fatty buildups known as plaques can cause the heart’s (coronary) arteries to constrict. Atherosclerosis is the term for this.
Blood flow through a constricted artery can be suddenly restricted or stopped by rupturing a blood clot or plaque in a blood vessel. Blood flow to the heart muscle may suddenly and significantly drop.
The heart muscle could function on the reduced amount of blood flow when there is little oxygen demand, like when you are resting, without inducing angina symptoms. Angina, however, can happen when the need for oxygen increases, as it does during exercise. 
Symptoms of angina:
Pain and discomfort in the chest are angina symptoms. The discomfort or pain in the chest could feel like:
Also, possible locations for burning, fullness, pressure, or squeezing pain include the arms, neck, jaw, shoulder, or back.
Other angina symptoms include;

• Dizziness
• Fatigue
• Nausea
• breathing difficulty
• Sweating

Angina can range in intensity, duration, and type. Unstable angina, a more deadly form of angina, or a heart attack may be indicated by new or different symptoms.
If you have any new or worsening angina symptoms, you should seek medical attention immediately so doctors can determine if you have stable or unstable angina.
Angina in women:
Women’s angina symptoms can differ from men’s typical angina symptoms. These distinctions could cause a delay in getting treatment. For instance, although women with angina frequently experience chest discomfort, it may not be the sole symptom or the one that affects them the most. Women may also experience symptoms like;

• Neck, jaw, teeth, or back discomfort
• Nausea
• Breathing difficulty
• Instead of chest tightness, a stabbing ache
• Abdomen (tummy) pain

When to see a doctor:
It may indicate a heart attack if your chest discomfort persists for more than a few minutes and doesn’t go away after you rest or take your angina treatments. Contact emergency medical services. If there is no other way to get there, only drive yourself to the hospital.
It’s crucial to consult your doctor if chest discomfort is a new symptom for you to identify the cause and receive the right treatments. If you have stable angina and it worsens or changes, you should visit a doctor soon.
Risk factors of angina:
The following characteristics may increase the risk of angina;

• Advancing years. Angina is more common in those 60 years of age and older.
• Heart disease in the family history. Tell your healthcare professional if your mother, father, or siblings have ever suffered from heart disease or a heart attack.
• Using tobacco. The lining of the arteries can be harmed by smoking, chewing tobacco, and prolonged exposure to secondhand smoke, which makes it possible for cholesterol deposits to build up and obstruct blood flow.
• Diabetes. The risk of coronary artery disease, which results in angina and heart attacks, rises due to diabetes’s acceleration of atherosclerosis and elevation of cholesterol levels.
• Elevated blood pressure. By promoting artery hardening over time, high blood pressure harms arteries.
• High triglyceride or cholesterol levels. Atherosclerosis can be brought on by having too much low-density lipoprotein (LDL) in the blood. Angina and heart attacks are more likely to occur in people with high LDL levels. Triglyceride levels that are too high in the blood are likewise unhealthy.
• Other health issues. The risk of angina is increased by chronic renal disease, peripheral artery disease, metabolic syndrome, and a history of stroke.
• Inadequate exercise. Sedentary behavior has been connected to high cholesterol, type 2 diabetes, hypertension, and obesity. Your healthcare advisor should discuss the appropriate exercise volume with you.
• Obesity. Angina can be brought on by heart disease, which is at risk due to obesity. The heart has to work harder to pump blood throughout the body when a person is overweight.
• Emotional tension. Blood pressure can be increased by excessive stress and anger. Stress-related hormone surges can cause artery narrowing and exacerbate angina.
• Medications. Prinzmetal’s angina may be brought on by blood vessel-tightening medications, such as some migraine medications.
• Drug abuse. Cocaine and other stimulants can lead to angina and cause blood vessel spasms.
• Chilly conditions. Cold exposure has the potential to cause Prinzmetal angina. 

Diagnosis of angina:
Your doctor will do a physical examination and question you about your symptoms to identify angina. You will have to inform the doctor of any risk factors, such as a family history of heart disease.
The subsequent tests are used to determine and validate angina;

• Electrocardiogram (ECG or EKG). It is a rapid and painless examination that measures the heart’s electrical activity. Sticky patches containing electrodes are put on the arms, legs, and chest. The test findings are shown on a wired computer to the electrodes. If the heart is beating too quickly, too slowly, or not at all, an ECG might reveal this.
• Chest X-ray. The health of the heart and lungs can be seen on a chest X-ray. A chest X-ray may be performed to find out if other illnesses are causing chest pain symptoms and to check for an enlarged heart.
• Blood test. When the heart muscle is harmed, as in a heart attack, certain heart enzymes enter the bloodstream. These chemicals can be found via a blood test for cardiac enzymes.
• Stress test. When the heart is working harder, diagnosing angina might occasionally be simpler. Usually, a stress test entails using a treadmill or stationary cycle while monitoring the heart rate. A stress test could be conducted concurrently with another test. You may be prescribed medications with heart-healthy effects if you cannot exercise.
• Echocardiogram. Sound waves provide images of the beating heart during echocardiography. The blood flow through the heart can be seen in these pictures. A stress test could include echocardiography.
• Test for nuclear stress. During a nuclear stress test, both at rest and stress, blood flow to the heart muscle is assessed.
• Computerized tomography of the heart (CT). Typically, during this test, you recline on a table inside a doughnut-shaped apparatus. The apparatus’s X-ray tube rotates inside the body to capture images of the chest and heart. A cardiac CT scan might reveal these conditions if the heart is enlarged or if there are any restricted heart arteries.
• Magnetic resonance imaging of the heart (MRI). This examination produces fine-grained heart pictures using radio waves and magnetic fields. Usually, you will be lying on a table within a long, tube-like machine that creates precise images of the blood arteries and the heart’s structure.
• Cardiovascular imaging. Coronary angiography employs X-ray imaging to see within the blood arteries in the heart. It is a procedure in the broader category of cardiac catheterization.

A medical professional inserts a tiny tube (catheter) through a blood vessel in the arm or groin to inject dye into a heart artery. The dye makes the heart arteries more visible on an X-ray. This type of X-ray may be referred to as an angiography by your doctor.
Complications of angina:
Angina can cause chest pain, making some activities, including walking, problematic. The most dangerous side effect, though, is a heart attack.
Warning signs and symptoms of heart attack:

• The center of the chest feels full, compressed, or pressured for more than a few minutes.
• Besides the chest, there may be a pain in the shoulder, arm, back, teeth, and jaw.
• Fainting
• Sense of impending doom
• An increasing number of chest discomfort episodes
• Nausea and diarrhea
• Ongoing discomfort in the upper belly (abdomen)
• Breathing difficulty
• Sweating

If you face these signs, you should immediately get emergency medical help.
Prevention of angina:
By making the same lifestyle adjustments that are used to treat angina, you can help avoid it. These consist of;

• Not a smoker.
• Consuming a balanced diet.
• Limit or stay away from alcohol.
• Doing regular exercise.
• The upkeep of a healthy weight.
• Taking care of various heart disease-related medical issues.
• Lowering stress
• Getting the appropriate vaccinations to prevent cardiac problems.

Treatment of angina:
Treatment options for angina include;

• Alterations in the way of life
• Medications
• Vascular surgery and stenting
• Heart surgery, open (coronary bypass surgery)

The objectives of treating angina are to lessen its frequency and severity and reduce the risk of mortality and heart attack.
You should seek immediate or urgent medical attention if you experience unstable angina or pain that differs from your typical angina discomfort.

• Medications:

Medication may be required if lifestyle modifications like eating well and exercising fail to improve heart health and reduce angina pain. Among the drugs used to treat angina;

• Nitrates:

Angina is frequently treated with nitrates. Nitrates relax and open up the blood arteries, allowing more blood to flow to the heart. Nitroglycerin is the kind of nitrate that is most frequently used to treat angina. Under the tongue is where the nitroglycerin tablet is put.

• Aspirin:

Because aspirin lessens blood clotting, blood can flow more easily through constricted heart arteries. Blood clot avoidance can lower the risk of a heart attack.

• Clot-resisting medication:

Blood clotting does not occur because certain drugs, including clopidogrel, prasugrel, and ticagrelor, reduce the likelihood that blood platelets will adhere to one another. If you can’t take aspirine, one of these drugs might be advised.

• Beta-blocker:

Beta-blockers lower the blood pressure by causing the heart to beat gradually and gently. These drugs also help to enhance blood flow by relaxing blood arteries.

• Statins:

Drugs known as statins are used to decrease blood cholesterol. Angina and heart disease are both influenced by high cholesterol. Statins block the chemical the body requires to produce cholesterol. They aid in preventing blood vessel obstructions.

• Blockers of calcium channels:

Calcium antagonists and calcium channel blockers relax and expand blood arteries to increase blood flow.

• Other drugs to lower blood pressure:

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers are additional medications for lowering blood pressure (ARBs).

• Ranolazine (Ranexa):

• Surgeries:

It may be necessary to have a catheter operation or open-heart surgery if lifestyle modifications, drugs, or other treatments are unable to relieve angina pain.
The following surgeries and methods are employed to treat angina and coronary artery disease;

• Angioplasty. A tiny balloon is placed into the constricted artery during angioplasty, also known as a percutaneous coronary intervention (PCI). After the balloon has inflated, a small wire mesh coil (stent) is often inserted to enlarge the artery and keep it open.

Angina is lessened or eliminated after angioplasty with stenting. If lifestyle modifications and medicines are ineffective in treating chronic, stable angina, angioplasty with stenting may be a helpful alternative.

• • Open heart surgery (coronary artery bypass surgery). A blocked or congested heart artery is bypassed during coronary artery bypass surgery using a vein or artery from another body part. The heart receives more blood after bypass surgery. Open heart surgery can be used to treat stable and unstable angina that has not responded to conventional therapies.

• Lifestyle modifications:

Angina is frequently caused by heart disease. Making lifestyle adjustments to maintain heart health is crucial to angina treatment. Don’t smoke, and try to limit your exposure to secondhand smoke.

• Exercise and weight control.
• Consume a healthy diet high in whole grains, fruits, and vegetables and low in salt, saturated fats, and trans fats.
• Control other medical disorders.
• Exercise relaxation techniques.
• Limit your alcohol intake.

References:
https://www.mayoclinic.org/diseases-conditions/angina/symptoms-causes/syc-20369373
https://www.webmd.com/heart-disease/heart-disease-angina
https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain
https://www.nhs.uk/conditions/angina/