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March-April 2012, Vol. XXVII, No. 2
 
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Your Health

Diagnosed with angina? Ways to cope with chest pain

Dealing angina

If your doctor has told you that you have angina, you know too well what it feels like—that squeezing, pressing pain under the breastbone. You may even feel it in your arm, jaw, shoulder, back, or neck.

Angina is the chest pain you feel when the heart doesn't get enough of the oxygen-rich blood it needs. It may be felt during certain activities, such as walking or cleaning. Emotional upset, extreme temperatures, heavy meals, alcohol, and smoking also can trigger angina.

Stable and unstable

The two most common forms of the condition are stable and unstable angina. If the pain is predictable and only happens during certain activities, such as exercise, it's called stable angina. The pain usually goes away after a few minutes of resting or taking prescribed angina medication.

But if chest pain doesn't stick to a pattern, becomes more severe or frequent, or lasts longer, the problem is unstable angina. Unstable angina can even happen while resting.

Unstable or stable angina is often a symptom of coronary artery disease, or narrowed arteries. This means sufferers also have a higher risk of a heart attack. People with angina should call their doctor if their angina becomes more frequent, lasts longer, or happens without exercise. These warning signs can mean the risk of a heart attack is much higher in the days and weeks that follow.

Chest pain of a heart attack typically is more severe and lasts longer than angina—often longer than 15 to 20 minutes. It does not get better with rest or medicine. In addition, it may be accompanied by other symptoms, including nausea, sweating, shortness of breath, lightheadedness and weakness. People who suspect a heart attack should seek immediate emergency help.

More women than men get angina. But not all women with angina may be at risk for heart trouble. Research suggests that fewer women than men with angina have coronary artery disease. More studies are looking at which women with angina are most at risk.

Make smart lifestyle choices

Smart lifestyle choices can ease chest pain and reduce heart risks. Within weeks, you may feel better. In some cases, lifestyle choices can have a lasting impact on chest pain and help lessen the need for surgery. Doctors recommend these measures:

  • Don't smoke.
  • Control your high blood pressure, high cholesterol, or diabetes if applicable.
  • Maintain a healthy weight.
  • Eat low-fat, low-cholesterol food. Avoid heavy meals if they trigger chest pain.
  • Moderate your alcohol intake, if you drink at all.
  • Manage daily stress.
  • Exercise. Avoid strenuous activities that can cause chest pain. But if your angina is stable, you need moderate exercise three to four times a week to keep your heart healthy. If you have been inactive, try walking for a few minutes at a time until you can work up to at least 20 minutes. Your doctor may also recommend cardiac rehabilitation, aimed at improving heart health through exercise and counseling.

Treating the pain

To help control angina, your doctor will probably recommend you take medicines that can help improve blood flow. Nitroglycerin is one type. You take it when you feel pain or expect to feel pain, such as before exercise. It works by widening blood vessels and helping the heart manage blood flow.

Other medicines also can ease the heart's workload. Beta-blockers lower heart rate and blood pressure, which reduces chest pain. Calcium channel blockers increase blood flow through arteries, which also relieves angina.

Your doctor may also prescribe aspirin, which can help ward off heart attacks and episodes of angina. The most common dose is 325 milligrams daily, but studies show a dose of only 75 milligrams a day may be effective in easing pain.

While medicine helps many people with angina, those with severe angina or who are at high risk for a heart attack may need:

  • Angioplasty, which opens up arteries to improve blood flow and ease chest pain
  • Bypass surgery, in which a blood vessel is grafted onto a blocked artery to bypass the blocked section and increase blood flow to the heart
  • Transmyocardial revascularization (TMR) for people who aren't candidates for angioplasty or bypass surgery. This procedure involves using a laser to create tiny holes in the heart, which relieves chest pain.

Researchers are also looking at experimental treatments, including gene therapy that increases blood flow to the heart muscle. They are also studying using testosterone patches in men to treat angina caused by exercise.


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