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Dr Diana R Holdright

Consultant Cardiologist

Dr Diana Holdright

Cardiac Conditions - Angina

Angina is the term used to describe symptoms arising from an inadequate blood supply to the heart. The most frequent manifestation of angina is exertional chest discomfort or heaviness, which may spread to the jaw, arm or wrist, although symptoms vary greatly from patient to patient and remarkably some patients (particularly diabetics) have no symptoms at all. Some patients also feel breathless with exertion; this reflects an impairment of the pumping action of the heart, also due to an inadequate blood supply, and a minority of patients will experience breathlessness as their only symptom of angina.

Angina typically occurs when the heart is stressed, for example with physical exertion or mental pressure; in these situations the heart beats harder and faster and needs more oxygen, but if the lining of a coronary artery has become narrowed with cholesterol and other deposits, the blood and oxygen supply to the heart muscle becomes inadequate, causing symptoms. This process of furring up is gradual and occurs over many years; only when a narrowing blocks 70% or more of the artery do symptoms typically develop. As the patient rests and the heart’s requirement for blood and oxygen diminishes, so too does the chest discomfort. It is this clear pattern of onset and offset of symptoms which is an important marker of possible angina. The way a patient feels his/her angina never changes and it is usually stable and predictable, for example occurring with taking the stairs quickly or climbing a fairly steep hill. Angina is usually worse in cold weather and with exertion after eating (postprandial angina), due to the increased workload on the heart at these times. In some patients the first activity of the day may cause angina, leaving them relatively symptom-free for the rest of the day (first effort angina).

In some patients, the symptom of angina can be mimicked by spasm from the gullet, known as oesophageal spasm. Oesophageal spasm is not uncommon and may be associated with a hiatus hernia, reflux of acidic stomach contents into the oesophagus (which, unlike the stomach, is not lined to cope with acidic substances) and spasm of the oesophageal muscles. To confuse matters further, use of a GTN spray, which relieves anginal symptoms within seconds by improving the blood supply to the heart, also relieves discomfort caused by oesophageal spasm; consequently, some patients with oesophageal spasm may be misdiagnosed with angina and vice versa.  

Angina can be effectively treated with medicines, angioplasty and bypass surgery returning patients to an excellent quality of life.

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