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Angina pectoris: symptoms, forms

by Josephine Andrews
Published: Last Updated on 280 views

Angina pectoris (stenocardia) is a sudden onset of pain, typically behind the breastbone. It is often accompanied by a feeling of tightness and pressure in the heart area and fear of death. Angina pectoris is a life-threatening warning sign that requires immediate medical attention. Here you can find out what other symptoms appear and what forms there are.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

I20 I25

quick overview

  • Symptoms: pain behind the breastbone, radiation to other areas possible, feeling of tightness and/or shortness of breath often with fear of death, unstable form: life-threatening, in women/elderly people/diabetes atypical symptoms such as dizziness, nausea
  • Causes and risk factors: lack of oxygen in the heart usually due to coronary heart disease , risk factors: smoking, high blood pressure, diabetes mellitus, old age
  • Diagnosis: Consultation with the doctor, symptoms, physical examination, ultrasound , electrocardiogram ( ECG ) at rest and under stress, long-term ECG , magnetic resonance imaging (stress MRI), scintigraphy
  • Treatment: Medication: Nitrogen preparations and others for the underlying disease, possibly (surgical) interventions such as balloon dilatation or bypass surgery, lifestyle change: renunciation of smoking, healthy nutrition, physical activity
  • Course and prognosis: Fast help for the course and prognosis is very important, as life-threatening courses with a heart attack are possible, depending on the severity of the underlying disease and lifestyle
  • Prevention: Refraining from smoking, exercise and a healthy diet

What is angina pectoris?

Angina pectoris (chest tightness, heart tightness, stenocardia) is what doctors call an attack of pain behind the breastbone. It is usually the main symptom of hardening of the arteries (arteriosclerosis) of the coronary arteries (coronary heart disease = CHD). Angina pectoris is actually a symptom and not a disease.

Doctors distinguish between typical angina pectoris and atypical angina pectoris . Typical angina pectoris meets all three criteria:

  1. pain behind the breastbone
  2. The trigger is physical or emotional stress
  3. Complaints are reduced by taking it easy on the body and/or by using nitro spray/capsules

In the case of atypical angina pectoris, only two of the three criteria are met. It is also possible that there is no pain in the heart area or only one criterion is met.

What are the symptoms?

Angina pectoris usually manifests itself with sudden pain and a feeling of tightness, burning, pressure or tightness behind the breastbone . The pain often radiates to other parts of the body, such as the neck, throat, lower jaw, teeth , arms or upper abdomen. In addition, there is sometimes pain between the shoulder blades.

Those affected often describe a feeling of heaviness and numbness in the arm, shoulder, elbow or hand. The left side of the body is usually affected. In addition, symptoms such as sudden shortness of breath , nausea , vomiting , sweating and/or an oppressive, choking feeling in the throat occur. These signs are often accompanied by feelings of anxiety that go as far as fear of death or suffocation.

Peculiarities in women

In women, angina pectoris usually manifests itself with different symptoms than in men: Symptoms such as tiredness, shortness of breath and stomach problems are the typical signs here. Classic chest pain, on the other hand, only occurs in a few women.

Peculiarities in older people

Older people (especially those over 75 years old) often show similar angina symptoms as women. During an attack, they often only complain of shortness of breath and a drop in performance.

Peculiarities of diabetes

Angina pectoris in diabetes (diabetes) has a special feature: Patients with diabetes-related nerve damage (diabetic polyneuropathy) often do not feel any pain because the damaged nerves no longer transmit the pain stimuli completely. In some cases, angina pectoris is therefore almost painless (silent) in people with diabetes.

What forms are there?

Depending on the course, doctors distinguish between different forms of angina pectoris: stable and unstable angina pectoris.

Stable angina pectoris: symptoms

In stable angina pectoris, the angina pectoris attacks are relatively similar each time. Triggers are physical or emotional stress; cold or a heavy meal sometimes lead to seizures. The pain sometimes radiates to the neck, lower jaw, teeth, shoulder and arms.

With rest, the symptoms usually subside within 15 to 20 minutes. When using a nitro spray against the signs of angina pectoris, they usually subside after about five minutes.

Doctors divide stable angina into five stages according to the Canadian Cardiovascular Society:

stage discomfort
0 no symptoms
I No complaints with everyday stress such as running or climbing stairs, but with sudden or prolonged stress
II Complaints associated with strenuous exertion such as running fast, climbing stairs after meals, when it is cold or under emotional stress. Normal physical exertion is little restricted
III Discomfort with light physical exertion such as normal walking or getting dressed
IV Discomfort at rest and discomfort with the slightest physical exertion

Unstable angina pectoris: symptoms

Doctors refer to different forms of chest tightness with different symptoms as unstable angina pectoris. It is possible that the seizures intensify from time to time or last longer. Or they also occur at rest or even under low stress. Rest or previously effective medication (such as nitrospray) hardly help against the symptoms.

A special form of unstable angina pectoris is the rare Prinzmetal angina. This is where the heart disease vessels spasm (coronary vascular spasm). It occurs at rest, for example while sleeping.

Unstable angina develops from a stable chest tightness or appears out of nowhere.

Doctors divide unstable angina pectoris into three degrees of severity:

Class severity
I New onset severe or worsening angina pectoris
II Angina at rest within the last month but not within the last 48 hours
III Angina pectoris at rest within the last 48 hours

Unstable angina has a high risk of heart attack (20 percent). It is therefore absolutely necessary to call the emergency doctor immediately in the event of a seizure! Doctors speak of acute coronary syndrome when unstable angina pectoris turns into a heart attack.

How does angina pectoris develop?

Angina pectoris is caused by reduced blood flow in the heart muscle. The cause is usually a narrowing of the vessels as a result of hardening of the arteries (arteriosclerosis) of the blood vessels that supply the heart (coronary vessels). Rarely, spasms of the vessels (vasospasms) trigger an angina pectoris attack, such as in what is known as Prinzmetal’s angina.

In arteriosclerosis – the main cause of angina pectoris – the blood vessels are narrowed by deposited fat, blood platelets, connective tissue and calcium. If the coronary arteries are affected, the heart receives too little oxygen and nutrients. Doctors then speak of coronary heart disease (CHD) with the main symptom being angina pectoris.

Risk factors favor the accumulation of blood lipids on the arterial walls. These risk factors are:

  • Smoking
  • Elevated blood pressure
  • Diabetes mellitus (diabetes)
  • High age

The wall of the blood vessel changes as a result of inflammatory processes – a so-called arteriosclerotic plaque develops. Colloquially, this is referred to as hardening of the arteries. Over many years, the vessels harden and their diameter decreases. If such a plaque ruptures, a blood clot forms at the site. Sometimes this occludes the artery completely.

When an artery closes and cuts off blood flow to part of the heart muscle, that area dies. Doctors call this a heart attack.

The following factors increase the risk of hardening of the arteries in the coronary arteries:

    • Unhealthy diet and obesity: In the long run, high-fat and high-calorie food leads to obesity and high cholesterol levels
    • Lack of exercise: Sometimes increases blood pressure and worsens cholesterol metabolism
    • Male gender: Men have a higher risk of arteriosclerosis than women before menopause. Women are largely protected by the female sex hormones, estrogen in particular. After menopause, when estrogen production stops, this protective effect is lost.
    • Genetic predisposition: Cardiovascular diseases run more frequently in some families, so genes seem to play a role. The risk is increased if first-degree relatives contracted CHD before the age of 55 (women) or before the age of 65 (men).
    • Smoking: Substances in tobacco smoke promote, among other things, the formation of unstable plaques in the blood vessels.
    • High blood pressure: Elevated blood pressure values ​​directly damage the inner walls of the vessels.
    • Elevated Cholesterol: High LDL cholesterol and low HDL cholesterol promote plaque formation.
    • Diabetes mellitus: In the case of poorly controlled diabetes, the blood sugar is permanently too high, which damages the blood vessels.
    • Increased inflammation values: If, for example, the protein CRP in the blood is increased, this makes the plaques unstable.
    • Older age: The risk of hardening of the arteries in the coronary arteries increases with age.

How is angina pectoris diagnosed?

If angina pectoris is suspected, doctors have various “tools” at their disposal to make and confirm a diagnosis.

interview and physical examination

First, the doctor collects the medical history (anamnesis) in conversation with the patient . He asks, for example, how long the symptoms of a heart attack have existed, how they are expressed and how or in which situation they arise. The doctor will also ask if you are already using a nitrospray and can use it to relieve the symptoms.

The information from the anamnesis interview helps the doctor to assess whether coronary artery disease (CHD) is causing the chest pain or whether another disease is behind it. Similar symptoms arise in some cases, for example, due to certain stomach diseases. A pulmonary embolism also triggers symptoms similar to angina pectoris.

The next step is a physical examination . The doctor listens to the heart and lungs , among other things , and taps the chest. This examination also includes blood pressure and pulse measurements. The doctor uses it to check whether the patient has high blood pressure (hypertension). A blood test provides information, especially in the case of unstable angina pectoris, as to whether a heart attack may be present.

Imaging procedures

Various imaging methods help, among other things, to check the heart function and the blood supply to the heart muscle:

Ultrasound of the heart: With heart ultrasound (echocardiography), the doctor examines whether the heart muscle has changed. This enables him to assess the heart chambers and heart valves and their function. The doctor usually performs this ultrasound through the esophagus. The patient is usually not aware of the examination because he is being anaesthetised.

Resting and long-term ECG: An electrocardiogram (ECG) shows the electrical activities of all heart muscle fibers as a sum in a heart voltage curve. The ECG is changed in more than half of the patients with angina pectoris. If the doctor suspects cardiac arrhythmia, he will have a long-term ECG created.

Stress ECG : The stress ECG is carried out by doctors in the clinic or practice using so-called bicycle ergometry . The patient rides a stationary bicycle with a gradual increase in the load . If there is insufficient blood flow to the heart muscle as a result of the stress, this is recorded by the connected devices. If angina pectoris occurs and the ECG changes, this is important for the diagnosis.

Stress magnetic resonance imaging: Stress magnetic resonance imaging (stress MRI) offers another examination option. To artificially stress the heart, the doctor injects drugs such as dobutamine and adenosine (these drugs make the heart beat faster and stronger). The doctor provokes a lack of oxygen in the heart and examines this or its consequences in the MRT.

Heart scintigraphy : The heart or myocardial scintigraphy shows the blood flow in the heart muscle at rest and under stress. To do this, the doctor first injects the patient with a weakly radioactive substance, which the muscle tissue of the heart absorbs. The so-called gamma camera then maps the radioactive rays and shows which areas of the heart are poorly supplied.

In addition, there are many other options for examining the heart that doctors use to reliably diagnose angina pectoris.

How is angina pectoris treated?

The first goal of treating angina pectoris is to prevent severe attacks and a heart attack. The risk of a heart attack is particularly high in the case of unstable angina pectoris. This can be recognized, for example, by sudden pain and a feeling of tightness in the chest when you are resting, or the usual angina pectoris symptoms are unusually severe.

Call the emergency doctor immediately if you have unstable angina pectoris! Since there is a high risk of a heart attack for those affected, it is essential for survival to be treated in hospital as quickly as possible.

The victim needs first aid until the emergency doctor arrives . The following simple measures help in such a situation:

  • Loosen clothing that is constricting, such as a collar or belt.
  • Elevate his torso.
  • Try to stay with the patient and calm them down.
  • Get fresh air: If the attack happens in a room, opening the window will help. Many sufferers find this beneficial.

Angina pectoris: medication

An acute attack of angina pectoris is usually treated with nitro preparations such as nitroglycerin in the form of a spray or a chewable capsule. Nitro preparations dilate the coronary arteries. This relieves the heart and reduces oxygen consumption. Since the vessels in the rest of the body also dilate, blood pressure drops.

Under no circumstances should you take nitro preparations together with sexual enhancers (phosphodiesterase-5 inhibitors)! This is life-threatening as both drugs lower blood pressure. As a result, it is possible for the blood pressure to drop so low that it is life-threatening.

Other medications that doctors prescribe in the long-term as part of angina pectoris therapy are:

  • Blood thinners such as antiplatelet drugs, acetylsalicylic acid or clopidogrel
  • Beta blockers to lower heart rate and blood pressure during exercise
  • Vasodilators for vasodilation through various nitrates
  • Statins for high cholesterol

Angina pectoris: cardiac surgery

Doctors use balloon dilatation to expand the narrowed section of blood vessel that causes angina pectoris . It works as follows: They insert a small balloon into the narrowed area of ​​the vessel via a thin plastic tube (catheter). They inflate this balloon on site so that it widens the constriction.

Another option for treating angina pectoris is bypass surgery . The surgeon bridges the narrowed piece of blood vessel with a piece of the body’s own or artificial artery to restore the blood supply.

Angina pectoris: healthy lifestyle

Successful angina treatment requires patient compliance. As a sufferer, it is advisable to adopt a healthy lifestyle that avoids or at least reduces risk factors for chest tightness. You can do this, for example, by:

  • Healthy eating
  • Regular exercise
  • Renunciation of nicotine
  • Weight loss when overweight

You are not alone, the doctor treating you is there to advise and support you as a contact person.

How does angina pectoris progress?

The prognosis and life expectancy for angina pectoris depend on the underlying disease. Angina pectoris is actually a symptom by definition and not a disease in its own right, but it should always be seen as a warning sign.

In most cases, angina pectoris is a sign of arteriosclerotic narrowing of the coronary arteries, i.e. coronary heart disease. Hardening of the arteries develops slowly over years. If it reaches a certain level, it sometimes triggers angina pectoris even with little exertion. The stronger and more frequent the attacks, the higher the risk of a heart attack.

Angina pectoris attacks lead to reduced performance and, overall, to a reduced quality of life for many of those affected.

In order to have a positive influence on the prognosis, it is particularly important to treat angina pectoris as early as possible. This not only includes the doctor prescribing the appropriate medication or performing an operation (balloon dilatation, bypass ). Those affected also have the opportunity to contribute to a favorable outcome through their behavior by giving up smoking and paying attention to their diet and regular exercise.

Can you prevent angina pectoris?

If you want to prevent angina pectoris, the same tips apply as for people who already suffer from chest tightness: lead a healthy lifestyle to keep your heart and blood vessels healthy. This includes:

  • to eat healthily
  • Paying attention to regular physical exercise
  • reduce obesity
  • To give up smoking
  • Avoid stress and find relaxation

These measures reduce the risk of coronary artery disease (CHD), the most common cause of angina pectoris. Smoking plays an important role as it constricts blood vessels and thereby negatively affects blood flow to the heart muscle and other parts of the body.

It is also important to have regular check-ups . Only in this way is it possible for the doctor to recognize and treat diseases such as diabetes, high blood pressure or increased blood cholesterol levels, which damage the blood vessels, in good time. If your doctor prescribes you medication, it is important that you take it regularly, even if you are feeling well at the moment.

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