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Coronary Artery Disease and Angina
Coronary artery disease (CAD) happens when arteries that supply blood to the heart muscle develop a blockage.
Chest pains caused by angina is the heart's response to insufficient blood supply caused by CAD. It is a warning signal that there is not enough blood flow for the needs of that moment. A person with narrowed arteries may develop angina during any activity that increases the heart's demand for blood beyond the available supply.
The most common symptom in both women and men is chest pain. But for women this may not be the most prominent symptom. "Chest pain" may feel like a burning, tightness, pressure or some other sensation. A better word than “pain” might be “discomfort.” This discomfort may radiate, or seem to originate, in the jaw, back, mid-stomach or either arm.
One of the distinguishing factors between women and men is that women tend to report more associated symptoms. These may include classic symptoms such as shortness of breath, nausea and vomiting – but may also include several less classic symptoms including fatigue, dizziness and palpitations.
While it is most common for both genders to get their symptoms with physical exertion, women may also experience their symptoms at rest, during sleep and with emotional stress. Likewise, women may have an increased frequency of symptoms around the time of their menstrual period.
People who have angina are usually managed initially with medical treatment, unless testing indicates severe disease with symptoms that do not respond to treatment. If medications, diet , exercise and cessation of smoking don't significantly improve symptoms of angina or if the person cannot tolerate his therapy, cardiac catherisation followed by angioplasty/stenting or coronary artery bypass graft surgery may be recommended. Women often have atypical symptoms caused by coronary artery disease.
If you are concerned about your heart, you can try this questionnaire for the Prediction of Coronary Artery Disease (CAD).
If angina symptoms worsen despite medical therapy, unstable or crescendo angina is present. There is another condition, silent angina, which occurs in patients who don't have any symptoms: usually the diagnosis is made incidentally, as part of other testing or findings, for instance prior to major surgery. These patients may be at a particular high risk, because they don't get warned with angina symptoms that their heart is not getting enough blood. All these situations may require aggressive treatment.
Here is a list of different types of angina (in order of severity):
- Chronic stable angina
- Silent angina
- Unstable angina
- Crescendo angina
- Angina at rest (your “engine” is not getting enough fuel while idling)
- Angina complicated by heart failure or heart attack:
Tests that show whether you are at risk include:
An exercise test can often determine if you have a risk of a heart attack or cardiac death. The test involves running on a treadmill or bicycling while an electrocardiogram is continuously monitored. In some cases, a radioactive tracer such as thallium or sestamibi is used to identify the particular regions in the heart that are not getting enough blood. In others, a Cardiac ECHO is performed before and after the test to demonstrate changes in the way the heart muscle works.
Cardiac catherisation involves passing a small catheter into the coronary arteries. Dye is injected into the artery and an x-ray image is used to show the outline of any blockages. Cardiac catherisation is usually recommended for people who are considered to have "high risk" disease based upon the results of other tests, such as the exercise tests described above. The results of cardiac catherisation can then help determine whether PCI or CABG is a better choice if a procedure becomes necessary.
Several factors can help determine whether medical or interventional treatment is a better choice.
As a result of studies that compared medical to interventional treatment, many experts do not recommend intervents initially unless you have certain characteristics, you cannot tolerate aggressive medical treatment or do not improve on your present management.
Percutaneous Coronary Intervention (PCI), uses a balloon to dilate narrowed arteries in the heart and may include placement of a stent to hold the artery open.
Coronary artery bypass graft surgery (CABG) involves sewing one end of an artery or vein above a blocked coronary artery and the other end below the blockage ("bypass"), thereby allowing blood an alternate pathway to the heart.