Angina

Each year in the UK around 320 000 people visit their doctor for angina. Over six million people in America and two million in the UK are affected. Angina (pronounced 'ann-jy-na') is a symptom of a problem, not a disease in itself. It is usually caused by narrowing of the coronary arteries by atheroma (see introduction to Chapter 2). It can also be caused by a high blood pressure (see the section Risks of high blood pressure in Chapter 2), disease of the aortic valve (see Chapter 7), severe anaemia, and rapid palpitations (see Chapter 6) or a mixture of conditions. Far and away the commonest cause is coronary artery disease (see Chapter 2).

The coronary arteries supply oxygen to the heart and the heart gets this supply between its beats, when it is refuelling itself. This means that the faster your heart beats, the less oxygen there is for the heart itself. If your arteries are narrowed, the flow is restricted. The balance will function well enough when you are not doing anything but, when your heart speeds up, there will come a point when the narrow arteries restrict the supply of oxygen to your heart muscle and pain develops. This is when angina is most often felt, as a chest pain, when you are active or when you are worked up about something, because the demands of your heart for oxygen are not being met by the supply of oxygenated blood to your heart muscle.

SYMPTOMS

My husband has got angina. He is obviously in pain but cannot describe it easily. What does it feel like?

The pain usually begins behind the breast bone. It is often felt as a tightness or a squeezing sensation; your husband probably describes it best by clenching his fist in front of his chest (see Figure 3.1).

The pain of angina can be regarded as a built-in warning device and tells him that the heart has reached its maximum workload. The onset of pain or discomfort indicates that he should slow down or stop any exertion. Alternatively, if emotion (such as anger) has lead to this, then he should relax and remove himself from the situation.

You cannot usually point to where angina pain is felt; it is more widespread and felt across the chest. It is brought on usually by effort, so it will build up if that effort is continued. When it begins, it is often quite mild - more of an ache - so it is easily confused with indigestion. Angina pain may spread (radiate) to the throat or neck, the jaw (like toothache), to the left or right arm or both, and sometimes to the back or stomach. It usually goes down the inside of the arm, in contrast to muscle pain which runs over the shoulder and down the outside of the arm. Rarely, angina occurs in one of these places without being in the chest; for example, a person gets pain in the left arm on effort which is relieved by resting.

Hand movements and chest pain. Heart pain is usually described with the flat of the hand (a) or a clenched fist (b). Heart pain is almost never localised or pointed to (c).

Figure 3.1 Hand movements and chest pain. Heart pain is usually described with the flat of the hand (a) or a clenched fist (b). Heart pain is almost never localised or pointed to (c).

Can my husband's chest pain be from causes other than heart disease?

There are many other causes of chest pain and here are some pointers to stop you worrying unnecessarily.

• Joint or muscle pain This is often worse when someone is changing position. This sort of pain can be reproduced by pressing on the ribs or breastbone.

• Lung disorders This pain is aggravated when you take a deep breath.

• Stomach problems Indigestion after a meal or on bending with an acid taste in your mouth (acid reflux).

• Gallbladder problems Colicky pain after a fatty meal may suggest gallstones.

• Stress, anxiety or over breathing.

Nobody should have chest pain that is a mystery. Do not assume your husband has angina but also do not let him ignore the pain. Get him to ask his doctor's advice. Table 3.1 shows the main differences in signs between heart and not-heart pain.

 
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