Angina: what it is, symptoms, types and treatment

Angina pectoris, or angina, corresponds to the feeling of heaviness, pain or tightness in the chest that is usually caused when there is a cardiac ischemia, that is, a decrease in blood flow through the arteries that carry oxygen to the heart. Learn how to identify and treat cardiac ischemia.

Most of the time, cardiac ischemia is caused by the accumulation of fatty plaques in the coronary arteries, called atherosclerosis, which are formed over the years of life, especially in people with high blood pressure, high cholesterol or decompensated diabetes. See what are the top 5 causes of atherosclerosis.

These changes happen more in people over 50 and must be treated quickly, as they are a great risk for the development of infarction, cardiac arrest and other cardiovascular diseases, such as arrhythmia, heart failure or stroke, for example.

Main types of angina

There are different types of angina, which can vary in the manifestation of symptoms, the main ones being:

1. Stable angina

It is caused by a transient ischemia, that is, it arises when the person makes some effort or suffers some emotional stress, for example. This type of angina is more common in people who already have some type of partial coronary atherosclerosis, which can get worse and even lead to a heart attack.

Symptoms: Tightness or burning sensation in the chest area, which lasts about 5 to 10 minutes, and which can radiate to the shoulder, arm or neck. Symptoms are usually triggered by effort or moments of great emotion, and improve with rest or with medications to dilate arteries and increase blood flow, such as Isordil.

Treatment: The treatment for stable angina should be rested or, if instructed by the doctor, with the use of vasodilator drugs, such as Dinitrate or Isosorbide Mononitrate (Isordil), to improve blood flow in the artery. If the symptoms last more than 5 to 10 minutes or are accompanied by other symptoms, you should immediately go to the emergency room.

Then, it is important to complement the investigation of the causes and level of coronary obstruction with tests such as stress testing, for example, in addition to treatment, according to the cardiologist's guidance, of risk factors for the heart, such as high blood pressure, high cholesterol and glycemia, in addition to having a diet low in salt, fat, sugars and physical activity. See what the diet should be like to have a healthy heart.

2. Unstable angina

It is a more serious situation than stable angina, because it is caused by a greater obstruction of oxygenation of the heart, due to a rupture and inflammation of the atherosclerosis plaque and, therefore, it causes more intense and constant symptoms, being a form of pre- infarction.

Symptoms: Pain, tightness or burning in the chest area that lasts more than 20 minutes, which also radiates to nearby locations and may be associated with other symptoms such as nausea, sweating and shortness of breath. When these symptoms appear, you should immediately go to the emergency room. Know what chest pain can be.

Treatment: The initial treatment is already done in the emergency room, with remedies to prevent the worsening of symptoms, such as:

• Medicines to improve blood flow, such as nitrate, such as Isordil, beta-blockers, such as Metoprolol, or calcium channel blockers, such as Verapamil and Morphine, when the symptoms are very intense; Medicines to reduce the formation of clots, with the use of antiplatelet agents, such as AAS and Clopidogrel or Prasugrel and Ticlopidine, and anticoagulants, such as Heparin. Anti-hypertensive drugs of the type ACE, such as Captopril, or lipid-lowering agents for cholesterol control, such as Atorvastatin.

After the initial treatment, the cardiologist proceeds to investigate the level of coronary obstruction and cardiac involvement through tests such as echocardiography, cardiac scintigraphy and cardiac catheterization.

In unstable angina it is also important to treat risk factors, such as pressure control, cholesterol, blood glucose, in addition to controlling food and practicing physical activities, attitudes that are fundamental to maintaining good coronary and heart health.

3. Prinzmetal angina or variant

It is caused by spasm of the coronary artery, even in people without accumulation of fat or other types of narrowing, and has no clear cause.

Symptoms: Pain or tightness of strong intensity, which occur even at rest and gradually improve after a few minutes. It is also common to appear during sleep or early in the morning.

Treatment: Treatment for this type of angina is done under the guidance of a cardiologist and is usually done using nitrate drugs or calcium channel blockers, such as Diltiazem and Verapamil, for example, to treat the episode of angina or, if the episodes are recurrent, you can make continuous use of this type of medication. AAS and beta-blockers are generally avoided.

How the diagnosis is made

At the time of the crisis, the diagnosis of angina is made by electrocardiogram, chest X-ray and measurement of cardiac enzymes in the blood, to differentiate the main causes of chest pain, such as stable, unstable angina and infarction. Learn how to identify a heart attack.

Other tests available for further investigation of coronary atherosclerosis and the level of impaired oxygenation of the heart, chosen by the cardiologist, are:

• Exercise test or stress test; Echocardiogram; Myocardial scintigraphy; Cardiac catheterization.

Cardiac catheterization is a very important test, because, in addition to more accurately quantifying the obstruction of blood vessels and assessing the presence of changes in blood flow, it is able to treat the cause of the obstruction, through angioplasty, with implantation of a stent or the use of a balloon, to open the artery. Know what it is for and what are the risks of cardiac catheterization.

Angina has a cure

Angina can be cured in people who are able to treat cardiac ischemia correctly and in a disciplined manner. Many cases are well controlled with the use of medications prescribed by the cardiologist, while others that are more severe require catheterization or even heart revascularization surgery. To learn more about this procedure, see how bypass surgery is performed.

Some useful tips for properly treating angina include:

• Take the medications prescribed by the doctor; Quit smoking; Adopt healthy eating; Exercise regularly (under professional guidance); Avoid overeating and alcoholic beverages; Avoid salt and caffeine; Keep pressure under control; Avoid stress; Avoid very hot or very cold temperatures, as they can also trigger an angina attack.

With these attitudes, in addition to treating angina, it is also possible to prevent the worsening or the appearance of new fatty plaques in the coronary arteries.