Angina (angina pectoris) is recurring discomfort, typically in the center of the chest, behind the breastbone. It usually lasts only a few minutes. It may take the form of feeling of heaviness, burning, tightness, oppressive pain, pressure or squeezing. It may sometimes spread to the arms, neck or jaws, or it may cause numbness in the shoulders, arms or wrists.

The symptoms in women may be less intense, last longer or appear in other areas of the body, such as the back, shoulders or neck. Shortness of breath and nausea may also occur in women.

Angina is caused by insufficient blood supply (and oxygen) to the heart muscle, especially during periods of exercise or emotional stress. In these periods, your heart rate and blood pressure increase and your heart muscle needs more oxygen.

Is angina the same as heart attack?

No. Although both conditions involve blood flow to the heart muscle, there is an important difference.

In angina, the blood flow is reduced. Permanent damage to the heart seldom occurs. In fact, the body can often increase blood flow to the heart muscle by expanding other arteries nearby and opening up tiny new branches to carry more blood to the affected area. This process is called collateral circulation and, if it becomes well developed, it can help reduce or reverse the symptoms of angina.

In a heart attack, blood flow is cut off suddenly by blocking of a coronary artery that supplies blood to the heart muscle. The heart muscle is often permanently damaged.

What causes angina?

Atherosclerosis ¾ the narrowing of coronary arteries by deposits of fatty substances such as cholesterol ¾ is the cause of angina and heart attacks. Atherosclerosis normally starts early in life and everyone has it to some degree by middle age.

Diagnosing angina

If you think you have angina, your doctor can usually make the diagnosis from your description of symptoms. Your physical examination and a resting electrocardiogram may be perfectly normal. In such cases, you doctor may recommend an electrocardiogram during an exercise test to determine if your heart muscle is getting enough oxygen. If the diagnosis of angina is still inconclusive, other tests may be recommended by your doctor.

Thallium stress test: In this procedure, a radioisotope (thallium) is injected into a vein and the blood flow to you heart is measured while you exercise.

Coronary arteriogram: This is an x-ray motion picture of the coronary arteries. Blood flow is made visible by a special that is injected into the arteries and is visible on the x-ray equipment. Narrowed or blocked arteries are easily identified, and the location and severity of blockage can be determined.

Medical treatment of angina.

Nitroglycerin is effective in relieving or preventing chest discomfort caused by angina. Tiny tablets that dissolve under the tongue or a mouth spray are typically used.

Nitroglycerin tablets are inexpensive and they react quickly. They are safe and not habit forming, and they can be used as frequently as needed to relieve or prevent symptoms. Your doctor will recommend dosage and use for your specific condition.

Long-acting forms of nitroglycerin may also be prescribed, or your doctor may prescribe beta blocking drugs to slow your heart rate and lower your blood pressure. Other options include calcium blocking and beta blocking drugs to reduce blood pressure and heart rate.

Interventional procedures.

If your angina can't be controlled by medication, your doctor may suggest one of the following procedures:

• Percutaneous transluminal coronary angioplasty (PTCA)
• Stent insertion
• Coronary Artery Bypass Grafting