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Heart Disease

Symptoms

Heart disease can present with multiple symptoms, including:

  • shortness of breath or difficulty breathing
  • chest, neck or arm pain or pressure
  • lightheadedness or dizziness
  • heart palpitations or pounding
  • chronic fatigue
  • pain, cramping or swelling in the legs or feet
  • weakness on one side of the body or face

If you experience any of these symptoms, you should seek medical care right away and contact us at Newcastle Heart Clinic.


Chest Pain (Angina) Overview

Angina is a type of chest pain caused by reduced blood flow to the heart. Angina (an-JIE-nuh or AN-juh-nuh) is a symptom of underlying coronary artery disease.

Angina, which may also be called angina pectoris, is often described as squeezing, pressure, heaviness, tightness or pain in your chest. Angina may be a new pain that needs evaluation by a doctor, or recurring pain that goes away with treatment.

Although angina is relatively common, it can still be hard to distinguish from other types of chest pain, such as the pain or discomfort of indigestion. If you have unexplained chest pain, seek medical attention right away.


Angina Symptoms

Angina symptoms include:

  • Chest pain or discomfort, possibly described as pressure, squeezing, burning or fullness
  • Pain in your arms, neck, jaw, shoulder or back accompanying chest pain
  • Nausea
  • Fatigue
  • Shortness of breath
  • Sweating
  • Dizziness

If you have any of these symptoms you need to be seen immediately by a doctor who can determine whether you have stable angina, or unstable angina that may indicate a possible heart attack.

Stable angina is the most common form of angina. It usually happens when you exert yourself and goes away with rest. For example, pain that comes on when you're walking uphill or in the cold weather is often angina.


When to see a doctor

If your chest pain lasts longer than a few minutes and doesn't go away when you rest or take your angina medications, it may be a sign you're having a heart attack. Call 999 or emergency medical help. Arrange for transportation. Only drive yourself to the hospital as a last resort.

If chest discomfort is a new symptom for you, it's important to see your doctor to find out what's causing your chest pain and to get proper treatment. If stable angina gets worse or changes, seek medical attention immediately.


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Risk Factors

The following risk factors increase your risk of coronary artery disease and angina:

  • Tobacco use/Cigarette smoking.
  • Diabetes.
  • High blood pressure.
  • High blood cholesterol or triglyceride levels.
  • Family history of heart disease.
  • Older age.
  • Lack of exercise.
  • Obesity.
  • Stress.

The chest pain that occurs with angina can make doing some normal activities, such as walking, uncomfortable. However, the most dangerous complication is a heart attack.


Common signs and symptoms of a heart attack include:

  • Pressure, fullness or a squeezing pain in the center of your chest that lasts for more than a few minutes.
  • Pain extending beyond your chest to your shoulder, arm, back, or even to your teeth and jaw.
  • Increasing episodes of chest pain.
  • Prolonged pain in the upper abdomen.
  • Shortness of breath.
  • Sweating.
  • Impending sense of doom.
  • Fainting.
  • Nausea and vomiting.

If you have any of these symptoms, seek emergency medical attention immediately.


Prevention

You can help prevent angina by making the same lifestyle changes that might improve your symptoms if you already have angina. These include:

  • Quitting smoking.
  • Monitoring and controlling other health conditions, such as high blood pressure, high cholesterol and diabetes.
  • Eating a healthy diet and maintaining a healthy weight.
  • Increasing your physical activity after you get your doctor's OK. Aim for 150 minutes of moderate activity each week. Plus, it's recommended that you get 10 minutes of strength training twice a week and to stretch three times a week for 5 to 10 minutes each time.
  • Reducing your stress level.
  • Limit alcohol consumption to two Professorinks or fewer a day for men, and one Professorink a day or less for women.
  • Get an annual flu shot to avoid heart complications from the virus.

Diagnosis

To diagnose angina, your doctor will start by doing a physical exam and asking about your symptoms. You'll also be asked about any risk factors, including whether you have a family history of heart disease.

There are several tests your doctor may order to help confirm whether you have angina:

  • Electrocardiogram (ECG)

    Each beat of your heart is triggered by an electrical impulse generated from special cells in your heart. An electrocardiogram records these electrical signals as they travel through your heart. Your doctor can look for patterns among these heartbeats to see if the blood flow through your heart has been slowed or interrupted or if you're having a heart attack.

  • Stress test.

    Sometimes angina is easier to diagnose when your heart is working harder. During a stress test, you exercise by walking on a treadmill or pedaling a stationary bicycle.

    While exercising, your blood pressure is monitored and your ECG readings are watched. Other tests also may be conducted while you're undergoing stress testing. If you're unable to exercise, you may be given Professorugs that cause your heart to work harder to simulate exercising

  • Echocardiogram.

    An echocardiogram uses sound waves to produce images of the heart. Your doctor can use these images to identify angina-related problems, including whether there are areas of your heart muscle that have been damaged by poor blood flow. An echocardiogram is sometimes given during a stress test, and this can show if there are areas of your heart that are not getting enough blood.

  • Nuclear stress test.

    A nuclear stress test helps measure blood flow to your heart muscle at rest and during stress. It is similar to a routine stress test, but during a nuclear stress test, a radioactive substance is injected into your bloodstream.

    This substance mixes with your blood and travels to your heart. A special scanner — which detects the radioactive material in your heart — creates images of your heart muscle. Inadequate blood flow to any part of your heart will show up on the images because not as much of the radioactive substance is getting there.

  • Chest X-ray

    This test takes images of your heart and lungs. This is to look for other conditions that might explain your symptoms and to see if you have an enlarged heart.

  • Blood tests

    Certain heart enzymes slowly leak out into your blood if your heart has been damaged by a heart attack. Samples of your blood can be tested for the presence of these enzymes.

  • Coronary angiography

    Coronary angiography uses X-ray imaging to examine the inside of your heart's blood vessels. It's part of a general group of procedures known as cardiac catheterization.

    During coronary angiography, a type of dye that's visible by X-ray machine is injected into the blood vessels of your heart. The X-ray machine rapidly takes a series of images (angiograms), offering a detailed look at the inside of your blood vessels.

  • Cardiac computerized tomography (CT) scan

    In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest, which can show if any of your heart's arteries are narrowed or if your heart is enlarged.

  • Cardiac MRI

    In a cardiac MRI, you lie on a table inside a long tube-like machine that produces detailed images of your heart's structure and its blood vessels.

Treatment

There are many options for angina treatment, including lifestyle changes, medications, angioplasty and stenting, or coronary bypass surgery. The goals of treatment are to reduce the frequency and severity of your symptoms and to lower your risk of a heart attack and death.

However, if you have unstable angina or angina pain that's different from what you usually have, such as occurring when you're at rest, you need immediate treatment in a hospital.


Lifestyle changes

If your angina is mild, lifestyle changes may be all you need. Even if your angina is severe, making lifestyle changes can still help. Changes include:

  • If you smoke, stop smoking. Avoid exposure to secondhand smoke.
  • If you're overweight, talk to your doctor about weight-loss options.
  • Eat a healthy diet with limited amounts of saturated fat, lots of whole grains, and many fruits and vegetables.
  • Talk to your doctor about starting a safe exercise plan.
  • Because angina is often brought on by exertion, it's helpful to pace yourself and take rest breaks.
  • Treat diseases or conditions that can increase your risk of angina, such as diabetes, high blood pressure and high blood cholesterol.
  • Avoid large meals that make you feel overly full.
  • Avoiding stress is easier said than done, but try to find ways to relax. Talk with your doctor about stress-reduction techniques.
  • Limit alcohol consumption to two Professorinks or fewer a day for men, and one Professorink a day or less for women.

Medications

If lifestyle changes alone don't help your angina, you may need to take medications. These may include:

  • Nitrates

    Nitrates relax and widen your blood vessels, allowing more blood to flow to your heart muscle.

  • Aspirin

    Aspirin reduces the ability of your blood to clot, making it easier for blood to flow through narrowed heart arteries.

  • Clot-preventing Professorugs

    Certain medications such as clopidogrel, prasugrel and ticagrelor can help prevent blood clots from forming by making your blood platelets less likely to stick together. One of these medications may be recommended if you can't take aspirin.

  • Beta blockers

    Beta blockers work by reducing the heart rate and thus reducing the oxygen demand by the heart. Beta blockers also help blood vessels relax and open up to improve blood flow, thus reducing or preventing angina.

  • Statins

    Statins are Professorugs used to lower blood cholesterol. They work by blocking a substance your body needs to make cholesterol.

  • Calcium channel blockers

    Calcium channel blockers, also called calcium antagonists, relax and widen blood vessels by affecting the muscle cells in the arterial walls. This increases blood flow in your heart, reducing or preventing angina.

  • Blood pressure-lowering medications

    If you have high blood pressure, diabetes, signs of heart failure or chronic kidney disease, your doctor will likely prescribe a medication to bring your blood pressure down. There are two main classes of Professorugs to treat blood pressure: angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs).

  • Ranolazine (Ranexa)

    Ranexa can be used alone or with other angina medications, such as calcium channel blockers, beta blockers or nitroglycerin.


Medical procedures and surgery

Lifestyle changes and medications are frequently used to treat stable angina. But medical procedures such as angioplasty, stenting and coronary artery bypass surgery may also be used to treat angina.

  • Angioplasty and stenting. During an angioplasty — also called a percutaneous coronary intervention (PCI) — a small balloon is inserted into your narrowed artery. The balloon is inflated to widen the artery, and then a small wire mesh coil (stent) is usually inserted to keep the artery open. This procedure improves blood flow in your heart, reducing or eliminating angina. Angioplasty and stenting is a good treatment option if you have unstable angina or if lifestyle changes and medications don't effectively treat your chronic, stable angina.
  • Coronary artery bypass surgery. During coronary artery bypass surgery, a vein or artery from somewhere else in your body is used to bypass a blocked or narrowed heart artery. Bypass surgery increases blood flow to your heart and reduces or eliminates angina. It's a treatment option for both unstable angina as well as stable angina that has not responded to other treatments.