Angina Fact Sheet
Angina is a symptom of coronary artery disease
(CAD), and is typically a recurring feeling of pain or discomfort in
the chest due to myocardial ischemia, i.e. an inadequate supply of
blood and oxygen to the heart muscle resulting from narrowing or
blockages in the coronary arteries.
Symptoms of Angina
Common symptoms include an uncomfortable pressure,
fullness, squeezing or pain in the center of the chest under the
breastbone. This discomfort also may be felt in the neck, jaw,
shoulder, back or arm. Angina symptoms in women may present
differently than those in men. Angina may be less intense or last
longer, or it may be experienced as nausea, difficulty breathing or
an extreme feeling of tiredness.
Quick Facts
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Approximately 6.8
million Americans suffer from angina (4.2 million women and 2.6
million men) |
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Roughly 1 in 44
people in the U.S. have angina |
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An estimated
400,000 new cases of stable angina occur each year |
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Angina typically
affects men older than 60 years and women older than 70 years |
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Approximately
150,000 angina patients annually are considered refractory to
medical and/or surgical therapy. |
Types of Angina
Stable angina
is the most predictable and
prevalent form of angina. Physical exertion is the most common
trigger although emotional stress and exposure to extreme
temperatures also may lead to anginal episodes. Angina attacks
typically last no more than five minutes and are usually relieved by
rest and/or nitroglycerin.
Unstable angina
is unpredictable. Patients
experience symptoms without an obvious trigger, often while they are
at rest. The discomfort may be more severe, prolonged (as long as 30
minutes) and different in character than stable angina symptoms.
Canadian Cardiovascular Society Angina
Classification System
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Class I |
Ordinary
physical activity does not cause angina, such as walking or
climbing stairs.
Angina occurs with strenuous, rapid or prolonged
exertion at work or recreation.
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Class II |
Slight limitation of ordinary
activity. Angina occurs on walking or climbing stairs rapidly,
walking uphill, walking or stair climbing after meals, or in
cold, in wind, under emotional stress or only during the few
hours after awakening. Angina occurs on walking more than two
blocks on the level and climbing more than one flight of
ordinary stairs at a normal pace and in normal condition. |
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Class III |
Marked limitation of
ordinary physical activity. Angina occurs on walking one to two
blocks on the level and climbing one flight of stairs in normal
conditions and at a normal pace. |
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Class IV |
Inability to carry on any physical activity
without discomfort – anginal symptoms may be present at rest. |
Treatment Options
The first line of treatment for patients is
medication that helps increase the supply of oxygen to the
oxygen-deprived heart muscle by dilating coronary vessels or
decreasing the demand for oxygen. Unfortunately, for most patients
with angina, medication becomes less effective over time. More
invasive options include angioplasty and coronary stent placements,
as well as coronary artery bypass grafting (CABG). However, these
procedures sometimes fail, pose risks and are expensive. There are
many factors that increase the risk of these invasive procedures,
including:
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Age |
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The existence of
comorbid conditions, such as diabetes or renal insufficiency |
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Small blood
vessels, frequently seen in women |
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Coronary anatomy
that is not suited for surgical intervention |
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Prior failed
interventional procedures |
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Previous CABG |
While some patients with more extensive disease or
who have disease of the left main coronary artery may require bypass
surgery, there is a new option for patients who cannot be treated
effectively with medication or who are unsuitable for or unwilling
to undergo invasive procedures. This treatment is called EECP ®
external counterpulsation
therapy.
EECP ®
Therapy
EECP therapy is a non-invasive outpatient treatment
that is used to relieve or eliminate angina. It is believed to
create new pathways around blocked arteries in the heart by
expanding networks of tiny blood vessels that help increase blood
flow to the heart muscle. EECP treatment can reduce or eliminate the
frequency and intensity of chest pain, decrease the need for
medication and greatly improve the ability to participate in
activities of daily living. After receiving EECP treatment, patients
often are able to enjoy moderate exercise for the first time since
developing angina.
EECP therapy is typically given in 35
one-hour-sessions over seven weeks. Patients lie down on a padded
table and have their calves and lower and upper thighs wrapped in
blood pressure-like cuffs. The system, which is synchronized to the
individual patient’s cardiac cycle, inflates the cuffs with air to
create external pressure when the heart is resting (diastole) and
deflates the cuffs just before the heart beats (systole). The
system’s action, which pulses counter to the heart's beating,
increases blood flow to the heart muscle, decreases the heart’s
workload and creates a greater oxygen supply for the heart muscle
while lowering the heart's need for oxygen.
Sources:
American Heart Association.
Heart and Stroke Facts;
National Heart, Lung, and
Blood Institute.
Diseases and Conditions Index: Angina;
American Heart Association.
Angina Pectoris
Treatment; Patient Health
International.
Angina Fact and Figures;
American Heart Association.
Transmyocardial Revascularization (TMR);
American Heart Association.
Heart Disease and Stroke
Statistics-2004 Update.
Dallas,Tex. American Heart Association;2003. |
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