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Electrocardiogram (ECG or EKG) at Cadence Heart

Chest Pain & Discomfort

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Introduction

Angina, also known as angina pectoris or ischemic chest pain, is a type of chest pain or discomfort caused by reduced blood flow to the heart muscles following various heart diseases such as coronary artery disease or a heart attack.

This imbalance between oxygen supply and oxygen demand leads to a squeezing sensation, or a feeling of tightness, heaviness, or pressure, in the chest. While angina itself is not a disease, it is often a sign of an underlying heart condition. Therefore, it is important to seek medical treatment if you are experiencing any unexplained chest pain, sudden or chronic.

What are the types of angina?

Medical illustration to explain Angina pectoris and

There are several types of angina, including:

  • Stable angina

This type of angina is triggered by stress or physical activity. It tends to last for short periods of time and goes away after a period of rest.

  • Unstable angina

Unstable angina occurs even when you are at rest and is often prolonged and recurrent.

  • Microvascular angina

Microvascular angina refers to angina caused by spasms in the smallest coronary arteries. It is often more severe and lasts longer than other types of angina.

  • Variant angina

Also known as vasospastic angina or Prinzmetal's angina, this rare type of angina tends to occur during sleep or rest. It is caused by spasms in the coronary arteries.

Other sensations that might accompany heart-related chest pain

Angina is sometimes accompanied by pain in the neck, jaw, shoulders, arms, or back. Other common symptoms experienced in conjunction with angina include:

Gender may also play a role in the type of symptoms experienced when it comes to angina. For example, women are more likely to experience atypical symptoms during angina.

Heart problems related to chest pain

Several heart problems are commonly associated with various types of angina. These include:

  • Coronary Artery Disease (CAD)

CAD refers to the build-up of plaque in the coronary arteries, which supply blood to the heart. This results in reduced blood flow to the heart, which can often lead to angina.

  • Myocardial infarction (heart attack)

Myocardial infarction is most commonly known as a heart attack. This is when blood flow to the heart is blocked and is often the result of CAD. Angina is one of the most common symptoms of a heart attack.

  • Myocarditis

Myocarditis refers to an inflammation of the heart muscle, also known as the myocardium. It is most often caused by viral infections and usually leads to angina and arrhythmia.

  • Pericarditis

Pericarditis is an inflammation of the outer lining of the heart or the pericardium. The pericardium is composed of several layers and can cause chest pain when these layers become inflamed and rub against each other.

  • Hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy refers to a disease where the heart muscles become hypertrophied, or abnormally thickened, resulting in symptoms such as angina and fainting. It is usually hereditary or caused by genetic mutations.

  • Mitral valve prolapse

The mitral valve is a valve in the heart that allows blood flow from the left atrium to the left ventricle. Mitral valve prolapse, which is sometimes known as Barlow's syndrome, refers to a condition where the flaps of the mitral valve bulge, or prolapse, up into the left atrium of the heart instead of closing evenly. This disrupts normal blood flow and often results in chest pain.

  • Coronary artery dissection

The walls of the coronary arteries are composed of thin layers of tissue. When these layers separate, it is known as coronary artery dissection. This can either be spontaneous or be caused by trauma. The symptoms of coronary artery dissection include angina, heart palpitations, nausea, and more.

How is it diagnosed?

Patient getting his blood pressure checked in Cadence Heart

Chest pain, in general, can be caused by a number of factors such as anxiety, muscular strain, or gastrointestinal issues. To determine whether your chest pain is heart-related, your doctor will ask about your symptoms, as well as your personal and family medical history. He or she will conduct a physical exam during your consultation, and may also perform one or more of the following tests:

An ECG measures heart rate and rhythm by recording the heart's electrical activity.

A stress test involves measuring your ECG and blood pressure while you exercise, often on a treadmill or stationary bicycle.

An echocardiogram uses ultrasound to produce images of your heart while it is beating.

  • Chest X-ray

These are used to look at the heart and surrounding area and can be useful for excluding other causes of chest pain, such as a lung condition.

  • Coronary angiography

During coronary angiography, x-ray imaging is used to look inside the blood vessels surrounding the heart.

  • Cardiac CT scan or MRI

Both of these scans are able to produce a more detailed picture of your heart than that provided by an X-ray.

  • Various blood tests

When presented with chest pain, your doctor may order general blood tests like a metabolic panel and complete blood count, or more specialised tests, such as that to detect cardiac troponin. Troponin is an enzyme that tends to leak into the blood following severe angina or a heart attack.

If you are at risk of heart disease or CAD, you will most likely be at risk for angina. This is why during a consultation, your cardiologist must do a thorough assessment of your medical history, family’s history of heart disease and your lifestyle choices.

How is angina treated?

Dr Devinder Singh of Cadence Heart checking the heart rhythm of a patient

Angina is usually a symptom of a more serious condition and, therefore, treatment will generally depend on the underlying cause of your chest pain. For example, if your angina is caused by CAD, your doctor may recommend that you undergo a coronary angioplasty in order to treat your CAD.

Other forms of treatment may include:

  • Lifestyle changes

Some risk factors are modifiable such as quitting smoking, eating healthily and exercising regularly. If you are overweight, attaining your optimal weight could greatly manage your risk.

  • Medications

However, some medications can immediately treat the symptoms of angina itself, such as nitroglycerin, which opens the blood vessels to improve blood flow to the heart. Other common medications used to treat angina include antiplatelets and those used to treat high blood pressure.

  • Cardiac Rehabilitation

If you are suitable, you could undergo a medically supervised programme to improve your cardiovascular health. This comes in the form of exercise training, education on heart-healthy practices and counselling to reduce stress.

Summary

Chest pain can have a wide range of causes. However, angina tends to be a symptom of such life-threatening heart conditions as heart attacks and CAD. As such, it is important that you seek immediate medical treatment should you experience any unexplained chest pain. With the help of various diagnostic tests, your cardiologist will be able to determine the cause of your chest pain and begin treatment accordingly.

Dr Devinder Singh

Senior Consultant Cardiologist &
Cardiac Electrophysiologist

Dr Devinder Singh is the Medical Director of Cadence Heart Centre. He is an experienced Senior Consultant Cardiologist & Cardiac Electrophysiologist with over 20 years of clinical experience.

His expertise lies in clinical cardiology, cardiac rhythm disorders (arrhythmia), cardiac pacing (including cardiac resynchronisation therapy) and cardiac magnetic resonance imaging. He performs electrophysiology studies and radiofrequency ablation of cardiac arrhythmias, and is well versed in pacemaker and defibrillator insertions.

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    Mt Elizabeth Medical Centre, Singapore 228510
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