Angina is often the very first sign signaling a heart attack. Even if every person feels angina differently, everyone who experiences this type of chest pain should see a doctor immediately. It’s true that not all chest pain is a sign of a heart attack, but it’s also difficult to figure out it isn’t, so seeing a doctor is the best way to know for sure.
Understanding unstable angina
Angina falls under two different categories — stable and unstable angina:
- Stable angina is predictable, doesn’t usually last longer than five minutes, and usually appears under physical exertion or when you’re performing an activity that requires extra oxygen.
- Unstable angina has unpredictable episodes and can occur both when you’re active, as well as when you’re resting. People that have unstable angina have a major coronary artery blockage that has reached a critical point where it cuts off the blood supply to the heart. It is a life-threatening problem that can lead to a heart attack if it’s not treated. This makes the diagnosis of unstable angina critical to a person’s health.
Causes and symptoms of unstable angina
Unstable angina is caused by coronary artery disease, a medical condition in which the arteries that supply the heart with blood and oxygen are too narrow or completely blocked by a blood clot. This happens because fatty deposits called plaques — a result of too much cholesterol in the bloodstream — eventually ends up on the walls of your coronary arteries. The chest pain is a result of your heart not getting enough oxygen and blood.
People who take nitroglycerin to ease the pain of stable angina may discover that the medication has no effect during an unstable angina attack. Unstable angina is and should be treated as a medical emergency.
Diagnosis of unstable angina
The diagnosis of unstable angina follows pretty much the same path as the diagnosis for coronary artery disease. In fact, the majority of heart disease tests are focused on EKG and echocardiograms, after which doctors choose to perform more in-depth tests to identify the problem with certainty.
If the doctor suspects that your chest pain is indeed caused by unstable angina, they may perform:
- Blood tests to look for biomarkers that could suggest heart muscle damage.
- An EKG, which is short for electrocardiogram and can help doctors see if there are any patterns to your heartbeats that could suggest reduced blood flow.
- Echocardiograms, sonograms of the heart showing if there is any blood flow restriction to the heart.
- Coronary angiography and heart catheterization, which provide the doctor with a deeper understanding of your heart’s current status and the caliber of your coronary arteries. Coronary angiograms are the most common tests in diagnosing unstable angina because they grant a clear image of potential coronary artery blockages.
Treatment and prevention of unstable angina
The treatment path for patients who are diagnosed with unstable angina will vary depending on their condition. Since this is a cause of coronary artery disease, a heart-related problem that’s severely influenced by a person’s dietary habits, lifestyle changes are mandatory for every person. These changes include:
- Giving up foods that are rich in fat and high in cholesterol.
- Losing weight if you are obese.
- Giving up smoking if you are a smoker ( as smoking causes artery damage).
- Managing stress (because it can cause your blood pressure to rise, causing further artery damage).
People with severe blockages may require a more invasive intervention, and there are two that is common in such a situation:
- PCI (which is short for percutaneous coronary intervention) is an invasive procedure that requires the insertion of a thin tube, called a catheter, meant to travel all the way to your blockage site. At the end of this tube, there’s a deflated balloon that, once it reaches its destination, will be inflated in order to push the walls of the narrow artery further apart from one another. In some cases, a more permanent measure must be taken in order to keep the artery open. The doctors use a small mesh cage, which is called a stent, which is permanently placed at the site. The goal of this entire procedure is to improve blood flow to the heart.
- Usually the last resort, some cases may require open-heart surgery, which is known as coronary artery bypass graft surgery. After opening your chest to reveal your coronary artery, the doctor extracts a healthy vessel from another part of your body (such as the leg) and uses it to create a new path that detours past the blockage site. As blood flows through this new vessel towards your heart, it will avoid the blockage that’s causing blood supply interruption.