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Angina pectoris (Chest tightness)

Severe chest pain with a characteristic feeling of chest tightness indicate angina pectoris. They can be a harbinger or a symptom of a heart attack. Learn about symptoms, causes and therapy.

Synonyms

Chest tightness, Constriction, Stenocardia

Definition

Angina pectoris

Angina pectoris (or stenocardia) literally means “chest tightness”. This also describes the complaints. Affected people report a seizure-like, sometimes violent, tightness in the heart or chest area. These pain attacks indicate a circulatory disorder in the coronary arteries and insufficient supply to the heart muscle. Thus, they are an important and typical symptom of coronary artery disease (CAD). However, every angina pectoris attack can also be a heart attack .

Forms of angina pectoris

Doctors distinguish between stable and unstable angina pectoris and the special form of Prinzmetal’s angina.

  • Stable angina pectoris: The stable angina pectoris occurs depending on the load and is triggered by various factors. This includes physical activities, mental stress, stress, cold or even sumptuous meals. The intensity of the symptoms remains almost the same with every attack.
  • Unstable angina pectoris: The unstable angina pectoris occurs independently of stress and is also referred to as resting angina. Any newly emerging chest tightness or chest tightness with variable symptoms is also an unstable angina pectoris. Angina nocturna is a special form. The symptoms occur mainly at night. When lying down, more blood flows back into the heart. This places higher demands on the previously damaged heart muscles. This additional stress manifests itself as angina pectoris.
  • Prinzmetal’s angina: Prinzmetal’s angina (also vasospastic angina) is a special form of angina pectoris. The chest discomfort is felt regardless of stress, often at night, and is caused by vascular cramps.

Symptoms

Symptoms of angina pectoris are usually characteristic. A rather dull pain begins behind the breastbone, which spreads like a tire over the chest. These pains are often perceived as extremely strong, oppressive and threatening. They typically radiate into the left arm, upper abdomen, neck or lower jaw. A radiation into other areas of the body is also possible. In addition, there is often shortness of breath and cold sweat, blood pressure also rises and the pulse races. Some patients are scared to death. Angina pectoris is sometimes misinterpreted as heartburn or heartburn is thought to be angina pectoris. In English, heartburn is also referred to as heartburn (“heartburn”).

An attack of angina pectoris can pass in a matter of seconds, but can also last for minutes, less often for hours. If an attack lasts for more than 15 minutes, there is a suspicion of a heart attack.

Causes

In most cases, angina pectoris is caused by coronary artery disease (CAD). The coronary arteries are narrowed as a result of arteriosclerosis. As a result, the heart muscle is insufficiently supplied with oxygen, especially during exercise. This reduced blood flow and insufficient oxygen supply cause the symptoms.

Angina pectoris is not only triggered by physical activities such as climbing stairs or jogging. Cold or heavy meals can also provoke an angina attack. In cold weather, for example, the resistance in the blood vessels increases. This reduces the blood flow to the heart muscle, breast complaints appear.

Sumptuous meals stimulate the digestive process, the blood supply to the stomach and intestines increases. The heart muscle then has less blood available, and there is an attack of angina pectoris.

Vascular spasms lead to Prinzmetal’s angina

Prinzmetal’s angina is an exception to angina pectoris. In this form, the cardiac muscle deficiency is triggered by vascular spasms of the coronary arteries. These vascular cramps (spasms) occur mainly at night and at rest.

Examination

Angina pectoris is diagnosed based on the typical symptoms. A blood test, an electrocardiogram (EKG) and a visualization of the coronary arteries (coronary angiography) can follow for further clarification.

Treatment

The therapy for angina pectoris is different. Depending on the severity of the symptoms and the condition of the coronary arteries and the heart muscle, drug or surgical measures are initiated.

Medicines for angina pectoris

Various active substances are available to the doctor for the medicinal treatment of angina pectoris:

  • The constricted coronary arteries are usually dilated with nitro-based vasodilators (such as isosorbide mononitrate and isosorbide dinitrate) or molsidomine.
  • In addition, blood pressure and pulse-lowering beta-blockers (e.g. atenolol, bisoprolol, carvedilol and metoprolol), calcium antagonists (such as verapamil or diltiazem) and dihydropyridines (such as amlodipine and nifedipine) are often given.
  • If beta blockers are not tolerated or should not be taken, the relatively new active ingredient ivabradine can help. Ivabradine lowers heart rate without affecting blood pressure or heart muscle strength.
  • The active ingredient trapidil can improve blood flow to the heart muscle.
  • In order to reduce the risk of vascular occlusion and thus the risk of a heart attack, low-dose acetylsalicylic acid and anticoagulant substances such as phenprocoumon are used.
  • To lower the risk of atherosclerosis or to stop the course of atherosclerosis, cholesterol-lowering drugs from the group of statins help, for example atorvastatin, simvastatin, lovastatin or pravastatin.

Surgical therapy

Sometimes narrowed coronary arteries are surgically widened or renewed. The methods of choice for the surgical treatment of angina pectoris are the so-called percutaneous coronary intervention (PCI) and the bypass operation. The PCI is done using a cardiac catheter. The doctor pushes a folded balloon – usually through the inguinal artery – to the coronary arteries. The balloon unfolds at the narrowed point (balloon dilation) and keeps the vessel open. A small grid frame made of stainless steel (so-called stent) around the balloon sometimes secures this method.

In a bypass operation, a vascular occlusion is bridged with another blood vessel.

Self-help

Even if an attack of angina pectoris feels threatening: keep calm. Sit upright and try to breathe calmly and evenly. The pain usually passes within a short time.

Patients with angina pectoris have spray or bite capsules with glycerol trinitrate (nitro spray, nitro capsules) as emergency medication. After use, the vessels widen and the chest discomfort usually improves quickly. If not, there could be a heart attack. In this case, please call the emergency doctor immediately.

Pay attention to the duration of the complaints. If the pain persists for more than 15 minutes, you should definitely alert the emergency services. Doctors refer to this condition as acute coronary syndrome.

Prevention

Regular medical check-ups provide information on possible risk factors for angina pectoris (e.g. arteriosclerosis). Statutory insured persons can have a check-up every two years free of charge at Check-up 35 from the age of 35. This offer should primarily be used by patients with diabetes and overweight as well as smokers.

Smokers are also advised to stop the vice. You can get information about this from your family doctor, health centers or your health insurance. Furthermore, you should pay attention to a normal body weight and a healthy, varied diet. Patients with fat metabolism disorders, elevated blood pressure values ​​and diabetics should pay attention to normal blood values ​​and carefully follow their therapies.

You will find a wealth of suggestions for a heart-healthy lifestyle in the special topic ” Heart- healthy living – heart failure, preventing heart attack and stroke “.

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