The chest pain of angina comes in four flavours

There are four types of angina women should know about, no matter how you pronounce it: ‘anj-EYE-nuh’ in Canada or Australia, or ‘AN-gin-uh’ in the U.S.  Angina is not the same as a heart attack – but it can lead to one. Here are the four types of angina you need to know:

• Stable angina: Mayo Clinic cardiologists define this as any pain/discomfort between neck and navel that comes on with exertion and is relieved by rest. When you climb stairs, exercise or walk, your heart muscle demands more blood, but it’s harder for the muscle to get enough blood when your arteries have become narrowed. Stable angina can also be triggered by emotional stress, cold temperatures, heavy meals, smoking or other activities that can narrow arteries.

• Unstable angina can strike without any link to physical exertion and is not relieved by rest or your usual angina medications like nitroglycerin. If a fatty plaque deposit in a coronary artery ruptures or a blood clot forms, it can quickly block or reduce flow through a narrowed artery, severely decreasing blood flow to your heart muscle. If the blood flow doesn’t improve, heart muscle deprived of oxygen dies – and that’s a heart attack, or myocardial infarction. Unstable angina is a serious medical emergency and requires urgent treatment.
  * Stable angina (persistent, recurring chest pain that usually occurs with exertion)
  * Unstable angina (sudden, new chest pain — or a change in the pattern of previously stable angina — that may signal an impending heart attack)
  A third, a rare type of angina called variant angina (also called Prinzmetal’s angina) is caused by a coronary artery spasm.

• Variant angina (also called Prinzmetal’s angina) is relatively rare (only 2% of all angina cases).  It’s usually caused by a coronary artery spasm, and is more common in women (particularly younger women) than in men. The artery can momentarily narrow during this spasm, suddenly reducing blood flow to your heart and causing severe pain. It nearly always happens while you are at rest. It doesn’t follow physical exertion or emotional stress. Attacks may be very painful and usually happen between midnight and 8 a.m. You may also have a blockage in at least one major coronary artery, and the spasm usually happens very close to the blockage. According to the Canadian Society of Internal Medicine, patients with Prinzmetal’s typically have good exercise tolerance, often with no abnormal EKG changes during conventional cardiac treadmill stress testing. Tragically, even an invasive diagnostic angiogram can sometimes fail to identify heart disease in patients with Prinzmetal’s. Drugs such as cocaine can also cause such a life-threatening spasm, which is why paramedics and medical staff may ask if you’ve ingested cocaine when you present with cardiac symptoms.

• Microvascular angina causes chest pain, but without any apparent blockage in a coronary artery. This pain is caused by an improper functioning of the tiny microvascular blood vessels that feed your heart. This condition is sometimes also called Syndrome X. Coronary microvascular angina is also called non-obstructive coronary artery disease. Doctors don’t know yet whether coronary microvascular angina is the same as microvascular disease linked to other conditions such as diabetes.  Standard diagnostic tests look for coronary artery blockages that affect blood flow in your large coronary arteries, but these tests can’t detect fatty plaque deposits that form, scatter, or build up in the smallest coronary arteries. And standard tests can’t detect when the arteries spasm or when the walls of the arteries are damaged or diseased.

For many women, angina symptoms can feel very different from the classic angina symptoms of men. For example, a woman may have chest pain that feels like a stabbing, pulsating, burning, heavy or  sharp form of chest discomfort rather than the more typical vise-like pressure and tightness of men. Women are also more likely to experience nausea, shortness of breath or abdominal symptoms. These differences may lead to delays in seeking treatment for many women.

Angina can also occur in the absence of any coronary artery disease. Up to 30% of people with angina with a heart valve problem called aortic stenosis, which can cause decreased blood flow to the coronary arteries from the heart. People with severe anemia may also have angina because their blood doesn’t carry enough oxygen. And those with thickened heart muscles need more oxygen and can have angina when they don’t get enough.

In a UK study of almost 100,000 people aged 45-89, epidemiologist Dr. Harry Hemingway of the University of London pointed out the difficulty in diagnosing angina in women, which is often missed by tests such as treadmill exercise electrocardiograms, compared to men. The UK researchers also found that angina in women over age 45 is connected with higher mortality rates.

Dr. Hemingway says:

“For women, angina is a more significant public health problem than many doctors, or indeed the general public, realise.  We need to ensure fair access to cardiac investigation and treatment services.” 

Dr. Peter Weissberg, medical director at the British Heart Foundation which funded the study published in the Journal of the American Medical Association, adds:

“Angina has traditionally been thought of as a male affliction. This study confirms that after age 45, women fare worse than men when they develop angina. Women with angina should receive prompt and appropriate treatment to reduce their risk of suffering a heart attack.”

There are several treatment options for these four types of angina ranging from medications alone to coronary bypass surgery in order to reduce the frequency or severity of your symptoms and to lower your risk of heart attack and death. Angina symptoms in women can be both physical and emotional.

Remember, all chest pain should be considered heart-related until proven otherwise.

Learn more about angina from the experts at Mayo Clinic.

Note: information on this website is not intended to replace medical advice

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Tags: angina, chest pain, health, heart attack, heart attack symptoms, medicine, microvascular disease, prinzmetal's angina