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Angina

When chest pain is diagnosed as angina?

Angina is a symptom of underlying coronary artery disease, which is usually caused by atherosclerosis, furring up of the arteries, often described as a fatty deposit’s buildup. Angina is caused by reduced blood flow to the heart muscle due to narrowed coronary arteries as a result of the above. When the arteries become narrowed, they limit the amount of oxygen-rich blood that flows to the heart muscle, leading to ischemia, mismatch between supply and demand. Classical angina is described as discomfort, pressure, heaviness, or pain in the chest, and it can also manifest in the shoulders, arms, neck, jaw, or back. This typically occurs on exertion. Atypical symptoms, which are more often manifested in female patients or patients with diabetes, can cause breathlessness, only jaw ache or even just generalized ache.

According to national guidelines to diagnose typical angina, three out of three of the following components need to be present. Firstly, the nature of the pain needs to be a constricting discomfort in the front of the chest, or in the neck, shoulders, jaw or arms. Secondly, symptoms must be precipitated by physical exertion and lastly, the symptoms are relieved by rest or using a spray, called GTN. Two of the above factors would point towards a typical angina and only one would be defined as non-anginal pain.

In addition to this, depending on a severity and an underlying cause, there are four different types of angina. Stable angina, which predictably occurs with exertion or stress and typically subsides with rest or medication. Unstable angina, which is more serious and can occur even at rest or with minimal exertion with no resolution after a period of rest or medication. Patients experiencing unstable angina should seek urgent medical attention. The above two types may require treatment with revascularization, either by implanting stents or performing coronary artery bypass surgery. Angina due to coronary spasm, which can occur at rest and may respond to medications that relax the muscular layers in the arteries. Microvascular angina, which is caused by furring up of very small arteries within the heart muscle and can be diagnosed in a catheter laboratory. This type is also treated with medications.

To diagnose angina and assess the extent of coronary artery disease, various diagnostic tests can used. They are either non invasive, such as computed tomography coronary angiography (CTCA), stress echocardiography and stress perfusion cardiac MRI or invasive, coronary angiography.

CTCA uses X-rays to generate high-resolution images, allowing visualisation of any blockages or narrowing in the heart arteries, it is often referred as a `doughnut` scan. Stress echocardiography involves performing an echocardiogram (ultrasound of the heart) before and after inducing stress on the heart, either through exercise or medication. Stress perfusion magnetic resonance imaging (MRI) includes a contrast injection into the bloodstream with MRI scans being taken before and after. The above tests can be performed via our clinics.

A coronary angiography is an invasive procedure that involves threading a catheter through the blood vessels to inject contrast into the coronary arteries. X-ray images are then taken to identify any blockages or abnormalities in blood flow. We perform this test at our Heart Centre in Basingstoke and coronary intervention is Dr Bart`s subspeciality, area of interest.

Once diagnosed, treatment of angina aims to relieve symptoms and improve quality of life. This typically involves a combination of lifestyle changes, medications and revascularisation (intracoronary stents or bypass surgery). Lifestyle modification is based on controlling risk factors, such as high cholesterol, high blood pressure and diabetes. In terms of medications, agents that relieve symptoms, reduce heart workload and improve blood flow are recommended (nitrates, beta-blockers or calcium channel blockers). In addition to this, antiplatelet treatment with aspirin is also beneficial.

Our clinics and specialised expertise ensure thorough investigation and comprehensive treatment for patients experiencing anginal symptoms.

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