Angina pectoris is favoured by cardiovascular risk factors. It is caused by an imbalance between the heart's oxygen supply and demand. Angina can be treated with medication or surgery.

1. Definition of angina

Angina is a pain in the chest behind the breastbone. It causes constrictive pain, making the patient feel as if the chest is in a vice. The pain can sometimes reach the stomach. The pain caused by angina usually occurs during exertion, or in a stressful situation. Five minutes are enough to make the attack disappear, after a period of rest or taking nitroxide. Angina is a symptom of heart disease or cardiovascular disease. The right and left coronary arteries and the anterior interventricular artery are the main vessels supplying the heart. They carry oxygen-rich blood, allowing the heart muscle to contract. If the oxygen supply is less than the heart needs, the symptoms of angina occur.

2. Symptoms of angina

The symptoms of angina are pain behind the breastbone in the middle of the chest. The pain may radiate to the arms, back, stomach, neck, jaw, and teeth. The patient experiences a feeling of tightness. The pain may be accentuated by stress, eating, or exposure to cold or wind. When the effort stops, it only takes a few minutes for the pain to subside. If the pain lasts only a few seconds, it is probably not angina.

Angina can lead to serious complications, the first of which is myocardial infarction. This is usually preceded by angina pectoris. The pain during an infarction lasts longer than during angina. Chest pain is usually the first symptom of a heart attack, but according to Vidal, 20% of people have a painless heart attack (including people with diabetes). A heart attack may be associated with other symptoms, such as anxiety, visual disturbances, shortness of breath, dizziness, fainting or nausea.

3. Causes of angina

According to the French National Health Insurance, 90% of angina pectoris cases are caused by atherosclerosis which reduces the calibre of the coronary arteries. The oxygen supply is reduced: this is known as coronary artery disease or ischaemic heart disease. The symptoms of angina appear when the arterial diameter is reduced by at least 50%. Atherosclerosis leads to the formation of atherosclerotic plaques consisting of cholesterol, which are deposited on the inner walls of the arteries. This deposition of cholesterol is accompanied by inflammatory reactions and a thickening of the inner wall of the arteries. Plaques take time to develop, but can lead to complete blockage of the vessel.

As of 31 December 2017, 1,210,620 people (72% men and 29% women) in the French health insurance scheme for salaried workers had coronary heart disease, according to the French health insurance scheme. This is the fourth most common cause of long-term sick leave, after diabetes, cancer, and psychiatric diseases. There are other rarer causes of angina pectoris:

heart valve abnormality;
cardiomyopathy;
severe hypertension;
arterial spasm.

4. Angina: when to consult a doctor?

Angina can be an emergency to consult a doctor if the pain does not stop after five minutes despite rest and taking nitroxide. Similarly, if the pain is unusual or if it is accompanied by other signs, such as malaise or nausea, it is imperative to call the emergency room. On the other hand, if the pain stops quickly, there is no need for an emergency room, but a consultation with a doctor is recommended afterwards to set up an appropriate treatment. You should have regular medical follow-up in case of angina pectoris:

consult your GP regularly and follow his or her advice, as well as a cardiologist, at least once a year;
carry out check-ups, such as blood tests;
Follow your treatment without changing it and without stopping it;
Follow healthy lifestyle rules and eliminate risk factors;
get an annual flu vaccination;
Inform any health professional of your treatment;
alert your doctor to any unusual signs or new symptoms.

Monitoring your angina does not usually require you to take time off work. However, if your work is physical, time off may be considered. The length of time off work depends on your occupation, the severity of your illness, your overall health, and any complications of your condition.

5. Examinations and diagnosis of angina

The doctor interviews the patient to assess the severity of the symptoms. The doctor looks for triggers, such as exertion, stress or eating. The doctor performs a stress electrocardiogram to diagnose angina. An ultrasound scan of the heart may also be performed to examine the coronary arteries and visualise any narrowing of the arteries. A coronary angiogram may also be recommended to visualise the condition of the coronary arteries.

6. Treatments for angina

Angina can be treated with certain drugs. Trinitrine and its derivatives dilate the veins of the heart and the arteries. These medicines are prescribed as sprays or tablets. They can be used for prevention as well as during an attack. There are also basic treatments to reduce the symptoms and possible complications of angina. These include beta-blockers, which reduce the blood pressure during exercise and the risk of recurrence of angina and heart attack.

Surgery may be considered to increase the diameter of the arteries and crush the cholesterol deposits. A small spring can then be placed to hold the artery apart. If the artery is damaged, a piece of the vein can be used to perform a bypass. Non-surgical treatment can also be offered: angioplasty. A very thin probe with an inflatable balloon is inserted into an artery and moved to the coronary. The pressure of the balloon crushes the atherosclerotic plaques and restores the artery to a sufficient diameter. Preventive treatments are also essential to avoid angina and heart attacks. The aim is to reduce excess cholesterol by adopting hygienic and dietary measures. Drug treatments can target high blood pressure, cholesterol levels, or diabetes.

7. How to prevent angina

Angina can be prevented by a program of physical exercise suggested by a doctor, by stopping smoking, and by choosing a balanced diet, according to the Montreal Heart Institute. Stopping smoking is essential if a person suffers from angina. Cigarettes reduce breathing capacity and the body's ability to oxygenate itself. After a year without smoking, the risk of a heart attack is halved, as is the risk of a stroke. Diet also plays an essential role in preventing angina. The intake of saturated fats of animal origin (butter, cheese, meat, etc.) should be reduced. On the contrary, it is advisable to increase the intake of fruit and vegetables and whole grains. All this helps to reduce cholesterol. Avoid eating industrial dishes that are high in sugar, fat, and salt. Cook your own food as much as possible. Steam rather than cook in butter. Moderate your alcohol consumption by not drinking more than two glasses a day.

Certain food supplements are recommended to prevent heart disease. The omega-3 fatty acids found in fish and vegetable oils are thought to help prevent cardiovascular disease. Similarly, omega-6 and omega-9 are recommended for prevention. Other food supplements can be considered, such as pectins, potassium, red yeast rice, soya proteins, or vitamin B3. Weight monitoring is also advisable if a patient has angina: the waist circumference should be monitored (less than 88 cm for women and less than 102 cm for men). The BMI can also be monitored. The help of a dietician is recommended.

Physical activity is essential in the prevention of angina, as it promotes the formation of new blood vessels. Moderate physical activity is particularly recommended for people who have suffered a heart attack, in order to strengthen the heart and compensate for the loss of efficiency caused by the heart attack. 30 to 60 minutes of moderate physical activity is recommended, five times a week. Endurance sports, such as walking, swimming, or hiking in the lowlands, should be preferred. You can also naturally increase your physical activity by taking the stairs instead of the escalator, walking instead of taking public transport, keeping your home clean by vacuuming or gardening, and going for walks. People with angina should get a flu shot. Severe flu can cause severe respiratory problems, putting a strain on the heart.