Unstable Angina – A Medical Condition

What is Unstable Angina ?

Angina is another name for heart-related chest pain. This type of pain can also be felt in nearby areas including:

• Shoulders
• Jaw
• Neck
• Back
• Arms

In this condition, your heart muscle is deprived of oxygen due to blockage or inadequate blood supply.

There are two types of angina: Stable Angina and Unstable Angina. Both are serious conditions and should be evaluated by your doctor, because both are indicators of coronary artery disease and can preclude a heart attack. Of the two, unstable angina is considered to be more dangerous than stable angina.

Stable angina occurs predictably. It occurs when you exert yourself physically or feel a great deal of stress. This type of angina gets predictably better with rest, deep breathing, and reduction of stress. This type of angina is predictable and generally stable over time.

Unlike stable angina, unstable angina can cause chest pain unpredictably, including during rest, exertion, or stress. Also, over time there is an increase in the frequency and severity of the pain. The term unstable angina refers to blocked arteries supplying your heart with blood and oxygen.

Angina attacks are emergencies that require medical attention. Unstable angina can lead to heart attack, heart failure, or arrhythmias (irregular heartbeats). There is a possibility that these conditions can be life-threatening.

Could you please tell me what causes unstable angina?

Unstable angina is typically caused by the build-up of plaque in the coronary arteries, which can lead to a reduction in blood flow to the heart muscles. The plaque is made up of cholesterol, fatty substances, reactive oxygen species, and other materials that can accumulate on the inside of the artery walls over time. As the plaque builds up, it can narrow the inside of the artery, making it more difficult for blood to flow through.

In some cases, a piece of plaque can break off and form a clot, which can further block the flow of blood to the heart. This can cause unstable angina, as well as a heart attack if the clot completely blocks the flow of blood to the heart.

There are several risk factors that can contribute to the development of plaque in the coronary arteries, including:

• High blood pressure
• High cholesterol
• Smoking
• Diabetes
• A family history of heart disease
• Age (the risk of unstable angina increases as you get older)
• Obesity
• Sedentary lifestyle
• High stress levels

It is important to note that unstable angina is a serious condition that requires prompt medical attention to prevent heart damage or subsequent heart attack. Unstable angina is more likely to occur among men 45 years of age and older and women 55 years of age and older.

What are the symptoms of unstable angina?

The main symptom of unstable angina is chest pain or discomfort that doesn’t occur in a predictable pattern. This pain may feel like a tightness, pressure, or squeezing in the chest.

It may also spread to the shoulders, arms, neck, jaw, or back. Other symptoms of unstable angina can include:

• Shortness of breath
• Sweating
• Anxiety
• Nausea
• Dizziness
• Fatigue

These symptoms may occur at rest or with only light physical activity and may be different or more severe than the symptoms of stable angina. It is important to seek immediate medical attention if you experience any of these symptoms, as unstable angina can be a sign of an impending heart attack.

Not everyone with unstable angina will have chest pain, some people may have atypical symptoms like breathlessness, feeling of indigestion, Fatigue, or even no symptoms at all.

How is unstable angina diagnosed?

Unstable angina is typically diagnosed through a combination of symptom picture, physical examination, an electrocardiogram (ECG), a stress test, and blood tests.

During the physical examination, a healthcare professional will take your blood pressure, listen to your heart and lungs, and check for signs of chest pain or discomfort. The healthcare professional may also order blood tests to check for signs of heart damage or to identify other possible causes of your symptoms.

An electrocardiogram (ECG) is a test that records the electrical activity of the heart. It can show if the heart muscle is not receiving enough blood flow, which can be a sign of unstable angina.

Additional diagnostic tests that may be performed to confirm the diagnosis of unstable Angina and to evaluate the underlying cause include:

• Stress test: a test that measures the heart’s response to physical activity.
• Coronary angiography: a test that uses X-ray to create detailed images of the coronary arteries.
• Echocardiogram: an ultrasound test to evaluate the heart function and blood flow.

Your healthcare provider may also order additional tests such as cardiac biomarkers or Cardiac CT scan to evaluate for any evidence of a heart attack or to evaluate the degree of stenosis in your coronary arteries.

Unstable angina is considered a medical emergency and requires prompt diagnosis and treatment to prevent permanent damage to the heart muscle or a heart attack.

How is unstable angina treated?

Treatment for unstable angina typically includes a combination of medications and procedures to improve blood flow to the heart and reduce the risk of a heart attack. The specific treatment plan will depend on the severity of the unstable angina and the underlying cause of the condition.

Medications that may be used to treat unstable angina include:

• Aspirin: to prevent blood clots from forming.
• Clopidogre or other anticoagulants including heparine: to prevent blood clots from forming.
• Nitrates: to relax the blood vessels and improve blood flow to the heart.
• Beta blockers: to slow the heart rate and reduce the workload on the heart.
• Statins: to lower cholesterol levels and prevent plaque build-up in the coronary arteries.

In some cases, procedures such as angioplasty or coronary artery bypass grafting (CABG) may be necessary to open or bypass blocked coronary arteries. Angioplasty involves using a small balloon to widen the narrowed coronary artery, and CABG is a surgery that uses a blood vessel from another part of your body to bypass the blocked coronary artery.

It is important to note that the goal of treatment is to prevent a heart attack or death, and to reduce the symptoms of unstable angina. Your healthcare provider will work with you to create a treatment plan that’s tailored to your individual needs, which may include lifestyle changes such as exercise, diet, and smoking cessation to help prevent a recurrence of unstable angina and improve overall cardiovascular health.

How Surgery helps unstable angina

Surgery can be an effective treatment option for unstable angina in certain cases. The two main types of surgery used to treat unstable angina are angioplasty and coronary artery bypass grafting (CABG). Angioplasty is a procedure that uses a small balloon to widen the narrowed coronary artery. A small tube called a catheter is inserted into a blood vessel in the leg or arm and guided to the narrowed coronary artery. Once in place, the balloon is inflated, which pushes the plaque against the artery wall, widening the artery and improving blood flow to the heart. Angioplasty may be combined with the placement of a stent, a small mesh tube that helps to keep the artery open.

Coronary artery bypass grafting (CABG) is a more invasive surgery that uses a blood vessel from another part of your body to bypass the blocked coronary artery. This procedure can improve blood flow to the heart by creating an alternate route for blood to flow to the heart.

Both procedures aim to improve blood flow to the heart, reduce chest pain and prevent a heart attack. CABG has been shown to be more effective than angioplasty, particularly when there are multiple blocked coronary arteries but it isn’t appropriate in every case because it is more invasive.

It is important to note that the choice of the treatment method depends on the specific case and the underlying cause of the unstable angina. Your healthcare provider will work with you to determine the best treatment options for your individual needs.

How Lifestyle changes help unstable angina

Lifestyle changes are an important part of managing unstable angina and preventing future episodes. These changes can help to reduce your risk of a heart attack, improve blood flow to the heart, and reduce symptoms of unstable angina, including pain and fatigue. Some lifestyle changes that can help to manage unstable angina include:

• Eating a healthy diet: Eating a diet low in saturated and trans fats, cholesterol and sodium can help to lower cholesterol levels and reduce plaque build-up in the coronary arteries. Also, a healthy diet can reduce inflammation which has been linked to angina and other coronary artery disease.
• Maintaining a healthy weight: Being overweight or obese can increase your risk of unstable angina by putting additional pressure on your cardiovascular system. Losing weight can help to improve blood flow to the heart and reduce your risk of a heart attack.
• Exercising regularly: Regular physical activity can help to improve cardiovascular fitness and reduce the risk of a heart attack. 
• Quitting smoking: Smoking damages the coronary arteries and increases your risk of unstable angina. Quitting smoking can help to reduce your risk of a heart attack and improve blood flow to the heart.
• Managing stress: Emotional stress can trigger episodes of unstable angina. Finding ways to manage stress, such as through exercise, meditation, or therapy, can help to reduce the risk of a heart attack.
• Reducing blood sugars: Diabetes is an independent risk factor of coronary artery disease and keeping balanced blood sugars helps reduce the risk of all types of angina.
• Managing other health conditions: If you have other health conditions such as high blood pressure or diabetes, it’s important to work with your healthcare provider to manage these conditions, as they can increase your risk of unstable angina.

It is important to work with your healthcare provider to create a lifestyle plan that’s tailored to your individual needs and to monitor progress regularly. Making these lifestyle changes can help you to reduce your risk of a heart attack, improve blood flow to the heart, and reduce symptoms of unstable angina.

What can I do to prevent unstable angina from occurring?

There are several steps you can take to reduce your risk of developing unstable angina:

• Maintaining a healthy lifestyle: Eating a healthy diet, maintaining a healthy weight, exercising regularly, and not smoking can help to reduce your risk of unstable angina by improving overall cardiovascular health.
• Managing other health conditions: If you have high blood pressure, high cholesterol, or diabetes, it’s important to work with your healthcare provider to manage these conditions, as they can increase your risk of unstable angina.
• Monitoring your symptoms: Be aware of the symptoms of unstable angina and seek prompt medical attention if you experience chest pain or discomfort, shortness of breath, sweating, anxiety, or nausea.
• Medications: If you have a high risk of developing unstable angina, your healthcare provider may prescribe medications such as statins, blood thinners, and anti-platelet medications to reduce your risk.
• Monitoring your heart health: Regular check-ups with your healthcare provider can help to identify any potential risk factors for unstable angina, and to detect any early signs of heart disease.
• Managing stress: Emotional stress can trigger episodes of unstable angina. Finding ways to manage stress, such as through exercise, meditation, or therapy, can help to reduce the risk of a heart attack.

If you’ve had unstable angina, you have a higher risk of having a heart attack or another cardiac event in the future, so it’s important to continue to follow your healthcare provider’s recommendations for monitoring and treatment and to maintain a healthy lifestyle in order to prevent recurrences. 

Overall, making lifestyle changes, managing any underlying health conditions, and staying in close communication with your healthcare provider can help to reduce your risk of developing unstable angina or a subsequent heart attack.