ANNOUNCER: Angina affects over 6 million Americans. It most often is described as pain or discomfort in the chest. But why does it happen? And what exactly is angina?
ROBERT S. SCHWARTZ, MD, FACC: Angina pectoris is the name for chest pain that's caused by the heart when it lacks blood. The most frequent cause is plaque that builds up inside the arteries of people's heart, and when that happens, it stops blood flowing into the heart. The heart is a muscle. The heart needs blood. And when it doesn't get blood, that lack of blood is manifested as chest pain, chest pain called angina pectoris, or, for short, angina.
GEORGE A. BELLER, MD, MACC: When there is a blockage, there is an impairment of blood flow through that blockage to the heart muscle, particularly under situations like exercise stress, where the heart needs more oxygen, and the only way it gets more oxygen is by getting more blood flow. And if there is an impediment to the blood flow, then there is a sensation of chest pain. It's the body's way of warning the person that there's not enough blood getting to the heart muscle, and that's actually what is angina.
ANNOUNCER: Although chest pain is common, it's not the only sensation a person with angina will experience.
ROBERT S. SCHWARTZ, MD, FACC: Angina can manifest itself as many things other than pain. Most common, patients refer to their pain as a pressure, or a band-like sensation, or "an elephant sitting on my chest that makes me short of breath." Sometimes it presents as a heartburn or a burning sensation in the chest, and not really a true pain per se. Other times it will present as something strange, such as an arm pain or a neck pain or a jaw pain.
ERIC L. MICHELSON, MD, FACC: The manifestations of angina, the symptoms that patients have, because angina is a symptom, vary widely from patient to patient and are interestingly, even the differences between what men and women may typically characterize as being their angina discomfort. Women, for example, may typically have either a feeling of discomfort in their abdomen, GI distress, indigestion, feeling dizzy, feeling shortness of breath, whereas for men it's just a little bit more typical for them to have that sort of squeezing feeling in their chest.
It's often a more vague discomfort in both men and women, but for men it's particularly more of that sort of fist in the chest discomfort, a little less typically for women.
SPENCER B. KING, MD, MACC: Sometimes it's a mild discomfort. Sometimes it's an excruciating pain. Sometimes it's a feeling of impending doom, that something terrible is going to happen. But it's a quite variable feeling.
The most important thing in recognizing angina is for patients or people to understand that if they have a feeling in the chest, arm, neck that is totally different from anything they've felt before, that they should pay attention to that. This could be a manifestation of angina.
ANNOUNCER: For some people, angina is very predictable but for others, it can appear with no warning
GEORGE A. BELLER, MD, MACC: The two types of angina that are described are stable angina, where the chest pain is predictable, like somebody walks from a parking garage, up a hill or up a bunch of steps, and every time they reach the tenth step or so they start feeling this pressure, and they will either stop or take a nitroglycerin, which is the major medication to stop the angina pain.
Unstable angina is when all of a sudden the patient starts to experience discomfort without any provocation. It can occur at rest. Or with very minimal exertion and not go right away when you stop your exercise or take a nitroglycerin. And it can come on repetitively, more frequently and more severe, and that is a warning to get right to the hospital, because the blockage has gotten suddenly worse.
ROBERT S. SCHWARTZ, MD, FACC: Typically, when these pains or these sensations come on with activity or with exertion, it's important to get in to your doctor very rapidly, because this could mean that the arteries to the heart are developing plaque and are narrowed and that the heart is lacking blood during those times that the sensation occurs.