Angina is an important warning sign that you may be in danger of having a heart attack. It can occur in men and women of any age, but is more common among people who are middle-aged or older. It usually occurs during exercise, emotional upset or stress, exposure to cold air, or after eating a big meal. However, angina may also occur while you are relaxing or even asleep.

This website describes the causes, symptoms, diagnosis, and treatment of angina and explains its role in coronary artery disease. It also explains the risk factors for CAD, how it develops, and lifestyle changes you can make to delay its onset and, perhaps, avoid it completely.

Be sure to discuss any additional questions or concerns you might have with your doctor.

What causes an angina attack?

Although angina may occur while you are resting or sleeping, it usually occurs when increased strain is put on the heart. This is referred to as "effort angina." An attack may be brought on by climbing stairs, walking uphill, sexual intercourse, or other forms of exercise. Angina can also occur shortly after eating (particularly after a large meal), during emotional stress, or during exposure to cold weather.

The symptoms of angina

Typically, an angina attack lasts less than 5 minutes. In addition to the chest pain described earlier, other symptoms include: stomach pain that may feel like an ulcer or indigestion; nausea and sweating; light-headedness; and difficulty breathing.

How is angina diagnosed?

Your doctor will probably take your medical history and do a physical exam, paying special attention to your pulse, blood pressure, neck, heart, lungs, and abdomen. Blood and urine tests and an "electrocardiogram" or ECG, a test that records your heart rhythms, may be done. (This can show certain changes that occur when you have a coronary spasm.) You may be given a stress or treadmill ECG, which records the activity of your heart while you exercise on a stationary bike or treadmill. You may also receive a coronary "angiogram,'' a special x-ray that can show blockages in your arteries and, possibly, areas of spasm. In addition, your doctor may have you wear a small, portable ECG recorder, called a Holter monitor, when you leave the office. This will record your heart rhythms for 24 to 72 hours.

Treatment for angina and CAD

If your angina is caused by coronary artery disease, an important part of treatment will be to adopt a healthier lifestyle. This includes not smoking, reducing or eliminating saturated fats and sodium in your diet, controlling your weight, and getting regular exercise, as prescribed by your doctor. You will also need to lower your blood pressure, blood cholesterol, and blood sugar if these levels are high. Often, the pain of angina can be controlled by a medication called "nitroglycerin," which temporarily widens the coronary artery, allowing blood to flow through to the heart muscle.

CAD may be treated with medications (including daily doses of aspirin) that thin the blood to prevent clotting.

If one or two arteries are blocked, your doctor may prescribe a "balloon angioplasty," a surgical procedure in which the artery is inflated, allowing blood to flow normally.

In more serious cases, another procedure, coronary bypass surgery, may be done. This involves "bypassing" the blocked artery with grafts of arteries or veins taken from other parts of the body.

Depending on your age, the seriousness of your condition, and other health factors, your doctor will determine which type of treatment is best for you.

Risk factors for CAD

Any of the following may put you at increased risk for CAD: an inherited tendency in your family; cigarette smoking; high blood pressure; diabetes; obesity; high blood levels of fat , such as cholesterol ; and not enough physical exercise .

Things you can do to reduce your risk

• Eat a healthy diet low in cholesterol and fat and high in complex carbohydrates and fiber.
• Begin a regular exercise program under your doctor's supervision.
• Carry your medication with you and take it as directed. (Nitroglycerin, for example, can be taken before strenuous activity to prevent angina.)
• Don't smoke.
• Limit your consumption of caffeine and other stimulants
• Have your blood pressure checked regularly.
• Report new or changing symptoms to your doctor at once.
• Learn techniques to help you reduce stress and anxiety in your life, such as deep breathing and relaxation exercises.
• Have regular checkups, so you and your doctor can keep a close watch on the health of your heart.
• If you are experiencing angina, get prompt medical attention.