Why Choose Cedars-Sinai Marina del Rey Hospital for Angina Treatment?
The well-trained cardiologists at Cedars-Sinai Marina del Rey Hospital will promptly evaluate your symptoms and provide the most appropriate, individualized treatment approach. Our highly skilled heart surgeons can perform complex interventions to treat coronary artery disease, the underlying cause of angina. Additionally, our specialists can guide you towards the most effective lifestyle changes and medication, which are essential in the prevention of plaque buildup in the coronary arteries.
Angina is a symptom of an underlying heart disease. The most common condition associated with angina is coronary artery disease (CAD). Angina is generally described as a squeezing type of pain or discomfort in the chest area. The pain may also radiate into the shoulders, arms, jaw, and neck. Angina occurs when a region of the heart muscle does not receive sufficient amounts of oxygenated blood. This can also lead to a heart attack.
CAD is a heart disease which typically occurs in adults when a wax-like substance known as plaque accumulates on the inner walls of the coronary arteries. The plaque deposits lead to the narrowing and stiffening of the arteries, as well as to the reduction of blood flow to the heart.
Angina may also appear as a symptom of coronary microvascular disease, a heart condition that affects the smallest coronary arteries, but not the blood flow.
Surgical Procedures Performed to Treat Angina at Cedars-Sinai Marina del Rey Hospital
Surgery is recommended for a heart disease which cannot be improved by non-invasive treatments, such as lifestyle changes or medication.
The surgical procedures which can alleviate the symptoms of CAD, including angina, are:
- Stenting: This type of surgery, also known as percutaneous coronary intervention (PCI), involves threading a flexible tube made of plastic with a small balloon attached to its tip through a blood vessel in order to reach the narrowed region of the coronary artery, which is then dilated. An alternative name for this intervention is angioplasty. Its purpose is to open up the blocked coronary artery and restore proper blood flow to the heart. Following dilation, a metal mesh tube, or stent, is positioned to keep the artery open.
- Coronary Artery Bypass Graft Surgery (CABG): This procedure involves the suturing of one end of the artery above the blockage with the other end below the region where plaque accumulated. The aim of this procedure is to create an alternative path through which blood flow will reach the heart. Portions of veins or arteries collected from the leg or chest wall will be used as bypass grafts. CABG can greatly improve blood flow to the heart, reduce chest discomfort and prevent heart attacks.
Both surgical interventions described above are also referred to as revascularization procedures, as the primary purpose of these methods is to restore proper blood flow to the heart.
Drugs and Other Treatments for Angina
The main objective of angina treatment is to relieve pain and discomfort. A doctor may also suggest additional measures, such as lifestyle changes or surgery, in order to prevent or reduce the risk of heart attack by attending to the underlying condition.
Cardiac Rehabilitation »
Enhanced External Counterpulsation »
Lifestyle Changes »
There are numerous types of angina. However, the most commonly encountered types are stable, unstable, variant (Prinzmetal’s) and microvascular angina. Each of them entail a set of specific symptoms which require appropriate treatment.
Stable Angina »
Unstable Angina »
Microvascular Angina »
Signs and Symptoms of Angina
The primary symptoms of angina include chest pain and discomfort, which is often described as squeezing, pressure, or tightness in the middle of the chest. The pain may radiate into the left arm, shoulder, neck, and jaw. Other signs and symptoms which may be associated with angina are:
Diagnosis of Angina
A doctor may order multiple tests in order to detect the cause of chest pain if unstable angina or another serious underlying heart disease is suspected. The following diagnostic tests can be undergone to properly identify angina:
- Electrocardiogram (ECG): This is a painless test which can monitor, as well as record, the electrical activity of the heart through electrodes that are attached to the chest. It can reveal signs of heart damage caused by coronary heart disease.
- Stress Testing: During this test, the patient is asked to exercise on a treadmill in order to make their heart beat faster. The activity of the heart and other related parameters will be constantly monitored. Images of the heart before and after exercising will also be obtained in order to determine if blood flow is properly reaching the heart chambers. The doctor will be able to observe potential signs of coronary disease, such as various abnormalities in heart rate, blood pressure, and heart rhythm.
- Coronary Angiography and Cardiac Catheterization: If coronary heart disease is suspected, a doctor may suggest a coronary angiography. This examination procedure is performed with the aid of a dye and special X-rays, which can reveal the inside region of the coronary arteries. Cardiac catheterization follows, during which the dye is injected into the coronary artery through a catheter (a thin, flexible tube), which is inserted into a blood vessel in the arm, neck, or groin region. Once the catheter is in place, the dye is injected. Special X-ray images will be taken as the dye flows through the coronary artery. This helps the doctor monitor the blood flow in the heart and blood vessels.
- Chest X-Ray: A chest X-ray can reveal the signs of heart failure.
- Computed Tomography Angiography (CTA): Unlike coronary angiography, this is a less invasive test which is also performed with the aid of special dyes and X-rays. During CTA, a doctor will be able to observe the blood flow in the coronary arteries. This procedure entails undergoing a CT scan while dye is injected through a needle placed into a vein in the arm. The blood vessels will thus appear highlighted on the images due to the dye. Additionally, an ECG machine will record the heart’s electrical activity through the electrode patches attached to the patient's chest during the scan.
- Blood tests: Blood tests may be requested to check the levels of cholesterol, sugar, and protein in the blood. Abnormal levels can indicate a high risk of coronary heart disease. A blood test which measures the C-reactive protein (CRP) in the blood may also be recommended. High levels of CRP imply an increased risk of coronary heart disease.
Risk Factors of Angina
The risk factors associated with angina are similar to those of coronary heart disease, since angina is often a symptom of the latter condition. Some of the factors which may increase one’s risk of developing angina include:
- High blood cholesterol
- High blood pressure
- Smoking or passive smoking
- Conditions such as diabetes or insulin resistance, metabolic syndrome, and thyroid disorders
- Lack of physical exercise or a sedentary lifestyle
- Being overweight or obese
- Gender; microvascular angina is more common in women than men. Nearly 70% of all cases occur in women at the time of menopause.
- Age; the risk for angina increases significantly after the age of 45 in men and 55 in women.
- Family history of early heart disease or personal history of stroke
- A high-fat diet
- Abnormal levels of stress
Causes of Angina
Coronary heart disease develops when the arteries supplying blood to the heart become narrow. It is often the cause of angina. Therefore, the underlying causes of angina are similar to the causes of coronary heart disease.
Underlying causes: Certain factors which cause damage to the inner lining of the coronary arteries can lead to coronary heart disease. These factors are smoking, high levels of fats and cholesterol in the blood, high blood pressure, and high amounts of blood sugar as a result of insulin resistance. Plaque can start accumulating on the region where arterial damage occurred. Gradually, the plaque deposits travel down the coronary artery or partially block blood flow to the heart muscles, causing angina. The plaque deposits may occasionally rupture and result in blood clots, which can cause a partial or complete blockage in the coronary arteries, as well as angina.
Immediate causes: There are certain factors which can induce or trigger angina, depending on the type of angina.
Stable angina: Physical activity, such as walking uphill or climbing stairs, is a common trigger for stable angina. Other factors include emotional stress, environmental conditions such as exposure to extremely hot or cold weather, contamination with heavy meals, and smoking.
Unstable angina: This type of angina is caused by the blockage of the coronary artery. The breakdown of plaque may result in blood clots which can obstruct the coronary arteries.
Variant angina: Variant angina develops due to a coronary artery spasm, which leads to the narrowing of the artery. Coronary artery spasms may occur as a result of emotional stress, cold exposure, smoking, and the use of cocaine or medicines which tighten or narrow the blood vessels.
Microvascular angina: Microvascular angina occurs as a result of a coronary microvascular disease, which affects the heart’s small coronary arteries. Blood flow may be reduced due to plaque deposits, spasms, or damage to the walls of the artery.
A wide variety of supplements have proven to be effective in reducing the risk of heart disease and its associated symptoms, such as angina. Nevertheless, the effectiveness of some supplements in alleviating angina has not been properly assessed or demonstrated yet. Therefore, it is highly recommended to consult your doctor before taking any nutritional supplements. The list below includes some dietary supplements which might be helpful in improving angina:
- L-carnitine: This amino acid can reduce angina, according to some clinical studies. However, it is important to mention that this supplement can interfere with blood thinners, such as Warfarin, and thus greatly increase the risk of seizures.
- Coenzyme Q10: Multiple studies have suggested that it promotes a healthy heart.
- L-arginine: This amino acid can increase blood flow and effort tolerance in patients who experience angina. It can also decrease blood pressure.
- Magnesium: The properties of magnesium are quite similar to those of a calcium channel blocker. It has been suggested that it can relieve chest pain that follows exercise.
Herbal remedies may interact with other medication and supplements and therefore should be taken only under the supervision of a doctor. Some of the remedies which might be efficient in the treatment of angina include:
- Hawthorn (Crataegus monogyna): This herb has been used in the treatment of heart disease for a long time. A study suggests that patients suffering from angina experienced an improved ability to exercise without pain after taking hawthorn.
- Kudzu (Pueria lobata): As a traditional Chinese remedy, kudzu has been used to treat heart disease for centuries. Various clinical studies reveal that this herb can reduce the frequency of angina episodes. But it can also produce side effects and interact with other medications.
- Suxiao Jiuxin Wan: According to a study, suxiao jiuxin wan, another Chinese natural medicine, can reduce the symptoms of heart disease, as well as the frequency of angina.
- Terminalia Arjuna: This herb is used in Ayurvedic medicine and has been demonstrated to be effective in lowering the number of angina attacks.
Homeopathic medicine may be used in conjunction with other medicine in order to reduce the risk of heart disease. However, it is essential to remember that homeopathic remedies can never replace proper treatment in the case of unstable angina. A professional homeopathic physician can assess your condition and recommend the most appropriate remedy for you.
Studies which evaluated the effectiveness of acupuncture in the treatment of angina have revealed mixed results. While some studies show that acupuncture can reduce the frequency of angina episodes and the need for nitroglycerine, others have shown no benefit at all. A Chinese study suggests that applying pressure with the fingertips on an acupuncture point located in the sternum region during a stable angina attack can effectively reduce pain. Additionally, another study discovered that acupuncture used in combination with conventional treatment can significantly improve the severity of angina attacks.
The best way to prevent angina is to adopt a healthy lifestyle and, if you already suffer from a heart condition, to seek appropriate treatment for the underlying cause of angina. You can delay the onset of angina and heart disease by making healthy choices, such as:
- Adopting a healthy diet low in saturated fats and rich in fiber, whole grains, fruits, and vegetables.
- Stop smoking and avoid exposure to secondhand smoke.
- Exercise or engage in sports for at least 30 minutes every day.
- Maintain a proper body weight for your height.
- Learn relaxation techniques or other similar methods to help you handle stress more efficiently.
Treatment of Underlying Conditions: You may delay the onset of angina by taking all the medication your doctor prescribes to you in order to control high blood pressure, high blood cholesterol, and diabetes. Your doctor may also suggest you avoid certain activities known to trigger angina.
Are you experiencing symptoms of angina or sudden chest discomfort? The cardiologists at Cedars-Sinai Marina del Rey Hospital can provide information, a comprehensive evaluation, and adequate treatment.