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Patient Information on Angina

Angina pectoris (angina) is a recurring discomfort, ache or pain which can be experienced anywhere from the waist up. Angina is often referred to as chest pain — but please be aware this is not always the case. It is often more of a discomfort. A lot of people can and do experience chest pain — but their angina signs and symptoms can also be felt in different areas from the waist up other than the chest.

REMEMBER THAT NOT ALL ANGINA IS PAINFUL AND NOT ALL CHEST PAIN IS ANGINA. Angina signs and symptoms can be experiences in the chest area, both arms, neck and/or jaw (wither side of the neck, jaw, or both sides at the same time), between the shoulder blades or abdomen.

REMEMBER, YOUR ANGINA CAN FEEL VERY DIFFERENT FROM HOW ANOTHER PERSON FEELS ANGINA — please read on to learn more about angina and how often people relate their angina signs and symptoms to something else! Please try and learn to refer to your angina signs and symptoms as angina. Then describe how you experience your angina to your nurse and doctor. Angina is not just chest pain.

  • The heart is a muscle that, like other muscles in your body, needs a regular supply of blood and oxygen.
  • Angina is caused by the buildup of fat and other materials in the arteries of your heart. These materials narrow your arteries and make it harder for the heart to get its supply of blood and oxygen.
  • Angina does not necessarily mean that damage to the heart muscle is in process, although it may be very painful or uncomfortable.
  • Angina may present itself in such forms as: 
  1. Chest discomfort, often described as feeling like:
    - squeezing
    - tightness
    - pressure
    - burning
    - heaviness
    - aching
  2. Arm discomfort — can be felt in left or right or both may start in the shoulders, or may start in elbows. Often described as aching (you may think it is arthritis).
    fingers and/or forearm may go numb and tingly, or feel heavy.
  3. Neck and/or jaw discomfort — may feel like a toothache or jaw ache.
  4. Discomfort between the shoulder blades in the back, may spread into base of neck.
  5. Abdominal discomfort — often feels like indigestion or heartburn.
  6. Shortness of breath.

Symptoms of Women and Heart Disease

We also inform women that they can experience the same classic signs and symptoms of angina the same way men do. However, women do not always feel warning signs of heart disease the same way men do. Angina or a feeling of pressure may come and go. And it may occur in the upper abdomen rather then in the center of the chest. A woman may also have trouble breathing or feel weak or tired when doing something that used to be easy. Or she may have heartburn or nausea that does not seem related to anything she has eaten. After a confirmed diagnosis of coronary artery disease, we instruct women if they feel any of these signs and symptoms to follow the nitroglycerin spray/tab protocol.

Activities that may bring on Angina:

  • Eating — especially large meals or eating very quickly.
  • Exertion — sudden bursts of exertion or doing more than your body is used to.
  • Emotions — any emotion can make your heart work harder.
  • Exposure to extremes in temperature — either hot or cold.
  • Smoking

Is all chest discomfort, aches or pains from the waist up Angina?

No, not at all. Not all chest discomfort, aches or pains from the waist up is angina. For example, if the discomfort, aches or pains lasts less then 60 seconds or if it goes away during a deep breath, after drinking a glass of water, or by changing position, it almost certainly is NOT angina and should not cause concern.


How to treat Angina:

Step 1) STOP — whatever you are doing **immediately**

Step 2) REST — sit or lie down, if discomfort continues or is not relieved within 30-60 seconds.

Step 3) TAKE NITRO — if you have nitro, you may take one spray (or one tablet) under the tongue, every 3 to 5 minutes **to a maximum of 3 times** IF YOU HAVE TAKEN 3 NITRO WITHIN 10-15 MINUTES WITHOUT RELIEF THEN YOU SHOULD CALL AN AMBULANCE, AND GO TO THE NEAREST HOSPITAL IMMEDIATELY. TIME IS CRUCIAL! You can continue to use your nitro spray/tablets every 5 minutes until the ambulance arrives. Quick action is all the more important because OF ADVANCES IN THROMBOLYTIC THERAPY "CLOTBUSTER". This is a treatment that uses drugs to try to limit damage to the heart, but dissolving clots. It's considered a genuine breakthrough, but it's useless if a person who's having a heart attack decided not to "bother anyone" by calling for an ambulance, and simply stays at home. THAT LACK OF ACTION CAN BE FATAL!

How to live with Angina:

  1. Notice what kind of activities bring on your angina and avoid them — if possible. If it can't be avoided then take nitro before the activity of when you have the first feeling of discomfort.
  2. Extreme cold may bring on angina — cover your nose and mouth with a scarf if you must go out when it is very cold. In the summer try to avoid hard activities in the hottest part of the day i.e. gardening, mowing grass, etc.
  3. Try to avoid emotional upsets if possible — when this is not possible take nitro if needed at these times. Practice relaxation exercises. DO NOT insist on doing everything yourself. Try to let other help you with your work. Cut down on hectic pressures, deadlines and overcrowded schedules. Practice energy conservation. Delegate when possible.
  4. Adopt good eating habits — digestion, like exercise makes the heart work harder, heavy meals place a strain on the heart. Eat slower. Take lighter meals, especially at night and rest after eating. Lose weight if advisable — angina lessens if weight is reduced to a normal level.
  5. STOP SMOKING

Can a person with Angina exercise?

Yes. It is very important to work with your family doctor or cardiac rehabilitation program to develop an exercise plan. Exercise may increase the level of pain free activity, relieve stress, improve the heart's blood supply, and help control weight. A person with angina should start an exercise program only with the doctor's advice. Many doctors tell angina patients to gradually build up their fitness level — for example, start with a 5-minute walk and increase over weeks or months to 30-60 minutes. The idea is to gradually increase stamina by working at a steady pace, but avoiding sudden burst of effort.

You should see your doctor if the angina becomes:

  • More frequent
  • Occurs with less activity
  • Changes its usual pattern
  • Occurs at rest
  • More severe
  • Lasts longer

NOTE: If you have angina PLUS:

  • Sudden sweating or
  • Nausea and/or vomiting or
  • Severe shortness of breath or
  • Generalized feeling of weakness or
  • You have tried 3 nitro within 10-15 minutes without relief

THEN assume this to be a heart attack and get to the nearest hospital immediately —call the ambulance — DO NOT drive yourself!!

Tips on Nitroglycerin:

  • Sit or recline when taking nitro if possible as it can make you feel dizzy or lightheaded.
  • If nitro has been prescribed for you be sure to carry it all times. It doesn't do you any good if it is at home and you are not, when you need it.
  • Do not leave the cotton in the bottle of nitro tablets after opening it.
  • NITRO PILLS ARE GOOD FOR ONLY 3 MONTHS FROM THE DATE THAT YOU OPEN THE BOTTLE. Nitro spray is good for up to 2 years from the date of purchase as long as you check the expiry date on the canister.
  • Nitro pump spray needs to be primed before first use with 3 sprays. Repriming with one spray in necessary when your Nitro pump spray has not been used for 14 days or more.
  • Do not swallow or chew the pills, only put them under your tongue as prescribed.
  • Remember that nitro is not addictive and will not hurt you, SO DON'T BE AFRAID TO USE IT EVEN IF YOU ARE NOT SURE THAT THIS IS ANGINA. It may give you a headache due to the way it works, but the headache usually becomes less severe with usage.

Nitro is very quick acting — within 20-30 seconds, and you may feel a tingling burning feeling under your tongue when you take it. It's effects only last about 20-30 minutes, so don't wait more than 5 minutes between doses.

  1. DEALING WITH MEDICAL EMERGENCIES — DEVELOP YOUR OWN PLAN.
    Take this opportunity to consider how well prepared you and your family are for possible medical emergencies, and for travel emergencies (be aware of travel restrictions for people who have been diagnosed with a recent medical condition). Consider these steps for your own heart care program.
  2. KNOW YOUR MEDICATIONS
    Be sure to use a journal to keep track of medication(s) that have been prescribed for you. Know the names, dosages, how often you are to take your medication(s), why you are taking them , and times you are to take them. Remember to update your medication journal as required. Listing new medication(s) — discontinue medication(s) remove from journal. Keep an up to date list in your wallet.
  3. GET PREPARED FOR EMERGENCIES
    Make a point of getting better prepared to cope with medical emergencies. Do you and your family know the numbers to call? Do you know which hospital with emergency facilities is closest to your home, your work, or your travel? What about hospital types and locations once your doctor has allowed you to travel again? When will you be covered once again with travel medical insurance? Take some time to discuss these matters with your partner or other family members.

An example emergency plan:

REMEMBER to act quickly in an emergency, you must be prepared ahead of time

  1. Keep emergency numbers by the phone
  2. Write down your own address and closest cross street
  3. Keep the phone near by
  4. Carry your nitroglycerin spray/tabs with you all the time!

These are just some simple tips to have prepared in case of an emergency – you or a family member might be so flustered that even the simplest things are forgotten.

LEARN ABOUT CPR

A course in cardiopulmonary resuscitation can be a wise investment, and literally a lifesaver. The Heart and Stroke Foundation in your province, or the St. John Ambulance, can tell you where CPR courses are offered in your community.

Disclaimer
Reviewed by Alberta clinical experts. Brought to you by HealthLink Alberta. Copyright.
This material is designed for information purposes only. It should not be used in place of medical advice, instruction and/or treatment. For more health advice call Capital Health Link at 780-408-LINK (5465) 24 hours a day, seven days a week. In Alberta, call Toll-free: 1-866-408-LINK (5465)

 

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