Dr Aidin Rawshani

All about coronary artery disease and angina pectoris


The human heart is an outstanding muscle. The heart works around the clock to pump blood through all the organs of the body. Since the heart is a working muscle, the heart needs oxygen (oxygen), which is contained in blood.

The heart receives blood through the coronary arteries, which are the heart’s own blood vessels. Like any other blood vessel in the body, coronary arteries can suffer from atherosclerosis, which means that fat and immune cells accumulate inside the wall of the blood vessel. Such an accumulation of fat and cells in the vascular wall causes it to become crowded in the vessel.

A narrowed vessel leads to worse blood flow through the vessel. If the accumulation (atherosclerosis) becomes very pronounced, then the heart muscle may suffer from a lack of oxygen and this manifests itself in the form of angina pectoris. The medical term for angina is angina pectoris, which means chest pain. Angina manifests itself as an unpleasant pain in the chest. This feels like a pressing, dull, firming discomfort over the chest. The pain is usually most pronounced on the left side of the chest and can also radiate into the left arm, up towards the jaws and it is common to have shortness of breath (you become tongue breathed) in connection with this. Sometimes the pain radiates into the back. In some cases, angina can be manifested by pains located in the upper abdomen.

People with diabetes have 2 to 5 times increased risk of coronary heart disease. Today, effective methods of treatment are available at all stages of coronary heart disease and the prognosis is favorable for most people.

Hundreds of thousands of Swedes have coronary heart disease and a significant proportion of all of them have angina pectoris. However, one can have coronary heart disease without having angina. In fact, atherosclerosis affects the majority of all people, especially people with hypertension, type 1 diabetes, type 2 diabetes, high cholesterol (LDL cholesterol), as well as smokers.

Angina is a manifestation of a relatively serious disease, since coronary heart disease can cause a heart attack, which in turn can lead to serious complications or, in the worst case, death.

Different types of angina pectoris

Stable angina pectoris (stable angina pectoris) means that you have angina that is relatively unchanged over time. The condition is stable in the sense that you usually get chest pain during physical activity and the pain is quickly relieved when activity ceases or when using nitroglycerin (which the doctor prescribes). This is classical angina and it is therefore characterized by pressing, dull chest pain during physical activity and the pain decreases when the activity ceases. This angina is caused by atherosclerosis of one or more coronary arteries.

Stable angina comes with physical exertion and ceases at rest. If the chest pain does not cease after 10 minutes of rest, you should call 112, because there may be a heart attack.

There are additional variants of chest pain that are due to heart disease:

  • Acute myocardial infarction (acute coronary syndrome) – this condition is also caused by atherosclerosis of the coronary arteries. The difference between acute myocardial infarction and stable angina is that a heart attack occurs if the atherosclerosis breaks and a blood clot is formed that closes all blood flow. When all the blood flow is shut down, part of the heart muscle does not receive oxygen, and that part of the heart muscle dies. This is the source of a heart attack, or in medical language myocardial infarction.
  • Prinzmetal angina – this condition rarely leads to a heart attack. It affects women more often and chest pain is caused by spontaneous narrowing of the coronary arteries, leading to poor blood flow. The forecast is very good.

As mentioned above, ordinary angina occurs when physical exertion, i.e. when the heart is working hard. This is because physical exertion increases the load on the heart muscle and if there are constrictions (atherosclerosis) in the blood vessels, oxygen starvation can occur in the heart muscle. Stable angina ceases when interrupting the effort. Sometimes angina can persist for up to 10 minutes. If you have angina for more than 10 minutes at rest, you should suspect that you have a heart attack, and therefore call 112.

How to diagnose angina pectoris

A skilled doctor can make the diagnosis only by interviewing you. Symptoms of angina are quite typical and a thorough interview and clinical examination can make the diagnosis. However, blood tests, X-ray examinations, ECG, work tests and possibly look directly at the coronary arteries with angiography (coronary angiography) are also prescribed. With an ultrasound examination of the heart (echocardiography), one can obtain a detailed picture of the heart and its function.

Symptoms of stable angina pectoris

  • Chest pain is localized across the chest, often with pulling to the left.
  • The chest pain is felt as a diffuse, dull, pressing discomfort.
  • The chest pain usually comes at physical exertion or mental stress. In both of these situations increases the load on the heart.
  • The pain can radiate to the left arm, back or jaws.
  • The pain is wound by using nitroglycerin.
  • The pain usually ceases within 5 minutes after the effort ceased.
  • Dizziness or fainting – this arises if angina pectoris leads to Rhythm disorders.
  • Nausea
  • Distressed breathing
  • Sweating (cold sweats)

When the angina has become unstable

Angina whose character has changed over the past 30 days is classified as unstable if the chest pains are more easily triggered, more severe or prolonged, or if they are not remediable with nitroglycerin. Unstable angina is an acute condition that requires calling 112. Unstable angina is called unstable angina pectoris in medical language. Approximately half of all those who suffer from unstable angina pectoris develop a heart attack if they do not receive treatment.

In unstable angina, you can have pain even at rest and then the condition is acute. Nitroglycerin usually does not remedy the pain altogether, although it can alleviate to some extent.

Atypical angina

Atypical angina, also called Prinzmetal’s angina, is rare. This type of angina occurs if the vessels of the heart contract spontaneously. Then angina can occur even at rest and it is common for it to come under stress. Symptoms of Prinzmetal’s angina cannot be distinguished from those of usual stable angina.

Risk factors for the development of coronary heart disease and angina

  • Age – Vascular fat increases with age.
  • High cholesterol – High levels of LDL cholesterol increases the risk of a heart attack. The fact is that LDL cholesterol is fundamental for developing coronary heart disease.
  • Genetics – Some hereditary predisposition increases the risk of a heart attack.
  • Occupation – A wide range of professional categories have an increased risk of coronary heart disease. Occupations where you are exposed to air pollution, smoking, sedentary, etc., increase the risk.
  • Lifestyle – sedentary, unhealthy food, etc., can increase the risk of coronary heart disease. Fruits and green are considered to reduce the risk of coronary heart disease.
  • Male sex – Men are at increased risk of coronary heart disease.
  • Alcohol – A low intake of alcohol is considered to increase the risk of coronary heart disease. People who drink moderate amounts of alcohol have a lower risk, compared to those who do not drink at all.
  • High blood pressure increases the risk of coronary heart disease.
  • Diabetes in all its forms increases the risk of coronary heart disease.
  • Air pollution in the form of particle pollution increases the risk of Ischemic heart disease.
  • Psychosocial stress – high stress level increases the risk of coronary heart disease.

LDL cholesterol occupies a special position. Today it is considered that LDL cholesterol is fundamental for the development of coronary heart disease. Other risk factors are considered to accelerate the course of the disease.

Statins, which are cholesterol-lowering drugs, work by lowering LDL cholesterol. Statins reduce the risk of coronary heart disease and heart attack. Today it is considered that all people who have diabetes and have reached the age of 40 should use statins.

Situations when angina is more easily triggered

Anyone who has angina may suffer more pronounced symptoms in the following situations:

  • Anemia (anemia)
  • High pulse (tachycardia)
  • Structural heart diseases (cardiomyopathy)
  • Heart failure
  • Valve disease
  • High blood pressure
  • Low blood pressure

Treatment of angina pectoris (angina pectoris)

Your doctor will recommend lifestyle changes with increased physical activity, more fruit and green, weight loss, smoking cessation (quit smoking) and stress management. If you use drugs, this should stop immediately, as several types of drugs significantly increase the risk of a heart attack. DASH diet is considered favorable in coronary heart disease.

High blood pressure should be treated with antihypertensive drugs. Effective antihypertensive drugs are ACE inhibitors (angiotensin-converting enzyme inhibitor) and ARB (angiotensin receptor blockers).

In principle, all should be treated with statins (cholesterol-lowering drugs).

If you have coronary heart disease (which includes people who have had a heart attack), you should eat blood thinners such as acetylsalicylic acid (Asipirin), clopidogrel (Plavix) or ticagrelol (Brilique). Blood-thinning reduces the risk of a heart attack because they prevent blood clots. Unfortunately, all blood-thinning causes an increased risk of severe bleeding in the brain and stomach.

Beta-blockers are considered to have a protective effect on the heart and are used by most people. Beta-blockers lower the pulse, thereby reducing the load of the heart, thereby relieving angina. One can obtain the same effect of so-called calcium channel blockers.

Nitrates (nitroglycerin) can widen the blood vessels of the heart, allowing more blood to flow to the heart. Nitrates also expand the veins, causing less blood to flow back to the heart, thereby reducing the burden on the heart. Nitrates are available in the form of tablets and sprays. These relieve angina quickly. Long-acting nitrates are available as tablets (Imdur) or skin patches.

Complications of angina

Heart rhythm disturbances – atrial fibrillation, ventricular tachycardia, etc. Myocardial muscle disease (cardiomyopathy) Sudden cardiac arrest Heart attack Valve disease (especially mitral insufficiency).

Before your visit to the doctor

If you are going to see a doctor/nurse to investigate if you have angina, you should consider the following questions and clarify it to the doctor/nurse:

How long does the pain or discomfort last? How often does the pain occur? How severe is the pain or discomfort? What brings pain or discomfort, and what makes it better? Where do you feel pain or discomfort? How does the pain or discomfort feel? Have symptoms changed and if so, in what way?

Your doctor/nurse will also need information about risk factors for coronary heart disease and other medical conditions. Even if your chest pain is not angina, it can still be a symptom of a serious ailment, and therefore require examination.

Your doctor may prescribe some of the following tests and examinations

A blood test to check the level of special cardiac markers (troponins and NT-proBNP). Cardiac markers can help doctors distinguish unstable angina, heart attacks, and heart failure. Your doctor can also control the levels of certain fats, cholesterol, sugar and proteins in the blood.

  • X-ray of the chest to look for lung diseases and other causes of chest pain that are not related to angina pectoris. One chest X-ray alone is not enough to diagnose angina or ischemic heart disease, but it can help exclude other causes.
  • Angiography to examine blood flow in the coronary arteries. This test can quickly diagnose ischemic heart disease as the cause of chest pain and help your doctor determine if an intervention to improve blood flow will benefit your future health.

If you are diagnosed with angina, your doctor will prescribe fast-acting medicines you can take to control your angina and ease the pain. Often, other drugs are also prescribed to help control angina in the long term. The choice of medicines may depend on what kind of angina you have.

Other treatment options for angina (angina)

Morphine is used in very pronounced angina. Morphine is pain relieving. In acute myocardial infarction and in very pronounced coronary artery disease, revascularization is needed, which involves either surgery of the coronary arteries or undergoing a so-called balloon burst.

Operation of the coronary arteries

Coronary artery surgery (CABG) involves reconnecting blood vessels in the heart and disconnecting past the constriction. This can give very good results. Coronary artery surgery is called CABG (Coronary Artery Bypass Grafting).


Balloon blasting, known in medical language as PCI (Percutaneous Coronary Intervention), involves inserting a small catheter into the coronary artery and widening (by means of an inflatable balloon) the constriction. In most cases, placing a metal mesh (so-called stent) in the coronary artery to keep it open.

All those who have coronary heart disease are regularly monitored via the health center, medical clinic or cardiac clinic. An individual care plan is always drawn up to optimize your quality of life and prognosis.

Do not forget

  • Ask your doctor/nurse if you really have been given all the medicines you should have! If you are concerned about being physically active, you should discuss this with your doctor.
  • Ask your doctor about sex life and other things related to your quality of life. The care is for you and you must dare to ask all the questions.
  • Ask if your diabetes can be optimized in any way.
  • Ask if you should get vaccinations, for example, for influenza or pneumococcus.
  • Ask what target values you should achieve regarding blood pressure, cholesterol, blood sugar, etc.

Before you start any training program, ask your doctor about what level of physical activity is right for you. Slow down or take breaks if physical exertion triggers angina. If emotional stress triggers your angina, try to avoid situations that make you upset or stressed. Smoking can damage and contract blood vessels, exacerbate angina and increase the risk of life-threatening complications.

Most people who have stable angina can continue their normal activities. This includes work, hobbies and sexual relations. Learn how much physical effort is required to trigger your angina so that you can try to stop and rest before the chest pain begins. Learn to reduce and cope with stress. Try to avoid or limit situations that cause anger, arguments and anxieties. Exercise and relaxation can help relieve stress. Alcohol and drug addiction cause stress.

Avoid exposure to very hot or cold environments, as extreme temperatures burden the heart. Eat smaller meals if large meals lead to chest pain.

Tell your doctor immediately if your symptoms worsen.

Regular checks

Blood pressure checks to ensure that your blood pressure is not too high. ECG can be recorded annually and should always be recorded in case of suspicion of a heart attack. Annual control of blood sugar if you do not have diabetes.Frequent controls of blood sugar if you have diabetes.Annual control of cholesterol.

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