Undertanding Unstable Angina

Grandma almost died – SEVEN times!

The attacks came with no warning. At any time of the day or night, it would hit her with uncaring abandon, leaving the hearty, cheerful old lady bent over and crippled with pain. Her face ashen and sweaty. The breath rattling wheezily through her chest.

In agony, she’d gasp for water – and her pills. I would rush to the fridge to fetch her brown colored bottle. A few moments after she placed the tiny white tablet under her tongue, she’d find blessed relief.

The uncertainty about when the next attack would come had us all on tenterhooks. We all knew she might die from one of them. That was nerve wracking.

It wasn’t until many years later that I learned about unstable angina, what causes it, and how to treat it. 

What is Unstable Angina?

Unstable angina is an acute coronary syndrome caused by reduced blood flow to heart muscle because of coronary artery obstruction or narrowing. In some cases, unstable angina can evolve into a heart attack.

Angina is chest pain or discomfort caused by reduction in coronary blood flow which results in the lack of oxygen supply to the heart. The chest pain is severe, crushing or compressive in nature, and may also be felt in the neck, jaw, left arm or upper stomach in addition to the chest.

Typically, anginal chest pain is brought on by activity or excitement, during which the heart works harder and the coronary artery obstruction makes it impossible for the oxygen supply to meet the increased demand.

Unstable angina differs from this in that it comes on suddenly and gets steadily worse. Indications of unstable angina are chest pain that:

  • feels different from previous angina
  • comes more often
  • occurs at lower activity levels, or even at rest
  • lasts longer, even for 10 to 20 minutes
  • does not respond to nitroglycerin

Because unstable angina can evolve at any time into a full-blown heart attack, it is a medical emergency that must be treated effectively and right away. Consulting a doctor is vital.

American Heart Association Signs of Heart Attack

What Causes Unstable Angina?

Like typical (or ‘stable’) angina, unstable angina also is most often caused by atherosclerosis that leads to the build up of cholesterol plaque inside coronary arteries. The narrow coronary artery delivers less blood to the heart, causing chest pain.

Unstable angina may also come from microvascular dysfunction, where the smaller branches of the coronary arteries are affected rather than the main coronary branches (called ‘Syndrome X’) or from coronary artery spasm (Prinzmetal angina).

Complications of Unstable Angina

The biggest danger of unstable angina is that it could lead to complete occlusion of blood flow to a portion of the heart muscle, resulting in a heart attack. Other complications are heart failure, and heart rhythm disturbances (arrhythmias), including potentially lethal ventricular fibrillation.

What To Do For Unstable Angina?

Given the uncertainty and risk of developing into a heart attack, unstable angina must be dealt with as a medical emergency. If there is new, unexplained chest pain or discomfort, one must consult a physician without delay. In the event of an attack of unstable angina, it is best to call for emergency medial assistance, especially if:

  • chest pain does not improve within 5 minutes of taking nitroglycerin (some physicians may recommend 3 doses in total)
  • chest pain doesn’t completely disappear after 3 doses of nitroglycerin
  • it is getting worse
  • the pain returns after initially being relieved with nitroglycerin

Whenever symptoms of angina are becoming more frequent, worse in intensity, occur at rest, or leave one feeling tired or light headed, it is likely to be turning into unstable angina and must be evaluated by a medical practitioner without undue delay.

Evaluation of Unstable Angina

A doctor will conduct a complete physical examination and then might order tests like an EKG (or ECG, electrocardiogram), echocardiogram, stress test (treadmill test), nuclear perfusion scan or coronary angiogram to identify the cause and evaluate the severity of the situation.

Depending upon the findings of this evaluation, the doctor may recommend an intervention like coronary angioplasty (PTCA) or coronary bypass surgery (CABG) to protect the heart against the deadly consequences of a heart attack or myocardial infarction.

In the meantime, medical treatment may include admission to hospital for rest, prior to further evaluation.

Nitroglycerine tablets are a first-line treatment and the mainstay of managing unstable angina. In addition, the doctor might prescribe a blood thinner like Heparin or anti-platelet aggregation drugs like Aspirin or Clopidogrel. This is to prevent the progression of unstable angina into a heart attack by making blood less ‘sticky’ and to inhibit clot formation inside the narrow coronary arteries.

Preventing Unstable Angina

Embracing a heart healthy lifestyle is the best way to prevent and avoid coronary heart disease including unstable angina. Minimizing risk factors for heart disease that are modifiable and following common sense precautions will help.

Eat healthy food, get regular exercise, quit smoking, drink in moderation, lose excess weight and avoid stress. This can help lower the probability of developing unstable angina.

In other sections of this site, we will discuss treatment options for coronary artery disease in greater detail.

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