Angina Treatment in Delhi, India

Insufficient blood supply to the heart occurs when plaque accumulates in the blood vessels, impeding normal blood flow. This condition, known as angina, prompts the heart to compensate by beating faster and harder in an effort to restore proper blood supply.

Angina, a condition marked by chest pain, can present in various forms, each differentiated by its cause and response to rest or medication.

Stable Angina

This common type typically occurs during physical exertion and eases with rest or angina medication. For instance, chest pain triggered by walking uphill or in cold weather often falls under this category. Stable angina episodes are generally predictable, resembling past instances of chest pain, and tend to be brief, usually lasting no more than five minutes.

Unstable Angina (a medical emergency) 

Unstable angina is less predictable and can happen even at rest or with less exertion than usual. It tends to be severe, lasting longer than stable angina, often more than 20 minutes. This pain doesn't subside with rest or standard angina medication. If blood flow isn't restored, it can lead to oxygen deprivation in the heart, risking a heart attack. Unstable angina is a serious condition needing immediate medical attention.

Variant Angina (prinzmetal angina) 

Unlike the other types, variant or prinzmetal angina isn't linked to coronary artery disease. It's caused by spasms in the heart’s arteries, temporarily reducing blood flow. This type is characterised by severe chest pain, often occurring in cycles, predominantly at rest or during the night. Angina medication can relieve the pain associated with this type.

Refractory Angina

In this type, frequent episodes of angina persist despite the use of a combination of medications and lifestyle modifications.

Angina arises due to diminished oxygen supply to the heart muscle, a condition known as ischemia. The heart requires oxygen, transported via blood, to function properly. When it doesn't receive enough, it leads to distress in the heart muscle.

Coronary Artery Disease (CAD) is the most prevalent cause of this reduced blood flow. In this condition, the coronary (heart) arteries narrow due to the build-up of fatty substances known as plaques, a process referred to as atherosclerosis.

Should these plaques rupture or a blood clot develop, they can swiftly obstruct or diminish flow through an already narrow artery, significantly reducing the oxygen supply to the heart muscle.

Under conditions of low oxygen demand, like during rest, the heart muscle might manage to function with this reduced blood flow without causing angina symptoms. However, during more oxygen-intensive activities, like exercise, the increased demand can lead to angina.

Several factors can elevate the likelihood of experiencing angina:

• Age: Angina typically affects older adults, particularly those aged 60 and above.
• Family history: If your parents, siblings, or children have a history of heart disease or heart attacks, it's important to inform your healthcare provider.
• Tobacco usage: Smoking, chewing tobacco, or prolonged exposure to second-hand smoke can harm artery linings, leading to cholesterol deposits and restricted blood flow.
• Diabetes: This condition heightens the risk of coronary artery disease, which can cause angina and heart attacks by accelerating atherosclerosis and raising cholesterol levels.
• High blood pressure: Chronic hypertension can lead to arterial damage, hastening the hardening of the arteries.
• Elevated cholesterol or triglycerides: High levels of bad cholesterol (LDL) in the blood can narrow arteries, increasing the risk of angina and heart attacks. High triglyceride levels are also detrimental.
• Other medical conditions: The presence of chronic kidney disease, peripheral artery disease, metabolic syndrome, or a history of stroke increases the risk of developing angina.
• Sedentary lifestyle: Lack of physical activity can lead to high cholesterol, hypertension, type 2 diabetes, and obesity. It's beneficial to discuss appropriate exercise types and levels with your healthcare provider.
• Obesity:Excess weight strains the heart and contributes to heart disease, potentially causing angina.
• Emotional stress: High levels of stress and anger can spike blood pressure. Hormonal surges during stress can constrict arteries and exacerbate angina.
• Certain medications: Some drugs, like those for migraines, that constrict blood vessels can trigger Prinzmetal's angina.
• Drug abuse: Using stimulants like cocaine can cause spasms in blood vessels, leading to angina.

Angina is characterised by discomfort and chest pain, which may manifest as:

• A sensation of burning
• A feeling of fullness
• The experience of pressure
• A squeezing sensation
• Additionally, this pain can extend to the arms, neck, jaw, shoulder, or back.

Other indications of angina encompass:

• Dizziness
• Tiredness
• Nausea
• Breathlessness
• Perspiration

The intensity, duration, and kind of angina can differ. The emergence of new symptoms or changes in existing ones could indicate a more severe form of angina (unstable angina) or a heart attack.

It's crucial to seek an immediate medical evaluation for any new or intensified symptoms of angina. A healthcare professional can assess whether the angina is stable or unstable.

Angina in women

Angina symptoms in women can vary from the traditional signs, potentially causing delays in pursuing treatment. While chest pain is a frequent symptom for women experiencing angina, it might not always be the primary or most common symptom. Women may also encounter symptoms like:

• Discomfort in the neck, jaw, teeth, or back
• Nausea
• Difficulty breathing
• Sharp pain rather than the typical chest pressure
• Pain in the stomach area

People who experience these symptoms must visit a heart hospital and seek medical assistance to avoid further complications. It must be noted that the severity of angina can be different in different people. Hence, getting it diagnosed is the best step one can take to identify the underlying issue.

To diagnose angina, your cardiologist will conduct a physical examination and inquire about your symptoms and any risk factors, including a family history of heart disease.

Various tests are employed to diagnose and confirm angina:

Electrocardiogram (ECG or EKG)

This swift, painless test records the heart's electrical activity. Electrodes attached to the chest, and sometimes limbs, connect to a computer, displaying the heart's rhythm. It can reveal abnormalities in the heart rate or patterns indicating impaired blood flow.

Chest X-ray

This test provides images of the heart and lungs, helping to identify if other conditions are causing chest pain or if the heart is enlarged.

Blood tests 

These tests detect specific enzymes that are released into the bloodstream when the heart muscle suffers damage, such as from a heart attack.

Stress test 

Often, angina is more detectable when the heart is under stress. This test usually involves physical activity, like walking on a treadmill, while the heart is monitored. For those unable to exercise, a medication that simulates exercise's effect on the heart may be used.

Echocardiogram 

Utilising sound waves, this test creates heart motion images, showing blood flow patterns within the heart. It's sometimes performed during a stress test.

Nuclear stress test 

Similar to a standard stress test, this version involves injecting a radioactive tracer into the bloodstream. A special scanner tracks how the tracer circulates through heart arteries, highlighting areas with poor blood flow.

Cardiac CT 

You lie inside a doughnut-shaped machine that uses an X-ray tube to capture heart and chest images. It can reveal heart enlargement or narrowed heart arteries.

Cardiac MRI 

This test, using magnetic fields and radio waves, generates detailed images of the heart. You lie inside a tubelike machine for these images.

Coronary angiography 

Part of cardiac catheterization, this procedure involves threading a catheter through a blood vessel to the heart arteries and injecting dye. The dye enhances the visibility of heart arteries on an X-ray, known as an angiogram.

The primary objectives of angina treatment are to lessen symptom frequency and severity and to reduce the risks of heart attack and death. Immediate treatment is necessary for unstable angina or angina that deviates from normal patterns.

Medications for Angina

• Nitrates: Used to dilate blood vessels, increasing blood flow to the heart. Nitroglycerin, placed under the tongue, is a common example, often used preventatively before activities like exercise.
• Aspirin: Helps in reducing blood clotting, improving blood flow, and lowering heart attack risk. Consult a cardiologist before starting regular aspirin use.
• Clot-preventing drugs: Medications like clopidogrel, prasugrel, and ticagrelor prevent blood platelets from clumping, reducing clot formation, especially for those who can't take aspirin.
• Beta blockers: These reduce heart rate and blood pressure, enhancing blood flow.
• Statins: Lower cholesterol levels to prevent blood vessel blockages.
• Calcium channel blockers: Relax and widen blood vessels for better blood flow.
• Other blood pressure medications:This includes ACE inhibitors or ARBs, particularly for those with high blood pressure, diabetes, heart failure signs, or chronic kidney disease.
• Ranolazine: For chronic stable angina unresponsive to other treatments; can be used alone or with other medications.

Therapies

• Enhanced External Counterpulsation (EECP): A non-drug option for increasing heart blood flow, involving pressure cuffs on the lower body. Beneficial for frequent, uncontrolled angina.

Surgical and procedural interventions

• Angioplasty with stenting (Percutaneous Coronary Intervention, PCI): Involves inserting a balloon to widen the artery, followed by placing a stent to keep it open. It's effective for unstable angina or chronic stable angina not responsive to other treatments.
• Coronary artery bypass surgery: A vein or artery is used to create a bypass around a blocked heart artery. Suitable for both unstable angina and stable angina unresponsive to other treatments.

Max Hospitals stands as a premier choice for angina treatments in Delhi, providing unparalleled healthcare services. Here's why Max Hospitals is a top destination for angina care:

World-Class Medical Expertise 

At the heart of Max Hospitals is a team of seasoned cardiologists and medical professionals specialising in Angina treatment. With a proven track record of successful interventions, they offer deep expertise and commitment, ensuring patients receive the best possible care for their heart health.

Comprehensive Patient Care 

Understanding that dealing with angina is both a physical and emotional journey, Max Hospitals offers holistic care. This encompasses everything from initial consultations and programs focusing on heart health management to continuous support after treatment. Patients and their families are supported by a compassionate and attentive team throughout their journey.

Reputation and Trust 

Max Hospitals has established a reputation for excellence in cardiac care, becoming a trusted name for angina treatment in Delhi and beyond. Our consistent results and patient-first approach have garnered the trust of patients seeking heart health solutions and the wider medical community.

Accessibility

With strategic locations across India, Max Hospitals ensures that top-quality angina care is readily accessible. Our branches in major cities offer a beacon of hope for many individuals seeking expert treatment for angina.

Choosing Max Hospitals for Angina means opting for a path of recovery backed by exceptional medical expertise, advanced technology, and dedicated patient care.

How is angina different from a heart attack?

Angina is a symptom of coronary artery disease characterised by chest pain due to reduced blood flow to the heart. It's typically triggered by physical exertion or stress and relieved by rest. A heart attack occurs when blood flow to a part of the heart is completely blocked, causing permanent damage to the heart muscle. Unlike angina, the symptoms of a heart attack are more severe, last longer, and do not improve with rest or nitroglycerin.

What measures can be taken to prevent angina?

Preventative measures include maintaining a healthy weight, eating a balanced diet, exercising regularly, managing stress, avoiding tobacco, controlling conditions like hypertension, diabetes, and high cholesterol, and following any treatment plans prescribed by your healthcare provider.

Can angina be naturally healed or managed?

While angina can't always be "healed" naturally, its symptoms and underlying causes can often be effectively managed through lifestyle changes like diet, exercise, and stress management. In some cases, these natural approaches can significantly improve heart health and reduce angina episodes. However, medical treatment may still be necessary.

What are the typical sensations associated with angina?

Common sensations include chest pain or discomfort, often described as pressure, squeezing, fullness, or pain. This discomfort can also spread to the arms, neck, jaw, shoulder, or back.

How should one take care of angina symptoms?

If you experience angina, stop and rest. Use prescribed nitroglycerin if advised by your healthcare provider. Monitor the pattern and severity of symptoms. If they're new, worsening, or don't improve with rest and medication, seek immediate medical attention as it may indicate a heart attack.

Can regular walking help in alleviating angina?

Yes, regular walking can improve cardiovascular health and endurance, potentially reducing angina episodes. However, it should be done within the limits prescribed by a healthcare professional, especially if you have chronic angina.

What is the expected heart rate during an episode of angina?

During angina, the heart rate may increase due to the heart working harder to supply oxygen to the body. However, the exact response can vary depending on individual health and the severity of the episode. Monitoring by a medical professional is essential.

Is there a permanent treatment for angina?

While there's no one-size-fits-all "permanent" cure, treatments like lifestyle changes, medications, and certain procedures (e.g., angioplasty, stenting, bypass surgery) can effectively manage symptoms and address underlying issues, significantly improving quality of life and reducing risks.

Is troponin elevated in individuals with stable angina?

In stable angina, troponin levels are typically not elevated because the heart muscle isn't suffering from prolonged lack of oxygen, which would cause damage. Troponin is a marker of heart muscle injury and is more likely to be elevated in heart attacks or unstable angina.

Reviewed by Dr. (Col.) Manjinder Sandhu, Principal Director - Cardiology, Cardiac Sciences, Interventional Cardiology, Cardiac Electrophysiology-Pacemaker on 15-Feb-2024.