A tightening or crushing sensation in the chest is often dismissed as fatigue or stress. But when such pain recurs, it may be a warning signal from the heart. In particular, if chest pain develops while climbing stairs or walking briskly and subsides with rest, angina should be suspected.
Angina is a condition in which the coronary arteries supplying blood to the heart become narrowed, preventing the heart from receiving the blood flow it needs. Unlike myocardial infarction, in which a vessel is completely blocked and heart muscle becomes necrotic, angina is characterized by symptoms that typically appear only during activity, such as climbing stairs.
On Seoul Economic Daily TV's "Now, the Master Doctor," airing at 9:30 p.m. on the 16th, Dr. Jang Deok-hyun, head of the Department of Cardiology at Sejong Hospital, will discuss the symptoms, diagnosis and treatment of angina, as well as lifestyle guidelines to prevent recurrence.
◇ Recurring Chest Pain When Climbing Stairs Signals Angina
The most important feature of angina is "recurring pain during activity."
While there is no pain at rest, pain develops when the heart needs more blood flow, such as when climbing stairs or walking quickly. Angina is also highly reproducible. If chest pain occurred yesterday while climbing two flights of stairs, similar pain is likely to recur in similar situations today.
"Typical angina pain appears when the vessels are already substantially narrowed," Dr. Jang explained. Symptoms generally arise when the coronary arteries are at least 50% narrowed, and patients who feel typical chest pain during exercise often have stenosis of 70-80% or more.
The nature of the pain varies among patients. Patients commonly describe it as "the chest being crushed," "tightening," "stuffy," or "spicy as if red pepper powder had been sprinkled on it." Many feel it as an unfamiliar pain they have never experienced before. "If pain persists for more than five minutes or does not respond to nitroglycerin, the emergency medication for angina, the patient should go to the emergency room," Dr. Jang stressed.
The main cause of angina is aging. Family history, hypertension, diabetes, hyperlipidemia, smoking and obesity also raise the risk. In particular, dietary habits involving frequent consumption of bread or fatty foods can lead to weight gain and hyperlipidemia, increasing the risk of coronary artery disease.
Family history is also important. Generally, having a family member who was treated for coronary artery disease before age 45 for men or before age 55 for women is considered a family history. However, beyond genetics, the dietary and lifestyle habits shared within a family also play a role.
◇ Exercise Stress Test, CT… Definitive Diagnosis Through Coronary Angiography
When angina is suspected, an exercise stress test or coronary CT may be performed. The exercise stress test checks whether chest pain is reproduced and whether electrocardiogram changes occur during exercise. Coronary CT involves administering a contrast agent to examine the condition of the coronary arteries.
However, coronary CT has limitations. Because the heart is constantly moving, imaging must be performed accurately within a short time, and severe calcification may obscure the condition of the vessels.
Echocardiography is not a test that diagnoses angina itself. While useful for assessing heart function and valve condition, angina is a condition in which blood supply becomes insufficient during activity, making it difficult to confirm with echocardiography performed at rest alone.
The definitive test is coronary angiography. It is an invasive examination in which a catheter is inserted through a blood vessel in the wrist or groin to directly examine the coronary arteries. Coronary angiography alone usually takes less than 10 minutes. When combined with stent placement, it takes about 30 minutes to an hour, and may take more than two hours if the vessel condition is complex or multiple sites require treatment.
◇ From Medication to Stenting… Aggressive Treatment for Unstable Angina
The basis of angina treatment is to prevent the vessels from worsening. Antiplatelet agents and lipid-lowering drugs are used, along with medications that lower heart rate or dilate vessels to control symptoms.
In stable angina, pain can sometimes be controlled with medication. However, unstable angina or myocardial infarction often requires stent placement or coronary artery bypass surgery.
Stent placement is a treatment that widens narrowed vessels and restores blood flow. Recently, lithotripsy procedures have also been introduced to treat severely calcified coronary lesions. When calcium deposits inside and outside the vessel have hardened so that balloon angioplasty or stents cannot expand properly, the procedure breaks the calcium and dilates the vessel.
Treatment is not the end for angina patients, who must more rigorously manage their cholesterol, blood pressure and blood sugar.
As studies have accumulated showing that lower LDL cholesterol levels reduce mortality in angina patients, guidelines have come to include maintaining LDL cholesterol below 55 mg/dL. Blood pressure should be managed below 130/80 mmHg, and blood sugar should target glycated hemoglobin below 7.0%. "Angina patients must rigorously manage cholesterol, blood pressure and blood sugar to prevent recurrence and progression," Dr. Jang stressed.
◇ Evening Exercise Recommended Over Early Morning Workouts
A combination of aerobic exercise and strength training is recommended. Moderate-intensity exercise, at a level where one breaks a light sweat and becomes slightly short of breath while talking, is appropriate. This includes light jogging, swimming and easy hiking.
However, caution is needed for early morning or pre-dawn exercise. Variant angina, in particular, is a condition in which the vessels suddenly contract under specific situations such as stress, drinking or temperature changes, with vasospasm more likely to occur in the early morning hours. Patients with general angina may also experience chest pain during morning exercise, so evening exercise is recommended whenever possible.
Avoiding alcohol is also important for patients with variant angina, as alcohol can trigger vasospasm. When chest pain occurs, it is important to immediately use nitroglycerin, a vasodilator that is rapidly absorbed when placed under the tongue. If vasospasm is not quickly resolved, it can lead to a heart attack.
Angina is not a condition that ends with a single treatment. "Even without pain, patients should generally have outpatient visits every three to six months and continue ongoing management," Dr. Jang said. "Taking medications properly, managing weight and exercising regularly are key to preventing angina and avoiding recurrence."
If you are unsure whether to go to the emergency room, watch this 3-minute video [Self-Diagnosis for Angina].
