Understanding unstable angina (a cause of heart attack): Causes, symptoms, and treatment

By: Mohan Garikiparithi | Heart Health | Friday, January 06, 2017 - 08:00 AM

unstable-anginaThere are three types of angina: stable, unstable, and variant. This article will focus primarily on unstable angina, which is when plaque in the blood vessels either ruptures or forms a blood clot, reducing or blocking the blood flow very suddenly. Unstable angina is not relieved by your common medications – rather, it requires emergency treatment.
The primary symptom in unstable angina is severe chest pain, but pain may also be experienced in the shoulders, neck, back, and arms. Unlike stable angina, the symptoms of unstable angina appear randomly and pinpointing the source of the pain may be difficult. For example, pain in stable angina arises with vigorous activity or physical strain. In unstable angina, pain and symptoms may appear even at rest.

Unstable angina is a sign that arteries are narrowing and that you are at a higher risk of a heart attack. If left untreated, unstable angina can result in a heart attack, heart failure, or arrhythmia – which are all life-threatening conditions.

What are the causes and risk factors of unstable angina?

Unstable angina results from a restricted blood flow to the heart – for example, when a person has coronary artery disease (CAD). In CAD, arteries become narrow due to plaque buildup – known as atherosclerosis. Having high LDL cholesterol or having high blood triglycerides can contribute to atherosclerosis. In unstable angina, the plaque along the arteries may rupture or form a blood clot, further decreasing the blood flow and thus triggering symptoms.

Contributing factors to unstable angina include high blood pressure, high-fat diet and high cholesterol, lack of exercise, smoking, diabetes, older age, and a family history of angina or other heart-related conditions. By controlling these risk factors, you can better prevent unstable angina or at least better manage the condition if already diagnosed.

Symptoms of unstable angina

The primary symptoms of unstable angina are chest pain that can feel like pressure, tightness, heaviness, or squeezing. Chest pain may also be accompanied by breathlessness, nausea, feeling of illness, feeling unusually tired, dizziness, and restlessness. These symptoms may occur at any moment regardless of your physical fitness level.

Other differences in symptoms of unstable angina compared to stable angina is that the chest pain begins to feel different, more severe, more reoccurring, lasts longer than 15 to 20 minutes, occurs without a cause, does not respond to medications, and appears with a drop in blood pressure and shortness of breath.

Diagnosing unstable angina

Aside from a physical examination, your doctor will run other tests to better diagnose unstable angina. These tests include blood tests to check for cardiac biomarkers (troponin) and enzymes creatine kinase (CK) that leak from your damaged heart muscle, electrocardiogram to see patterns in your heartbeats indicating reduced blood flow, echocardiography to produce images of your heart to check for angina-related problems, stress tests to cause your heart to work harder and make angina easier to detect, computed tomography angiography, as well as coronary angiography and heart catheterization to study the state of health and caliber of your arteries.

Treating unstable angina

Treatment for unstable angina depends on severity of the condition. For starters, you may be put on a blood thinner because thicker blood has greater difficulties passing through narrow arteries. You may also be prescribed medications that target cholesterol, anxiety, arrhythmias, and blood pressure.

You may have to undergo an angioplasty, a procedure in which doctors open up blocked arteries – the artery is held open by a stent.

Lifestyle changes, too, can go a long way in protecting your heart in unstable angina. These involve eating a healthy diet, not smoking, exercising, reducing stress, and losing weight if overweight.

Unstable angina prevention

Adhering to the lifestyle habits and changes listed above is a good way to lower your risk and prevent unstable angina.

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