Angina is chest pain or discomfort. It is a sign that the heart needs more oxygen. There are two types of angina:
Another name for angina: angina pectoris.
Angina is often caused by plaque buildup in the coronary arteries (in your heart). Plaque is made up of fatty substances, like cholesterol, in your blood. The plaque builds up slowly, over a number of years. In time plaque can harden and narrow the coronary arteries. Eventually the plaque can slow or block blood flow to the heart, cut off the oxygen supply, and cause angina.
Atherosclerosis is the general medical term for plaque buildup that clogs arteries. Coronary artery disease (CAD) is the medical term for atherosclerosis in the coronary arteries in particular. Angina, therefore, often results from atherosclerosis and from CAD.
Of course, chest pain is not always caused by reduced oxygen supply to the heart. Sometimes chest pain is not angina (heart related) at all. It could instead be related to a lung condition, for instance. Or it might simply be heartburn from spicy food.
Everyone experiences angina slightly differently. Angina can feel like heaviness, pressure, squeezing, or burning in your chest. Sometimes the pain is located in your back, shoulder, arm, neck, or jaw.
Angina usually lasts several minutes. If your angina lasts more than 5 minutes, don’t delay in getting help. Dial 911 right away, since you could be having a heart attack. Prompt treatment can prevent or limit lasting damage to the heart.
If you have angina, your doctor may suggest one or more of the tests listed below to find out the underlying cause. The test results can also help your doctor choose the best treatment(s) for you.
In some cases you may be sent to specialists for diagnosis and testing- and sometimes for treatment. To learn more, go to the Your Treatment Team section.
An angiogram is an image of your blood vessels, similar to an x-ray. An angiogram shows:
An angiogram might be ordered if your doctor suspects blockages in:
The angiogram begins with a cardiac catheterization. During a cardiac catheterization, a small, flexible tube called a catheter is inserted into a blood vessel in your groin or arm. Your doctor gently “steers” the catheter toward your blocked blood vessel. Once the catheter is in place, your doctor injects dye to begin the angiogram. The dye allows your blood vessels to show up as images on a monitor-almost like roads on a map. If the angiogram shows a blocked artery, your doctor may be able to treat it at the time with a procedure such as balloon angioplasty.
Your test will be performed in a “cath lab.” When you have an angiogram you undress and put on a hospital gown or sheet. You lie on an exam table and an intravenous (IV) line is put into your arm. The IV delivers fluids and medications during the procedure. The medication makes you groggy, but not unconscious. The doctor makes a small incision for the catheter. The area of the incision will be numbed so you shouldn’t feel pain, but you may feel some pressure as the catheter is inserted. When the doctor injects the dye, you might notice a:
A cardiac catheterization is a procedure in which a small, flexible tube called a catheter is inserted into a blood vessel. The catheter is usually put into a blood vessel in your groin (or sometimes in your arm). Your doctor gently “steers” the catheter toward your heart, or toward a blood vessel that might be blocked. A cardiac catheterization is the first step in a number of heart and blood vessel tests and procedures.
For instance, a cardiac catheterization is often the first step in an angiogram. In an angiogram, your doctor injects dye through the catheter into your arteries to find any blockages. With a catheterization, your doctor can also:
During a cardiac catheterization, your doctor may also treat any blocked blood vessels with one or more of these procedures to improve blood flow:
Your procedure will be performed in a “cath lab.” When you have a cardiac catheterization you undress and put on a hospital gown or sheet. You lie on an exam table and an intravenous (IV) line is put into your arm. The IV delivers fluids and medications during the procedure. The medication makes you groggy, but not unconscious. Electrodes on your chest monitor your heart’s activity during the procedure. A blood pressure cuff on your arm also regularly takes your blood
pressure. The doctor makes a small incision (usually in the groin) for the catheter. The area will be numbed so you shouldn’t feel pain, but you may feel some pressure as the catheter is inserted. You won’t be fully asleep, so during the test your doctor or nurse might ask you questions to make sure you are not feeling pain, for instance. Afterwards you might be in the hospital overnight. Most people have a fairly rapid recovery.
A chest x-ray produces an image of your heart, lungs, and nearby blood vessels. It reveals the:
An x-ray can help diagnose many different conditions, including heart diseases. And if you have a cardiac device like a pacemaker, the x-ray also shows the device and the coated wires (leads) that carry the energy to your heart.
When you have a chest x-ray you undress from the waist up and put on a hospital gown. You are partly covered by a shield-a heavy apron made of flexible lead-to protect you from any excess radiation. (X-rays use only a small amount of radiation to create the image.) You stand in front of the x-ray machine and hold your breath while the image is taken. Your doctor usually orders two views: one from the back and one from the side.
An echocardiogram (also called an echo) is a three-dimensional, moving image of your heart. An echo uses Doppler ultrasound technology. It is similar to the ultrasound test done on pregnant women. The echo machine emits sound waves at a frequency that people can’t hear. The waves pass over the chest and through the heart. The waves reflect or “echo” off of the heart, showing:
When you have an echocardiogram, you undress from the waist up, put on a hospital gown, and lie on an exam table. The technician spreads gel on your chest and side to help transmit the sound waves. The technician then moves a pen-like instrument (called a transducer) around on your chest or side. The transducer records the echoes of the sound waves. At the same time, a moving picture of your heart is shown on a special monitor. You may be asked to lie on
your back or your side during different parts of the test. You may also be asked to hold your breath briefly so that the technician can get a good image of your heart. An echo is a painless test. You feel only light pressure on your skin as the transducer moves back and forth.
An electrocardiogram (ECG or EKG) reveals how your heart’s electrical system is working. The ECG senses and records your heartbeats, or heart rhythms. The results are printed on a strip of paper. An ECG can also help your doctor
diagnose whether:
In all, there are three kinds of tests that record your heart’s electrical activity, each for a different period of time:
The peaks on an electrocardiogram (ECG) strip are called waves. Together, all the peaks and valleys give your doctor important information about how your heart is working:
When you have an electrocardiogram (ECG) you undress from the waist up, put on a hospital gown, and lie on an exam table. As many as 12 small patches called electrodes are placed on your chest, neck, arms, and legs. The electrodes, which connect to wires on the ECG machine, sense the heart’s electrical signals. The machine then traces your heart’s rhythm on a strip of graph paper.
A stress test is a type of Electrocardiogram (ECG or EKG). Regular ECGs examine how your heart beats at rest. Stress tests examine your heart’s response to exercise, or stress. There are many variations of stress tests. But the purpose of most stress tests is to find out if your heart is getting enough blood and oxygen.
Stress tests are often done to reproduce symptoms like chest pain or shortness of breath. The test looks at:
The test can show:
In one of the simpler types of stress tests, you walk on a treadmill or pedal a stationary bike. You begin at an easy pace. The machine is slowly adjusted to make you work harder. You continue exercising until you feel symptoms or until you get too tired. A stress test is also known as an exercise test, a treadmill test, or an exercise ECG.
During a nuclear stress test, the technician or nurse inserts an intravenous (IV) line-usually in your arm. A small amount of a radioactive substance called thallium is injected through the IV into your bloodstream. Usually a nuclear stress test is done as part of a regular stress test, since the thallium can give your doctor more information about whether your heart gets enough blood and oxygen. But a nuclear stress test can be done even if you are unable to exercise, since another medication can also be given to make your heart work harder. After the thallium is injected, you lie on a table underneath a special camera. The camera then takes images of your heart. Any part your heart that doesn’t receive enough blood and oxygen also receives less thallium. Therefore that part of your heart shows up as a lighter color on the image.
When you have a stress test you undress from the waist up and put on a hospital gown. As many as 12 small patches called Electrodes are placed on your chest, neck, arms, and legs. The electrodes connect to wires on the electrocardiogram (ECG). The machine then records the electrical activity in your heart from each of the electrodes.
A blood pressure cuff is also put on your arm, and your blood pressure is checked often. If you have a nuclear stress test, you will also have an IV inserted (usually into your arm).
A stress test itself does not usually cause any pain, although sometimes it reproduces painful symptoms. However the test gives you a workout, since you exercise until you’re very tired. Usually a nurse talks to you and gives you instructions throughout the test. The nurse continues to monitor your symptoms, your blood pressure, and your heart rate for about 10-15 minutes after you stop exercising.
Because lifestyle factors can affect angina, part of your treatment may include living a healthier lifestyle. For example, if you are having problems with stress, your doctor or nurse may be able to help-by making suggestions or by sending you to a specialist. To learn more, go to the Risk Factors section.
Other types of treatment depend on your test results. Your doctor might suggest one or more of these medications or procedures.
Medications
Procedures
If you have a heart or blood vessel condition, you might want to know more about some of the medications you take. The information in this section describes some medications commonly prescribed for heart or blood vessel conditions. It also includes some tips to help you take your medications as ordered.
Make sure you tell your doctor-or any new doctor who prescribes medication for you-about all the medications and supplements you take. Your doctor can then help make sure you get the most benefit from your medications. Telling your doctor this information also helps avoid harmful interactions between medications.
You may also want to discuss these topics with your doctor or nurse each time you get a new medication:
In some cases, your heart needs several months to adjust to new medications. So you may not notice any improvement right away. It also may take time for your doctor to determine the correct dosage.
Blood tests are sometimes necessary for people who take heart medications. The blood tests help your doctor determine the correct dosage- and therefore help avoid harmful side effects.
Never stop taking your medication or change the dosage on your own because you don’t believe you need it anymore, don’t think it’s working properly, or feel fine without it.
Be sure to talk to your doctor or nurse if you have:
And don’t hesitate to ask your pharmacist if you have questions about how and when to take your medications.
“ACE” is short for “angiotensin-converting enzyme.” ACE inhibitors are medications that help prevent your body from producing too much of a natural chemical called angiotensin II.
All medications are approved by the Food and Drug Administration (FDA) for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.
To treat high blood pressure
To treat Heart Failuree and related conditions, such as Low Ejection Fraction (EF) To reduce damage after a heart attack and to help prevent further heart attacks
ACE inhibitors block an Enzyme that is needed to produce angiotensin II. The body uses angiotensin II to maintain proper blood pressure and fluid balance. But angiotensin II can have harmful long-term effects on your heart and blood vessels. It can cause blood vessels to narrow and can also raise blood pressure.
Taking ACE inhibitors can:
You can understand the purpose of anticoagulants by looking at the root words of the term. Anti = counter or against; coagulant = thicken or clot.
All medications are approved by the Food and Drug Administration (FDA) for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.
To reduce the risk of blood clots that could lead to Stroke and other medical conditions
Anticoagulants are often called blood thinners, although they don’t actually thin the blood. Rather, they help prevent clots from forming in your blood.
These medications treat conditions related to Atherosclerosis, or arteries blocked by plaque. plaque buildup can lead to a blood clot.
Taking anticoagulant medications can:
Beta blockers get their name because they “block” the effects of substances like adrenaline on your body’s “beta receptors.”
All medications are approved by the Food and Drug Administration (FDA) for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.
To treat high blood pressure
To slow fast arrhythmias (abnormal heartbeats, or heart rhythms)
To prevent angina (chest pain due to blocked blood flow to parts of the heart) To prevent long-term damage after a heart attack
To treat heart failure and related conditions, such as low ejection fraction (EF)
These medications block activity of your sympathetic nervous system. The sympathetic nervous system reacts when you are stressed or when you have certain health conditions. When your system responds, your heart beats faster and with more force. Your blood pressure also goes up.
Beta blockers block signals from the sympathetic nervous system. This slows your heart rate and keeps your blood vessels from narrowing. These two actions can result in:
Lower heart rate Lower blood pressure
Less angina (chest pain related to the heart)
Fewer arrhythmias (abnormal heartbeats, or heart rhythms)
Calcium channel blockers help relax the heart muscle and blood vessels.
All medications are approved by the Food and Drug Administration FDA for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.
To treat high blood pressure
To treat angina (chest pain) which can result from atherosclerosis (blocked blood vessels) and Coronary Artery Disease (CAD)
To treat some arrhythmias (abnormal heartbeats, or heart rhythms)- usually fast arrhythmias
Calcium channel blockers prevent calcium from entering parts of the cells in blood vessels. When calcium is blocked from entering these cells, it relaxes the blood vessels and the heart. As a result, calcium channel blockers:
Decrease the work of the heart by allowing more blood and oxygen to flow to the heart muscle
Lower the heart rate Lower blood pressure
One purpose of vasodilators is to lower blood pressure. To understand how vasodilators work, imagine the same amount of water moving through a 1-inch diameter hose versus a 2-inch diameter hose. The bigger the hose, the less pressure on the walls of the hose.
Medications such as vasodilators can help relax and dilate blood vessels that have become narrowed (constricted).
All medications are approved by the Food and Drug Administration (FDA) for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.
You may have heard of other types of vasodilators. Beta blockers, which are a common heart and blood vessel medication, are one type of vasodilator. Another type is calcium channel blockers.
To treat high blood pressure
To treat/prevent angina (chest pain related to the heart) which can result from Atherosclerosis (blocked blood vessels) and Coronary Artery Disease (CAD)
Vasodilators help relax and dilate the blood vessels, so blood moves through them more easily. This helps to:
Lower blood pressure
Allow the heart to work with less effort Decrease the amount of angina (chest pain)
An atherectomy opens blocked blood vessels by cutting away plaque buildup. It is a procedure that uses local numbing. General anesthesia is usually not needed.
Cutting away the plaque opens the artery and allows the blood to flow more freely, which can reduce your:
An atherectomy begins with a catheterization. During a catheterization, a small, flexible tube called a catheter is inserted through a blood vessel in your groin (or sometimes in your arm). Your doctor gently “steers” the catheter toward your blocked vessel. Dye put in through the catheter allows your blood vessels to show up as images on a monitor-almost like roads on a map. (This part of the procedure is called an angiogram.) The catheterization and angiogram are typically part of an atherectomy.
Once there is a clear image of the blockage, your doctor begins the atherectomy. The doctor uses a special catheter with a tiny cutting tool on the end. The tool scrapes away the plaque on the inside of the artery. The tool is specially designed to cut only the plaque and not to damage the blood vessel in any way. Without the plaque blocking the vessel, blood may be able to flow more freely.
After the atherectomy, your doctor may use another catheter to implant a stent. A stent is a tiny mesh tube that holds your artery open. The stent may help prevent your artery from becoming blocked again.
Usually you are told not to eat or drink anything for a number of hours before the procedure. Your procedure will be performed in a “cath lab.” You lie on an exam table and an intravenous (IV) line is put into your arm. The IV delivers fluids and medications during the procedure. The medication makes you groggy, but not unconscious.
The doctor makes a small incision for the catheter. The area will be numbed so you shouldn’t feel pain, but you may feel some pressure as the catheter is inserted. During the atherectomy your doctor or nurse might ask you questions to make sure you are not feeling pain, for instance. You may be in the hospital overnight. But most people have a fairly quick recovery.
A balloon angioplasty opens blocked blood vessels by pressing plaque against the artery wall. It is a procedure that uses local numbing. General anesthesia usually is not needed.
This procedure opens the artery and allows blood to flow more freely, which can reduce your:
A balloon angioplasty typically begins with a catheterization. During a catheterization, a small, flexible tube called a catheter is inserted through a blood vessel in your groin (or sometimes in your arm). Your doctor gently “steers” the catheter toward your blocked vessel. Dye put in through the catheter allows your blood vessels to show up as images on a monitor-almost like roads on a map. (This part of the procedure is called an angiogram.) The catheterization and angiogram are typically part of the procedure. Once there is a clear image of the blockage, your doctor begins the angioplasty.
During angioplasty, the doctor uses a special catheter with a small balloon on the end. The doctor inflates the balloon near the blockage in your artery. The inflated balloon presses the plaque against the artery wall, allowing for better blood flow.
After the balloon angioplasty, your doctor may use another catheter to implant a stent. A stent is a tiny mesh tube that holds your artery open. The stent may help prevent your artery from becoming blocked again.
Usually you are told not to eat or drink anything for a number of hours before the procedure. Your procedure will be performed in a “cath lab.” You lie on an exam table and an intravenous (IV) line is put into your arm. The IV delivers fluids and medications during the procedure. The medication makes you groggy, but not unconscious.
The doctor makes a small incision for the catheter. The area will be numbed so you shouldn’t feel pain, but you may feel some pressure as the catheter is inserted. During the angioplasty your doctor or nurse might ask you questions to make sure you are not feeling pain, for instance. You may be in the hospital overnight. But most people have a fairly quick recovery.
If you have one or more blocked coronary arteries, your heart may not be getting enough blood and oxygen. If a less invasive procedure, like a balloon angioplasty, isn’t likely to open your arteries, your doctor may recommend bypass surgery. During bypass surgery, your doctor creates new pathways to route blood around blocked vessels.
A bypass is an open-heart surgery that requires general anesthesia. The full name for a bypass is a coronary artery bypass graft (or CABG, pronounced “cabbage”).
During bypass surgery your doctor takes (harvests) a piece of a healthy blood vessel- often from your chest, arm, or leg. This harvested vessel becomes the new path for blood flow around the blocked artery. Your doctor chooses the healthy vessel(s) based on the size and location of your blocked artery. Doctors usually choose from among these three options when taking vessels for bypass:
It’s okay to remove pieces of these blood vessels for bypass because other vessels take over for them. Doctors more often choose arteries, rather than veins, for grafts. Veins sewn-or “grafted”–to heart arteries sometimes clog up again. Arteries are less likely to do so.
Traditional bypass surgery begins with an incision in your breastbone (sternum). With the traditional form of bypass surgery, your doctor needs to operate on a completely still heart.
So you receive medications to stop your heart. A heart-lung machine then does the job of both the heart and the lungs:
Your doctor sews (grafts) one end of the healthy blood vessel just below the blocked artery. The other end of the healthy vessel is then sewn above the blocked artery. Blood flows through the new vessel, around the blocked area. This “detour” is the bypass graft. After bypass surgery, your blood flows more freely through your coronary arteries. So bypass surgery can lower your risk of heart attack.
A single bypass detours around one blocked artery. A double bypass detours around two blockages, and so on.
Newer types of bypass
In addition to traditional bypass, some less invasive kinds of bypass surgery now exist. Neither of these two types of surgery uses the heart-lung machine. Your doctor can tell you whether either of these less invasive surgeries might work for you.
Minimally invasive bypass surgery-this requires a smaller incision near your ribs instead of the large incision through the breastbone.
Off-pump bypass surgery- a tool holds part of your heart still while the doctor operates. The rest of your heart beats as usual during this type of surgery.
Coronary bypass surgery is the most common type of vessel bypass. But blood vessels outside the heart-peripheral vessels- can also become blocked. This is called peripheral vascular disease (PVD), or peripheral artery disease. A bypass is sometimes needed to treat PVD.
The blood vessels in the leg are the peripheral vessels that most often get blocked. For bypass surgery on leg arteries, the healthy vessel is either another vessel from the leg or an artificial vessel. Peripheral artery bypass requires general anesthesia. However, because it is not a heart surgery, the heart-lung machine is not needed.
Usually you are told not to eat or drink anything for a number of hours before your surgery. You lie on an exam table and an intravenous (IV) line is put into your arm. The IV delivers fluids and medications during the surgery. You are then
wheeled into the operating room, where you receive medication that makes you unconscious during the surgery. After surgery you may spend a few days in the intensive care unit (ICU). That’s to make sure your heart is pumping normally and your chest is healing normally. You are usually out of the hospital within a week. You may have pain at the incision site for several weeks, but medication is provided for pain. At home, recovery often takes 4-6 weeks.
After your bypass surgery, your doctor may recommend cardiac rehabilitation. This involves a team of healthcare experts who work with you to help you recover. To avoid future heart-related problems, the team:
A stent is a tiny mesh tube that helps keep an artery open. Your doctor implants a stent in a newly opened artery to reduce the risk of repeat blockage or narrowing following an angioplasty procedure. Stents are often implanted in arteries supplying blood to your heart (coronary arteries) or neck (carotid arteries). A stent implant is a procedure that uses local numbing. General anesthesia is usually not needed.
There are two kinds of coronary artery stents: bare metal and drug-coated. A drug-coated stent is a bare-metal stent coated with a special medication, or drug, to help reduce the chance of the artery becoming blocked again. The drug
coating is released from the stent over the period of time when a new blockage is most likely to happen.
A drug-coated stent implant may reduce your need for a second procedure (such as a coronary stent procedure or bypass surgery) to re-open the artery.
Before a stent implant, your doctor may open the blocked artery by performing an atherectomy or a balloon angioplasty. Those procedures-and the stent implant-involve a catheterization. During a catheterization, a small, flexible tube called a catheter is inserted through a blood vessel in your groin (or sometimes in your arm). Your doctor gently “steers” the catheter toward your blocked vessel.
Dye put in through the catheter allows your blood vessels to show up as images on a monitor-almost like roads on a map. (This part of the procedure is called an angiogram.) The catheterization and angiogram are typically part of a stent implant.
After clearing the blockage, the doctor uses a special catheter to place the stent in your newly opened artery. The stent helps:
Usually you are told not to eat or drink anything for a number of hours before the procedure. Your procedure will be performed in a “cath lab.” You lie on an exam table and an intravenous (IV) line is put into your arm. The IV delivers fluids and medications during the procedure. The medication makes you groggy, but not unconscious.
The doctor makes a small incision for the catheter. The area will be numbed so you shouldn’t feel pain, but you may feel some pressure as the catheter is inserted. During the stent implant your doctor or nurse might ask you questions to make sure you are not feeling pain, for instance. You may be in the hospital overnight, and there may be tenderness at the incision site. Most people have a fairly quick recovery.
Our knowledgeable and courteous staff will help set up a consultation for you, schedule surgical procedures, discuss your insurance, and answer any questions you may have.
1100 N. Palm Canyon Dr. Suite 206
Palm Springs, CA 92262
78-900 Ave 47 Suite 202,
La Quinta, CA 92253
