Vascular spasms are usually due to the constriction of one or more of the coronary arteries. As a result, the heart does not get enough oxygen, which is especially noticeable during physical exertion. Vascular spasms can reduce physical performance, but most can live about as usual. Having angina increases the risk of a heart attack.

Vascular spasms that have been unchanged for several months are called stable vascular spasms. Newly discovered vascular spasms that come already after a slight exertion or that you get without your effort are called unstable vascular spasms. Vascular spasms that have rapidly deteriorated are also called unstable. These may be signs that you will have a  heart attack and you should seek medical care as soon as possible.

Symptoms of angina

It is common for you to have any of the following symptoms of angina:

  • A pressure across the chest, often when exerted.
  • Shortness of breath that comes with effort.
  • A feeling that it is tight in the chest.
  • Pain in the chest that sometimes radiates into an arm, to the neck, back or lower jaw.

Several different symptoms of angina

Vascular spasms can cause several different symptoms. It is common to have pain behind the sternum where the heart sits. If the pain radiates from the chest, it usually goes in the direction of the left arm, but also out towards the right arm. It can also hurt your neck, back or lower jaw.

The pain can be very strong and it can feel difficult to breathe. It causes many to react with anxiety and anxiety. Sometimes the pain is less clear and you may feel pressure over your chest or become very breathless. The symptoms usually last for a few minutes and often release after rest.

Vascular spasms often occur in connection with physical exertion or in strong emotional expressions such as anger or agitation. Sometimes it starts at rest, for example, you wake up from angina. Strong cold, heat. blown and stress can trigger or aggravate angina.

Chest pain is not always caused by angina

Chest pain is one of the most common reasons for seeking emergency hospital care and can sometimes be a sign of a heart attack. But chest pain does not automatically mean that you have heart problems. The pains can have many causes, such as irritation of the mucous membrane of the lower esophagus or diseases of the stomach and biliary tract. Diseases of the lung or pulmonary sac such as infections can cause similar symptoms. This also applies to certain muscle injuries.

When and where should I seek care?

Contact a health care provider if you are concerned that you have angina. You can contact many receptions by logging in.

If it’s in a hurry

  • A pressing or spasmodic pain in the chest that does not go over.
  • An unclear and unpleasant feeling in the chest that lasts longer than 15 minutes and that you do not know what it is due to.
  • Have chest pain and at the same time are short of breath and cold sweat or have chest pain in combination with irregular heartbeats.

How can I prevent angina?

There is much you can do yourself to reduce the risk of angina and not to make it worse. In the first place, it is about changing your lifestyle. You can do this by following these steps:

  • Stop smoking if you smoke.
  • Be physically active regularly.    
  • Eat a healthy diet, which means more fruits, vegetables, and fish.
  • Learn to deal with stressful situations and anger.

To get help with changing your lifestyle, contact a nurse at a heart clinic or a health care center.

Diabetes and blood pressure should be checked

The risk of angina may increase if you have diabetes and high blood pressure. It is therefore important that you have the diabetes disease under good treatment and get help from your doctor to lower blood pressure to levels below 140/90.

Exercise, fruits, and vegetables reduce the risk

The risk of cardiovascular disease is reduced if you move regularly. Blood pressure is lowered and blood fat balance is improved. The risk of aging diabetes is reduced, as is the risk of getting a blood clot.

The risk of angina and heart attack also decreases if you eat fruits and vegetables every day.

Heredity plays a certain role

Often, atherosclerosis is due to an inherited inability to care for the body’s blood fats. The hereditary genes can also affect the body’s ability to metabolize sugar substances found in the blood. High blood pressure and obesity can also be hereditary.

How common is angina?

Vascular disorders have, with a changed way of life and an increased average life expectancy, become a people’s disease.

Differences between women and men

Vascular spasms are about twice as common in middle-aged and middle-aged women. One explanation is that the hormone estrogen has a protective effect that makes women sick about ten years later in life than men. In connection with menopause, the levels of estrogen decrease, and then the risk of angina in women increases.

Good chances to get better

Many people with stable angina get good help from drugs and treatments. The prognosis may be worse if you have at the same time impaired pumping function in the heart or limited blood flow in several coronary vessels. Coronary artery surgery can improve such a situation.

Investigations

When you come to a doctor to find out if you have angina, the doctor needs to get answers to these questions, among others:

  • Where is the pain or discomfort?
  • How can pain or discomfort be described?
  • Will the pain or discomfort come with exertion?
  • How long does the pain or discomfort last?

After the call, the doctor examines the heart and lungs and makes blood pressure measurements in both arms.

The ECG can provide answers 

You must always undergo an ECG examination, which means that ten electrode plates are attached over the chest and over the wrists and ankles. The study can show if the heart has oxygen deficiency, which is a clear sign of angina. But you may have angina even though the examination shows no signs of it. Therefore, other investigations are also needed.

Often, blood tests are taken that may show anemia, diabetes or elevated blood fat levels. The samples can show different risks that you have and provide a basis for how you should be treated.

Exercise test

You also need to do a work test to see if your heart gets oxygen deficiency when it is strained. You can do a work test on an exercise bike or on a walkway. During the test, symptoms, heart rate, blood pressure, ECG are checked and if you have symptoms such as chest pain or shortness of breath.

You can often do the examination at a hospital, but it can also be done at a specialist clinic.

Ultrasonography

Ultrasound examination is another examination that often needs to be done. It is called echocardiography and provides an image of heart muscle function and heart valve function. It can also be made as an alternative to work tests if you cannot cycle for various reasons or if the result is difficult to interpret. The study is then called stress echocardiography.

coronary angiography

Sometimes you may need to have a coronary x-ray. The examination is carried out in hospitals. The doctor inserted a thin plastic tube called a catheter through a blood vessel into the arm or groin up to the coronary artery. When a contrast agent is injected, the constrictions possibly present in the coronary vessels are visible. 

Other investigations

Sometimes a computed tomographic examination of the coronary heart is done.

Another study is cardiac scintigraphy. It is a study that is usually done only after a referral from a heart specialist if the results of the work test are difficult to interpret.

Treatment for angina

Drugs are the most common treatment for angina pectoris to reduce the stress on the heart and to increase blood flow in the coronary vessels. Medicines also relieve pain, shortness of breath and fatigue. You will be given other medicines to relieve the symptoms if you have angina pectoris despite the preventative medication.

Surgery if medication is not enough

Some form of coronary artery disease may be necessary if the drugs do not help enough or if the risks of myocardial infarction are considered particularly high. The operations performed are either balloon dilation of coronary vessels, also called PCI or coronary artery surgery, also called bypass surgery or CABG.

Which treatment for angina is most appropriate depends on what the various studies show. Coronary artery surgery is often better for the elderly, especially if there are several constrictions in the coronary vessels. The risks of recurrence of vasoconstriction are less after coronary artery surgery. Balloon enlargement is a milder procedure than coronary artery surgery and is often better for younger people with few constrictions in the vessels. The risk of relapse is greater, but then treatment can be done.

Balloon widening of coronary vessels

The treatment widens the vasoconstriction to improve blood flow. Often, a metal mesh called a stent is also inserted into the coronary artery to keep it widened. Balloon enlargement is often done directly in conjunction with the coronary x-ray.

Coronary artery bypass surgery

Sometimes there are several constrictions in the coronary vessels that can sit in difficult places. In that case, coronary artery surgery may be involved, so-called bypass surgery. The operation means that the blood is led past the constriction in the coronary vessels.

How is life affected by angina?

Most people manage their everyday tasks and interests despite occasional vasoconstriction attacks. There are also no barriers to sexual intercourse. However, it is important to listen to the body’s signals and to adapt to the new situation. Having angina can affect physical energy and social life.

You can always ask a doctor or nurse where you will receive your treatment if there is something you are wondering about the disease.

What happens in the body?

The heart is a muscle that is large as a clenched hand and pumps out oxygen-rich blood to all organs of the body. The heart also needs oxygenated blood to function. It is the coronary vessels that supply the heart with blood. They lie in grooves on the outside of the heart and are filled with blood as the heart muscle rests between each heartbeat.

Constriction of the vessels

Vascular spasms are also called angina pectoris and are usually due to constriction in one or more coronary vessels. The constriction is caused by atherosclerosis which is due to the fact that fat, blood cells and connective tissue have been stored in the inner vessel wall for a long time. This is sometimes also called atherosclerosis.

High levels of blood fat increase the risk

High levels of blood fat cholesterol can increase the risk of angina. A certain amount of cholesterol is needed, for example in order for the body to produce hormones. Cholesterol levels in the body are affected by hereditary tendencies, but what you eat is also of great importance. The body gets more cholesterol than it needs if you eat too much-saturated fat and the cholesterol can then be stored in the vessel wall. Saturated fat is found in milk, butter, cream and other fat that comes from animals.

There are two main types of cholesterol. Most of the cholesterol in the blood is LDL cholesterol, which is harmful. It is transported around the blood and stored in the cell wall. The risk of blood vessels narrowing increases the higher the level of LDL cholesterol you have.

HDL cholesterol is the beneficial cholesterol and has a protective function as it transports cholesterol to the liver where it breaks down. So it is good with a high level of HDL cholesterol in the blood.

Oxygen deficiency leads to chest pain

You get oxygen deficiency in the heart muscle if enough blood cannot pass due to coronary artery congestion. Then the first signs of angina, which are chest pain and pressure sensation, appear. Other symptoms are shortness of breath that comes quickly or a feeling that it is tight in the chest. The symptoms usually come when you strain your body, for example when you walk up a hill or carry heavyweight. They can also be associated with strong mental stress. Symptoms usually cease quickly after the end of the effort.

Other causes of angina

A less common cause of angina is a temporary muscle spasm or contraction of the coronary artery. It prevents enough blood to pass into the heart. It is called spasms or spasms.

You can also get symptoms reminiscent of the symptoms of angina without having any constrictions in the vessels. For example, it may be due to changes in one or more heart valves or that the heart muscle is thickened.

More information

The Cardiovascular Foundation supports research in cardiovascular, cardiovascular and pulmonary diseases. There is some information about all kinds of heart disease.

Hjärtlung Riksförbundet works to ensure that heart and lung disease are entitled to a dignified and content-rich life even after an illness. The organization organizes, among other things, a heart and lung school.

The National Board of Health and Welfare draws up national guidelines for the treatment of various diseases, including heart disease. The guidelines provide recommendations on how, for example, health care, social services, and dental care should prioritize their resources. They are based on unified science and proven experience.

The guidelines are also available in a version aimed at patients. The patient version gives you knowledge of the requirements you can place on the care and care in which you live. 

Ehtisham Nadeem

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