By: John J. Kelly III, M.D., F.A.C.C.

When most patients worry about “heart disease”, they are thinking about coronary artery disease. The symptoms that mark the onset of significant coronary artery disease can sometimes be difficult for individuals to recognize. Angina pectoris is a term that is used to describe sensations of pain that are caused by limitations of the blood flow to the heart muscle. These symptoms are caused when coronary arteries become narrowed. The arteries can no longer deliver enough blood to the heart muscle. This imbalance between supply and demand leads to problems. The area of the heart that is threatened is not getting enough oxygen and nutrients to allow it to meet the demands of the body.

Most commonly, symptoms of angina are related to physical exertion. They are relieved by rest. These symptoms may have their onset when individuals are physically active or doing some unusual physical activity. Being under pressure and rushing can also unmask the symptoms of angina. Sometimes emotional events and cigarette smoking can bring on angina. Sometimes it is noticeable if you have to be at all physically active after a heavy meal.

Different people feel different symptoms. This is one of the great difficulties in recognizing the symptoms of coronary artery disease early on. Often patients will feel a discomfort somewhere in their chest described as a tightness or a fullness. Some-times it is described as a squeezing or pressure-like sensation. Some patients will feel a burning sensation. At other times, the only symptom will be indigestion or a fullness in the epigastric area. Sometimes, patients will have symptoms of neck, shoulder, arm or jaw discomfort. Sometimes, the discomfort is in the back between the shoulder blades. At other times, the only symptom is shortness of breath with physical exertion.

Recognizing that you are getting into trouble with coronary artery disease can sometimes be very difficult. Part of the difficulty comes from human nature and our desire to deny problems. We often try to blame different symptoms on something that is more benign or less threatening to us. Sometimes the symptoms are very vague. Some patients simply feel more fatigued and have a decline in their exercise capacity. Probably the most important thing to do is to be honest with one ’s self when these symptoms occur and not ignore them.

Angina pectoris is a very treatable condition. Doctors have many options for tackling the problems caused by angina pectoris. The base of all therapy is lifestyle modification. Patients need to reevaluate their diet, their exercise habits and eliminate smoking if they are smokers. Medications can be employed to stabilize angina and some medications can even help promote progression of narrowing in the artery. In more urgent situations, cardiac catheterization can be performed and blockage of an obstruction can be relieved by different types of interventional procedures including balloon angioplasty and coronary stenting. Some patients are best treated with open heart surgery to improve their entire heart’s blood supply. Which of these treatment options is best for an individual depends on how many blockages are present and where they are located.

Angina is one of the most common signs of coronary artery disease. It is a discomfort that is caused when your heart muscle does not get enough blood supply. Angina can be different things for different people. It is important to pay attention to the things your body is telling you and discuss them with your physician if you feel at all concerned.