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ID: 259
Category: Heart condition
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createdon: 05 Jun 2023
updatedon: 05 Jun 2023

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Author: Khoa Tran
Published Jun 05, 2023
Updated Jun 05, 2023

Table of contents

Angina

Etymology and Pronunciation

angina (an-juh-nuh)
angere - Latin for  "to choke" or "to strangle"

History of Angina

Angina is a medical condition characterized by chest pain or discomfort caused by reduced blood flow to the heart. 

A study published in The Lancet in 2013 presented whole-body computed tomography (CT) scans of mummies from different regions, including ancient Egypt and ancient Peru. These scans revealed atherosclerosis, a characteristic feature of CHD, in a significant number of the studied mummies. This suggests that atherosclerosis may have existed in premodern humans, spanning over 4000 years.

During the late Middle Ages (1500 B.C), an ancient Egyptian medical text known as the Papyrus Ebers, originating from around 1500 B.C., contains the earliest description that resembles angina pectoris. The content of this papyrus dates back even further, to an older dynasty between 2500-2000 B.C. The text mentions chest pain, shoulder pain, and stomach discomfort, with a grim prognosis of impending death. However, these symptoms were believed to be related to a stomach ailment, leading to treatments involving herbs that induced vomiting and diarrhea.

From 460-370 B.C, The term "angina" first appears in writings attributed to the Greek physician Hippocrates (460-370 B.C.). He used the term "xuvaYXtj" to describe chest pain radiating into the shoulder and arm, often accompanied by difficulty breathing. This term is derived from "xudrv" (the dog) and "aYXill" (to narrow, to compress). Interestingly, Hippocrates regarded angina pectoris and angina tonsillaris (throat-related disease with a characteristic "barking" voice) as the same condition.

In a well-known letter, around 60-65AD., from Seneca to Lucilius, dated around 60-65 A.D., Seneca describes experiencing symptoms similar to angina pectoris, which physicians at the time called "meditatio mortis" (preparation for death). It is worth noting that Tacitus' description of Seneca's suicide reveals indications of generalized atherosclerosis, as Seneca could only bleed to death after being placed in a warm bath due to his hardened extremities. 

Galen, another prominent figure, referred to angina pectoris as "Kardialgia," highlighting the connection between the stomach and the heart. Galen recognized the innervation of both organs by the vagal nerves and associated heartburn and tachycardia with a sympathetic transmission from the stomach to the heart. This connection between the heart and stomach continues to influence today's nomenclature, as the term "ventricle" means "little stomach."

From 1452-1564, anatomical illustrations by Leonardo da Vinci (1452-1519) and Andreas Vesalius (1514-1564) demonstrated a detailed understanding of the heart and coronary vessels. Despite this knowledge, prevailing beliefs suggested that the coronary veins carried blood from the liver to the heart.

In 1628, a significant breakthrough occurred in the understanding of the human circulatory system. It was during this year that W. Harvey published his ground breaking work, "Exercitatio Anatomica de Motu Cordis et Sanguinis" (Fig. 3). Harvey's publication not only described the circulation of blood through the lungs and the body, but it also shed light on the supply of blood to the heart through the coronary arteries. This marked a pivotal moment in unraveling the mysteries surrounding angina pectoris.

In 1761, Italian anatomist Giovanni Morgagni described arterial lesions as "hardening of the arteries" for the first time. However, it was the British clinicians who made significant strides in this field during the late 18th century.

One notable figure was the surgeon John Hunter, who personally experienced angina pectoris and meticulously studied its symptoms. He observed a clear correlation between physical exercise and the onset of anginal attacks. Sadly, in 1793, during a heated discussion at St. George's Hospital, John Hunter succumbed to an anginal attack. His autopsy revealed marked ossification of the coronary arteries, solidifying the connection between coronary health and angina pectoris. John Hunter's case serves as a classic example of how physical and mental stress can acutely trigger anginal episodes.

In the early 1900s, ECG (electrocardiography) technology, which made it possible to measure the electrical activity of the heart and detect abnormalities. This led to the discovery that angina was often caused by a narrowing or blockage of the coronary arteries, which prevented adequate blood flow to the heart muscle.

In the late 19th century, cardiovascular physiologists observed that occlusion of a coronary artery in dogs led to rapid fatal "quivering" of the ventricle. the vascular system and identified risk factors associated with thrombus formation.

In the 19th century, Claude Bernard conducted catheterizations on animals, measuring pressures in their vessels and cardiac chambers. In 1929, Werner Forssman performed cardiac catheterization on himself, sparking further exploration by Andre Frederic Cournand and Dickinson Richards. Their collective efforts in understanding cardiac hemodynamics earned them the Nobel Prize in Physiology or Medicine in 1956.

In the mid-20th century, further advances in technology such as coronary angiography and cardiac catheterization allowed physicians to directly visualize the coronary arteries and diagnose blockages. Later, imaging technologies such as CT scans and MRI have been developed, which allow for non-invasive visualization of the heart and blood vessels.

Modern Understanding of Angina

Angina is a medical condition that affects the heart. It is caused by restricted blood flow to the heart muscles. This lack of blood flow can cause chest pain or discomfort that can spread to other parts of the upper body, such as the shoulders, arms, neck, and jaw. 

People with angina often describe the discomfort as a feeling of pressure or squeezing in the chest. Some people have difficulty breathing or experience dizziness, nausea, or sweating. The pain or discomfort usually goes away within a few minutes after resting or taking medication. 

Angina is a symptom of underlying heart disease, so it is important to seek medical attention if you experience chest pain or discomfort. A doctor can perform tests to determine if you have angina or another heart condition. Some people with angina may need medication or surgery to improve blood flow to the heart muscles. 

To reduce the risk of angina or other heart conditions, it is important to maintain a healthy lifestyle. This includes eating a nutritious diet, getting regular exercise, and managing any underlying health conditions, such as diabetes or high blood pressure. 

Overall, angina is a serious medical condition that requires prompt medical attention. People with chest pain or discomfort should seek medical attention immediately and follow their doctor's recommendations for treatment and prevention.

Causes of Angina

Angina is a condition where there is a temporary shortage of blood flow to the heart muscle. The reduced blood flow is a result of narrowed or blocked arteries that supply blood to the heart. This can lead to chest discomfort or pain, shortness of breath, and/or a feeling of tightness in the chest.

The most common cause of angina is atherosclerosis. This is a buildup of cholesterol and other substances in the artery walls. Over time, this can cause narrowing or blockage of the coronary arteries, which reduces the flow of blood to the heart muscle. Other factors that can increase the likelihood of developing angina include smoking, high blood pressure, high cholesterol, diabetes, obesity, family history of coronary artery disease, and certain medications.

In addition, physical exertion or emotional stress can trigger an angina attack in some people. This is because the heart needs more oxygen when it is working harder, but a narrowed or blocked artery cannot supply the needed oxygen to the heart muscle.

Overall, prevention and early detection of angina is key to maintaining a healthy heart. This includes making lifestyle changes such as quitting smoking, maintaining a healthy weight, and managing other medical conditions such as high blood pressure, diabetes, and high cholesterol.

Treatments for Angina

Mild angina can be treated with lifestyle changes such as quitting smoking, losing weight, getting regular exercise, and eating a balanced diet. These changes will help promote blood flow to the heart.

If lifestyle changes are not enough to reduce the symptoms, medications can help. Nitroglycerin is commonly used to reduce chest pain associated with angina. Nitroglycerin works by relaxing the blood vessels, which allows more blood to flow to the heart.

Other medications that may be used to treat angina include beta-blockers, calcium channel blockers, and ACE inhibitors. These medications work to help control blood pressure and reduce the workload on the heart.

For severe cases of angina, medical procedures such as angioplasty or bypass surgery may be necessary. During angioplasty, a small balloon is inserted into the blocked artery and inflated to open it up. In bypass surgery, arteries or veins from other parts of the body are used to create new pathways for blood to flow to the heart.

It is essential to have regular check-ups with your health care provider to monitor your condition and ensure that your treatment plan is effective.

Lifestyle Changes

- Quit smoking: Smoking damages blood vessels and reduces the amount of oxygen in the blood. Quitting smoking is one of the most important steps you can take to improve your heart health and reduce angina symptoms.
- Maintain a healthy weight: Excess weight puts additional strain on the heart and can worsen angina symptoms. Aim for a healthy weight by following a balanced diet and engaging in regular physical activity.
- Adopt a heart-healthy diet: Eat a diet rich in fruits, vegetables, whole grains, and lean proteins. Limit your intake of saturated and trans fats, cholesterol, sodium, and processed foods. Consider the DASH (Dietary Approaches to Stop Hypertension) or Mediterranean diet, both of which are associated with heart health benefits.
- Exercise regularly: Engaging in regular physical activity can improve heart health and reduce angina symptoms. Consult your doctor before starting an exercise program to determine the most appropriate activities and intensity level for you.
- Manage stress: Stress can trigger angina symptoms. Find healthy ways to manage stress, such as deep breathing exercises, meditation, yoga, or engaging in activities you enjoy. Consider incorporating stress-reduction techniques into your daily routine.
- Monitor and control other health conditions: Manage any other health conditions you have, such as high blood pressure, high cholesterol, or diabetes. Keeping these conditions under control can reduce the risk and severity of angina symptoms.
- Limit alcohol consumption: Excessive alcohol consumption can increase blood pressure and worsen angina symptoms. If you drink alcohol, do so in moderation, following the guidelines recommended by healthcare professionals.
- Get enough sleep: Aim for an adequate amount of sleep each night. Poor sleep can contribute to increased stress and worsen angina symptoms. Establish a regular sleep routine and create a comfortable sleep environment.
- Follow up with your healthcare provider: Attend regular check-ups with your doctor to monitor your condition and make any necessary adjustments to your treatment plan.

Nutrional Changes

- Eat a heart-healthy diet: Focus on consuming foods that promote heart health. Include plenty of fruits, vegetables, whole grains, and legumes in your diet. These foods are high in fiber, vitamins, minerals, and antioxidants, which can help reduce the risk of heart disease and improve overall cardiovascular health.
- Choose lean protein sources: Opt for lean proteins such as skinless poultry, fish (especially fatty fish like salmon, mackerel, and trout rich in omega-3 fatty acids), beans, lentils, and tofu. These protein sources are lower in saturated fat compared to red meats and can help maintain a healthy weight.
- Reduce saturated and trans fats: Limit your intake of saturated and trans fats, as they can contribute to the development of plaque in the arteries and increase the risk of angina. Avoid or minimize consumption of high-fat dairy products, fatty meats, processed snacks, fried foods, and commercially baked goods.
- Opt for healthy fats: Include foods rich in monounsaturated and polyunsaturated fats, such as avocados, nuts, seeds, and olive oil. These fats can help improve cholesterol levels and overall heart health.
- Limit sodium intake: Excessive sodium consumption can increase blood pressure, putting additional strain on the heart. Limit your intake of high-sodium foods like processed meats, canned soups, salty snacks, and fast food. Opt for fresh, whole foods and season your meals with herbs and spices instead of salt.
- Increase fiber intake: Include fiber-rich foods like whole grains (oats, brown rice, whole wheat bread), fruits, vegetables, and legumes in your diet. Fiber can help lower cholesterol levels and promote heart health.
- Moderate alcohol consumption: If you choose to drink alcohol, do so in moderation. Limit your intake to one drink per day for women and up to two drinks per day for men. Excessive alcohol consumption can increase blood pressure and worsen angina symptoms.
- Stay hydrated: Drink an adequate amount of water throughout the day to maintain proper hydration. Dehydration can strain the heart and potentially trigger angina symptoms.
- Be mindful of portion sizes: Pay attention to portion sizes to avoid overeating. Maintain a balanced and moderate caloric intake to maintain a healthy weight.

Symptoms

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Fainting / loss of consciousness
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Abdominal pain
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Lightheadedness
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Chest pain
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Shortness of breath
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Swelling in the legs, ankles, or abdomen
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Fatigue

Confirmation Tests

- Computed tomography angiography (CTA)
- Echocardiogram
- Electrocardiogram (ECG)
- Heart monitor

Supplimentary Articles

The estimated prevalence of Angina is 4-7% for men and 5-7% for women aged 45-64, and 14-15% for men and 10-12% for women aged 65-84.
A Brief History of Angina Pectoris

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