Angina pectoris

Angina pectoris results from a mismatch between restricted coronary artery blood flow and an increased myocardial workload and due to this heart muscle doesn't get enough oxygen-rich blood.. The pain may spread to the left shoulder, left arm and hand; neck, throat, jaw, back and/or stomach. The patient may be temporarily short of breath, and/or feel weak and/or anxious, feel like pressure or squeezing in your chest.
Angina isn't a disease; it's a symptom of an underlying heart problem. Angina usually is a symptom of coronary heart disease(CHD). It occurs if a waxy substance called plaque (plak) builds up on the inner walls of your coronary arteries. These arteries carry oxygen-rich blood to your heart.
Plaque narrows and stiffens the coronary arteries. This reduces the flow of oxygen-rich blood to the heart muscle, causing chest pain. Plaque buildup also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow, which can cause a heart attack.

Types of Angina
The major types of angina are stable, unstable, variant (Prinzmetal's), and microvascular. 

Stable Angina
The pain or discomfort:
• Occurs when the heart must work harder, usually during physical exertion
• Doesn't come as a surprise, and episodes of pain tend to be alike
• Usually lasts a short time (5 minutes or less)
• Is relieved by rest or medicine
• May feel like gas or indigestion
• May feel like chest pain that spreads to the arms, back, or other areas

Unstable Angina
The pain or discomfort:
• Often occurs at rest, while sleeping at night, or with little physical exertion
• Comes as a surprise
• Is more severe and lasts longer than stable angina (as long as 30 minutes)
• Usually isn’t relieved by rest or medicine
• May get worse over time
• May mean that a heart attack will happen soon

Variant Angina
The pain or discomfort:
• Usually occurs at rest and during the night or early morning hours
• Tends to be severe
• Is relieved by medicine

Microvascular Angina
The pain or discomfort:
• May be more severe and last longer than other types of angina pain
• May occur with shortness of breath, sleep problems, fatigue, and lack of energy
• Often is first noticed during routine daily activities and times of mental stress

Causes 
• Smoking
• High amounts of certain fats and cholesterol in the blood
• High blood pressure
• High amounts of sugar in the blood due to insulin resistance or diabetes

Stable Angina
Physical exertion is the most common trigger of stable angina. Severely narrowed arteries may allow enough blood to reach the heart when the demand for oxygen is low, such as when you're sitting.
However, with physical exertion—like walking up a hill or climbing stairs—the heart works harder and needs more oxygen.
Other triggers of stable angina include:
• Emotional stress
• Exposure to very hot or cold temperatures
• Heavy meals
• Smoking

Unstable Angina
Blood clots that partially or totally block an artery cause unstable angina.
If plaque in an artery ruptures, blood clots may form. This creates a blockage. A clot may grow large enough to completely block the artery and cause a heart attack. Blood clots may form, partially dissolve, and later form again. Angina can occur each time a clot blocks an artery.

Variant Angina
A spasm in a coronary artery causes variant angina. The spasm causes the walls of the artery to tighten and narrow. Blood flow to the heart slows or stops. Variant angina can occur in people who have CHD and in those who don’t.
The coronary arteries can spasm as a result of:
• Exposure to cold
• Emotional stress
• Medicines that tighten or narrow blood vessels
• Smoking
• Cocaine use

Microvascular Angina
This type of angina may be a symptom of coronary microvascular disease (MVD). Coronary MVD is heart disease that affects the heart’s smallest coronary arteries.
Reduced blood flow in the small coronary arteries may cause microvascular angina. Plaque in the arteries, artery spasms, or damaged or diseased artery walls can reduce blood flow through the small coronary arteries.

Symptoms
• pressure,
• heaviness,
• tightening,
• squeezing, or
• aching across the chest, particularly behind the breastbone.
This pain often radiates to the neck, jaw, arms, back, or even the teeth.
Patients may also suffer:
• indigestion,
• heartburn,
• weakness,
• sweating,
• nausea,
• cramping, and
• shortness of breath.
Angina usually occurs during exertion, severe emotional stress, or after a heavy meal, when the heart muscle demands more blood oxygen than the narrowed coronary arteries can deliver. 

Risk factors include:
• smoking
• sedentary lifestyle
• high blood pressure, or hypertension
• high blood fats or cholesterol
• hypercholesterolemia
• diabetes
• family history of premature ischemic heart disease

Angina in women
A woman's angina symptoms can be different from the classic angina symptoms. For example, women often experience symptoms such as nausea, shortness of breath, abdominal pain, or extreme fatigue, with or without with chest pain. Or a woman may feel discomfort in her neck, jaw or back or stabbing pain instead of the more typical chest pressure. These differences may lead to delays in seeking treatment.

Home Remedies for Angina Pectoris
• Cloves are also helpful, peel two or three cloves from the top and pop them like pills in every morning. 
• Garlic is well known for reducing cholesterol in body, eating garlic directly or with honey can useful in treatment of angina.
• Lemon: many people find that lemon juice is an effective treatment of angina. This is because lemon juice eliminates and stops cholesterol accumulation in the blood vessels.
• Holy Basil leaves are also very helpful with problems related to angina. Chew few fresh Basil leaves every morning. In the scarcity of fresh basil leaves, take dry Basil leaves and make a tea of that leaves and drink this every morning. 
• Mix some pure honey, a slice of lemon, and warm water together and take this mixture as an initial thing in the morning before eating or drinking anything else. 
• Another efficient home remedy that can be start morning is onion juice. Make puree a full onion with water, of course peeled one. Drink this juice in the morning on an empty stomach to decrease the cholesterol in bloodstream and in body. 
• Beet juice is also helpful in controlling Angina. 
• Daily intake of fresh grapes and apple are one of the easiest home remedies for Angina. Apples are helpful in proper blood circulation.
Preventions :
• Don't smoke. Cigarettes remove oxygen from the blood. They excite the heart, and make the blood cells stick together. If someone stops smoking, after five years their risk of a heart attack falls to about the same as non-smokers. 
• Lowering high blood pressure High blood pressure makes the heart work harder. So blood pressure needs to be controlled. 
• Weight reduction. Keeping close to the recommended weight for your height and age will keep your blood pressure down and reduce the workload on your heart. 
• Lowering blood cholesterol. If your blood cholesterol is too high you will be given statins and advised on diet, eg. 
Cut down on saturated fats – in dairy products and fatty meats. Eat lean meats, use little or no butter, and switch to skimmed or semi-skimmed milk. Grill food rather than frying it. 
● Polyunsaturated fat is in corn oil, sunflower oil, safflower oil, and soya oil – and is good. 
● Monounsaturated fat is in olive oil, groundnut oil, and rape oil – and is good. 
● Eat plenty of fresh fruit and vegetables – five fruits & vegetables a day. 
• Reduce stress. If you have angina then you should learn to relax more. Some hobbies will help you relax, but the important thing is to find out the stresses at home or work that you cannot cope with. Try to avoid activities that cause mental and emotional turmoil. 


Everyday life with angina
• Exercise will help to keep your weight down – most people feel better generally when they are fit. Walking, swimming, and cycling are all good for the body's systems. You should take 30 minutes of exercise 3 to 5 times a week. 
But weight lifting and press-ups are types of intense exercise that are not recommended. Highly competitive exercise such as squash may be dangerous if you have a heart condition.
• Sexual intercourse. The combination of physical activity and sexual excitement may bring on an angina attack. You do not need to avoid sexual activity, unless it produces angina. Taking a GTN tablet or spray beforehand will usually help. A useful rule is that if you can climb two flights of stairs without pain you can safely manage sexual intercourse. Sex is a normal part of life, if symptoms occur ask for advice. Do not avoid sex as this may lead to unnecessary frustration and reduce your enjoyment of life. 
• Driving. Do not drive if you get angina while driving. If angina only occurs on exercise and is stable, driving is permitted and notification to DVLA is not needed. 
• Holidays and travel are important and are recommended. You should organize your journey to allow plenty of time. Avoid carrying heavy pieces of luggage. Air travel should be no problem in modern pressurized aircraft. At an airport, take a rest in the departure lounge, so that an angina attack is less likely when you walk to the departure gate. You should avoid high mountains, though if you have mild or moderate angina you should be all right at heights up to about 2000 metres or 6600 feet.
• Contact your doctor if your angina attacks become more frequent or more severe. This is especially important if your angina develops at rest or on minimal exertion, or if GTN seems to become less effective. If the angina is worsening, or occurs on only slight exertion or at rest,