What is going on during angina?
Your heart needs blood in two different ways. First, it needs blood so that it can supply it to the rest of your body. Second, it also needs blood to the heart muscle, so the muscle itself can do the work it needs to do. These two functions have different blood supplies. Angina is mainly caused by too little blood to the heart muscle.
What causes angina?
Anything that causes too little blood to the heart muscle can cause angina. A well-known example involves coronary artery disease: blockage of a coronary artery results in considerable pain, and ultimately in heart attack (myocardial infarction) including death of some heart tissue. But there are many other causes of angina. Small blood vessels leading to the heart can become partly blocked (microvascular disease) or the blood vessels may spasm. Microvascular disease is more common among HCM patients.
Chest pain is a highly burdensome and common symptom in those with HCM. It is described differently by different patients; however, commonly expressed as a "tightness" or as if an "elephant is sitting on my chest." It is usually brought on by exertion and relieved by rest, but pain may occur at rest or during sleep, and may persist. In HCM, the main coronary arteries are usually normal, but the greatly thickened muscle demands an increased oxygen supply which cannot be met in some circumstances, thus leading to chest pain.
Treating angina
Angina is a symptom, not a disease, and it is a symptom of many different heart problems. To a great extent, the treatment depends on which kind of angina is occurring and its cause.
Should you seek emergency attention?
Should you seek medical attention if you are having chest pains? If the pains are new to you, that is the safest course. Having HCM doesn't give us immunity to other heart problems, including coronary artery disease, so getting checked for new pain is wise. Sometimes digestive tract problems (gas pains, heartburn) are confused with angina. There is no simple way to distinguish between them. The best advice is that if you are having new chest pains, it is best to get checked quickly! True enough, a visit to the emergency room may seem a waste if it is gas pains - but since they may be heart-related pains, it is much wiser to seek medical attention.
Talk with your cardiologist
Beyond that, discuss it with your cardiologist. Ask when they think you should go to the emergency room or contact them. Your doctor will be able to determine whether it is angina and whether it is stable or unstable. They will likely perform a physical exam, inquire about symptoms, as well as ask about your family history of cardiovascular conditions. If it is determined that the angina is unstable, you may need emergency treatment to prevent a heart attack. Your doctor may need to conduct further tests, such as an EKG, stress test, blood work, and cardiac catheterization.
Drugs for angina
In many patients, beta blockers or calcium channel blockers are successful in reducing or eliminating chest pain. Your cardiologist may prescribe ranolazine, a sodium channel blocker used for angina.
Nitroglycerine is often prescribed for chest pain, and HCM patients should almost always avoid it. Part of its effect is to dilate blood vessels. That can work in many people to relieve angina, but in obstructed HCM patients it tends to have the effect of greatly increasing the gradient, thus making things worse!
The bottom line is that angina is a very unpleasant symptom. Many people with HCM experience it, but many are able to be treated for it. Lifestyle changes, medication, and cardiac rehab can be used to help the pain and discomfort associated with angina. These treatments will also help prevent or lower your risk for heart attack because they are aimed at treating the cardiovascular condition that you have. It is important to remember that not all chest pain indicates heart disease.
