Angina Pectoris

 

What is angina pectoris?

Angina pectoris is characterized by chest discomfort (heaviness, crushing sensation rarely frank pain) due to reduced blood flow to the heart. It can be described as stable, unstable and variant (Prinzmetal). Untreated angina can lead to heart attack (myocardial infarction), disturbance of heart rhythm (arrhythmia) and heart failure. Treatment includes lifestyle modification, medication and intervention.

What are the symptoms of angina pectoris?

The main symptom is chest pain. The pain is typically described as heaviness, squeezing, smothering and choking sensation. It may radiate to the shoulder, arms, back even to neck, jaw and upper part of the abdomen. Pain starts with exertion and relieves with rest (stable angina), sometime the attacks occur with minimal exertion or with increasing frequency or severity of pain (unstable angina). In case of variant angina attacks occur at rest especially during night.

There are other symptoms associated with pain :

  • Profuse sweating
  • Nausea and vomiting
  • Breathing problems
  • Loss of consciousness

What causes angina pectoris?

The underlying cause of angina is the imbalance between supply and demand of oxygen (via blood) to the heart muscle.

  • Stable angina (most common) : During exertions heart has to pump more blood to requiring organs thus increasing oxygen requirement of heart also. The coronary arteries are sometimes narrowed by fatty deposits (atherosclerotic plaques) on the walls. During rest the requirement of the heart can be easily met with the blood supply even through the narrowed arteries hence no symptoms of angina. But the situation changes with exertion as the demand of the heart cannot be fulfilled by the meager blood supply through the narrowed arteries.
  • Unstable angina: sometimes the fatty deposits on the arterial walls rupture, form clot and block the already narrowed arteries further. This type of angina typically occurs at rest or with minimal exertion.
  • Variant /Prinzmetal angina: in this type there is sudden temporary spasm (contraction) of the narrowed arteries. It usually occurs in 2% of the angina patients.

Risk factors

  • Co-existent diseases: high blood pressure, diabetes, high cholesterol
  • Family history of heart disease
  • Cigarette smoking
  • Alcoholism
  • Sedentary life-style (lack of exercise)
  • Stressful life
  • Obesity

How is angina pectoris treated?

Treatment includes lifestyle modification, drug treatment and surgery. Patients need to be aware of the dangers and potential for a heart attack. Since the symptoms of angina pectoris and a heart attack are similar, patients sometimes delay seeking treatment when they are having a heart attack in the belief that it is just a persisting case of angina pectoris.

Lifestyle modification:

  • Cessation of smoking
  • Moderate alcohol consumption
  • Regular exercise with advice from a doctor
  • Dietary modification
  • Weight reduction
  • Stress management

Drug therapy :

  • Nitrates (relaxes the arteries thus increasing blood flow): during attack placed under the tongue for immediate relief of the pain, skin patches are used for long-term benefit.
  • Low dose aspirin (reduces the chance of clot formation): chewable tablets for immediate and long-term benefit.
  • Beta blockers (reduces work load on heart).
  • Statins (to lower co0existent high cholesterol).
  • Calcium channel blockers (relaxes arteries).
  • ACE inhibitors (relaxes arteries).

Surgical procedures :

  • Angioplasty and stenting: widening of narrow arteries by tiny balloon and subsequent stenting (inserting wire) to maintain it.
  • Bypass surgery: vein or artery from other part of the body used to bypass the narrowed (blocked) artery to maintain blood flow to heart.

 

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