What You Should Know About Angina

Angina is chest pain or discomfort caused when heart muscle doesn't get enough oxygen-rich
blood because of deposition of waxy substance called plaque in the coronary arteries. Patient
feels discomfort in shoulder, arms, neck, jaw, or back squeezing, bursting, gas or indigestion.
Angina can also be a symptom of coronary disease. Angina can also be a symptom of coronary
microvascular disease.

Types of angina
angina pectoris
unstable angina
variant angina
micro vascular angina

Angina pectoris
Pericardial chest pain is usually precipitated by stress or exertion relieved rapidly by rest or
nitrates. It is usually due to atherosclerotic heart disease.

Unstable angina
Unstable angina does not follow a regular pattern. It can occur when at rest and is considered
less common and more serious because rest and medication does not relieve it. This can signal
a future heart attack within a short time - hours or weeks.
Variant and microvascular angina
Variant (Prinzmetal's) angina and microvascular (smallest vessels) angina are rare and can
occur at rest without any underlying coronary artery disease.

This angina is usually due to abnormal narrowing or relaxation (spasm) of the blood vessels,
reducing blood flow to the heart. It is generally relieved by medicine.

Causes of angina
Angina is most frequently the result of underlying coronary artery disease. The coronary arteries
supply the heart with oxygen-rich blood. When cholesterol aggregates on the artery wall and
hard plaques form, the artery narrows. Because of deposition of waxy substance it is very
difficult for oxygen-rich blood to reach the heart muscle as the arteries become too narrow. The
plaque narrows the arteries or may break off and form blood clots that block the arteries. The
actual angina attacks are the result of the reduced oxygen supply to the heart. Common triggers
include:

Physical exertion is a common trigger because the heart needs more oxygen than it receives
in order to work harder

Severe emotional stress

A heavy meal

Use of fast foods

Exposure to extreme temperatures.

Smoking may trigger angina attacks.

Symptoms of angina

Angina is usually felt in the chest region as:

squeezing

pressure

heaviness

tightening

burning or aching across the chest, usually starting behind the breastbone. This pain often
spreads to the neck, jaw, arms, shoulders, throat, back, or even the teeth.

Patients may also complain of symptoms including:

 indigestion

heart burn

weakness

sweating

nausea

cramping

shortness of breath

Occasionally, a gallop rhythm and an apical systolic murmur due to transient mitral regurgitation
from papillary muscle dysfunction are present during pain only. Supraventricular or ventricular
arrhythmias may be present, either as precipitating factor or as a result of ischemia.

Diagnosis of angina
All the chest pain may not be angina. It may be gas, peptic ulcer , chronic cholecystitis
esophageal spasm, or functional gastrointestinal disease. A correct diagnosis for chest pain is
important because it can predict the likelihood of having a heart attack.

The process will start with discussion of symptoms, risk factors, and family medical history. Here
are the some test which are required to diagnose this disease:

Blood tests - to check levels of fats, lipid, cholesterol, sugar, and proteins

electrocardiography- records the changes in myocardial infarction atrioventricular or intra

ventricular conduction defects and changes of left ventricular hypertrophy

echocardiograph- image the left ventricle and reveal segment wall motion abnormality
which may indicate ischema or prior infraction

Electrocardiogram (EKG) - records electrical activity of the heart and can detect when the
heart is starved of oxygen.

cardiac magnetic resonance imaging (MRI)- is an evolving modality that provides high
resolution image of the heart and great vessels without radiation exposure
 Stress test - blood pressure readings and an EKG while the patient is increasing physical
activity.

Chest X-ray - to see structures inside the chest

Coronary angiography - dye and special X-rays to show the inside of coronary arteries (dye
is inserted using cardiac catheterization).

Prevention
control unhealthy cholesterol levels

control hypertension

quit tobacco smoking

control diabetes

control being overweight or obese

metabolic syndrome

avoid sedentary lifestyle

remain physically active

learn how to handle stress, eat fruits, vegetables, whole grains, low-fat or no-fat dairy
products, and lean meat and fish.

Treatment
1-treatment of acute attack-

Sublingual nitroglycerine is the drug of choice. It acts in about 1-2 min. Nitrate decreases
arteriolar and venostone , reduces preload and afterload and lower the oxygen demand of heart.
As soon as the attack begins, one fresh tablet is placed under the tongue. Nitrates prevent or
reduce the intensity of angina attacks by relaxing and widening blood vessels.

2-prevention of further attack

aggravating factor
long acting nitrates
 beta-blockers
calcium channel blockers
ACE (angiotensin-covering enzyme) inhibitors

oral anti-platelet medicines

anticoagulants
Medicine which lowers the cholesterol levels are also given by the specialist. In some cases
angioplasty or coronary artery bypass grafting is recommended by the specialist.

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