Angina Pain and Related

Cardiovascular Problems

Ric and Jennifer

What is Angina Pain?

A condition often referred to as
angina pectoris --refers to thoracic
pain originating from a lack of oxygen
to the heart muscle (ischemia)

Described by a feeling of discomfort or

heavy pressure localized in the chest
region

How it differs from a Heart

Attack

Angina pain is a short pain resulting

from the muscle temporarily receiving
insufficient amounts of oxygen
vs.
Myocardium infarction results in
cardiac arrest and permanent damage
to the heart muscle, results from a
complete cut off of oxygen

Types of Angina
1.) Angina of Effort- A medical condition that often
results from atherosclerosis

-arteries can supply sufficient oxygen to resting heart but fail

to do so during periods of exercise or stress resulting in a

painful sensation
2.) Variant Angina- An uncommon condition that exists
independently of atherosclerosis
-arteries cannot supply enough oxygen to the resting heart;
the condition does not result from excessive work by
myocardium
*can also occur as a result of eating (postprandial) and while
sleeping (nocturnal)

Symptoms of Angina
Pain/heaviness

under the sternum

Can be experienced elsewhere (back,
arms, neck, shoulders, or jaw
regions)
Breathlessness and Fatigue
Increased risk of heart attack

Causes of Angina
Excessive exercise and stress when
coupled with atherosclerosis (effort)
Insufficient coronary arterial muscle
spasms (variant)
The difference between demand and
supply of blood/oxygen to myocardium

---5% of angina cases actually result from a predisposed heart

demanding an abnormal amount of oxygen to function
*more common in the adult population as risk for coronary heart
disease increases

Detection Methods
Physicians
Electrocardiogram
accurate)

Stress

Tests

Angiograms
cases)

non-invasive (85%

invasive (used in other 15% of

Electrocardiogram
Electrocardiogram*-

useful to confirm
Angina pain and other abnormal
features
-must be coupled with some sort of
stress test (before, during, and after)
Echocardiogam- associates symptoms
and ECG levels during a 24 hour
period
(used with nocturnal angina)

Angiogram
a virtual x-ray of coronary arteries
Image is derived by the placement of
a catheter in a major coronary artery
Dye is injected to see the blood
flow to the heart
*Most accurate and effective way to
determine presence and severity of
angina

Risk Factors
Cigarette

Smoking (results in atheroma)

High cholesterol intake (results in atheroma)
Extreme temperatures
Emotional Stress
Alcohol Abuse
Heredity ethnic
predispositions/diabetes
Personality Type

Treatments
Often

can be alleviated within minutes

by relaxation/resting
Intake of prescribed angina medications
often consisting of nitroglycerin (reduces
ischemia)

Reduce

risk factors through

conventional treatments
Surgical procedures increase blood flow
to the heart

Conventional Treatments
Exercise/yoga

and even massage therapy

have been said to alleviate painful effects
Behavioral counseling-reduce cholesterol,
smoking, drinking, and obesity (i.e.- diet)
Nitroglycerin meds.- increases diameter
of blood vessels (taken orally or transdermally)
Beta blockers- decrease demand and
workload of myocardium

Surgical Treatments
Coronary

Bypass Surgery- blood

vessel from leg often grafted on the
blocked artery, increasing blood flow
Balloon angioplasty- catheter with
small balloon placed into coronary
artery to expand blood vessel
Angioplasty and bypass surgery often
followed by behavioral counseling to
reduce risk factors like obesity

Final Thought
*We must take preventative efforts to
help reduce the presence of Coronary
Artery Disease, as it is the underlying
cause of angina pain *

Road Map
Coronary

Heart Disease

What is it?
Risk

Factors

Unavoidable
Treatable or changeable
Myocardial

Infarctions

What is it?
Symptoms
Treatment options

What is Heart Disease?

Called Coronary Heart Disease or Coronary
Artery Disease
Diagnosed when arteries that supply blood
to heart muscle becomes hardened and
narrowed

Caused by plaque on inner walls and called

atherosclerosis
Eventually Heart suffers from lack of oxygen and
causes
Angina
Heart Attack (Myocardial infarction)

Clogged arteries

Who can develop Heart

Disease?

Unavoidable Risk Factors

Age
Sex
Heredity

Treatable Risk Factors

Smoking
High Blood Pressure
High Blood Cholesterol
Physical Activity
Obesity
Diabetes

Unavoidable Risk Factors

Increasing Age Fact of life,
everyone gets older. 83 % of people
who die from Heart Disease is over 65
Being male Have a greater risk and
die younger
Heredity -- Children with parents
suffering from Heart Disease; African
Americans greater risk of High Blood
Pressure and Heart Disease

Risk Factors that can be

changed or treated
Smoking

Smokers have increased risk

2-4 times greater than non-smokers
High Blood Cholesterol The greater
amount of cholesterol greater increase
risk of heart disease
High Blood Pressure Greater the
pressure, the harder the heart must
work, causing heart to thicken and
stiffer

Treatable Risk Factors (cont)

Physical Inactivity inactive lifestyle

increases risk of heart disease; regular
moderate-to-vigorous physical activity helps
prevent heart and blood vessel disease
Obesity and overweight people with
excess body fat are more likely to develop
heart disease and strokes
Diabetes mellitus Even when glucose
levels are under control, there is still an
increased risk, but risk is greater if left
untreated

Predicting who will develop

heart disease

Subjects: 2489 men and 2856 women 30

to 74 yrs. Old
Baseline reading
12 years later
Subjects 383 men and 227 women developed heart
disease
Those with heart disease were associated with high
blood pressure, total cholesterol, LDL and HDL, sex,
Used prediction equation to predict likelihood of
developing disease
Age, diabetes, smoking, blood pressure, total
cholesterol, and LDL

Results And Discussion

28 % of male and 29 % female cases

attributed to blood pressure levels that
exceeded normal high130/85
27 % of male and 34 % female cases
attributed to high total cholesterol (greater
than 200 mg/dL)
Study confirmed the medical guidelines for
blood pressure, total Cholesterol, and LDL
as accurate for predicting risk of middleaged white population

Myocardial Infarctions

Also known as an MI or heart attack

Happens when the blood supply to the
heart is blocked long enough to cause
death of heart tissues
If enough permanent damage occurs,
the patient may die

Myocardial Infarction

Symptoms of MI

Angina
Pain or discomfort in upper arms, left
shoulder, back, neck, jaw or stomach
Difficulty Breathing
Sweating or cold sweat
Fullness, indigestion, or heartburn
Feeling Lightheaded
Extreme weakness
Rapid, irregular heart rate

Treatment Options
Before

getting to the hospital

Quick response time is critical

Call 911 if observe symptoms and do
CPR if necessary
Can take asprin, heprin, antiplatelet
drugs, therombic therapy
At

the hospital

Angioplasty
Bypass surgery

References

Larson, J.P. (2006) Angina. Encyclopedia of

Medicine.
Satyamurthy, I. & Sharma, V. (2004). What is
Angina? DoctorNDTV, Aug. 13.
<http://www.americanheart.org>
Peter W. F., Wilson MD, Ralph B. ,DAgostino PhD,
Levy MD, Belanger BS, Sibershatz PhD, Kannel MD.
(1998). Prediction of Coronary Heart Disease Using
Risk Factor Categories. Circulation 97, 1837-1847.
Retrieved November 6, 2006 from
http://circ.ahajournals.org/cgi/reprint/97/18/1837.pd
f
.
http://en.wikipedia.org/wiki/Myocardial_infarction
http://www.clevelandclinic.org/heartcenter/pub/gu
ide/disease/cad/mi_symptoms.htm