Angina Pectoris

Introduction

ANGINA PECTORIS ("ANGINA") is a recurring pain or discomfort in the chest that happens when some part of the heart does not receive enough blood. Angina is a common symptom of coronary artery disease that occurs when the coronary arteries are narrowed or blocked. It is usually relieved within a few minutes by resting or by taking prescribed angina medicine. Important Note: Not all chest pain is angina and therefore should always be evaluated by a Physician. The main function of the heart is to deliver oxygen-rich blood to every cell in the body. The arteries are the passageways through which the blood is delivered and the veins are the passageways through which the blood is collected and returned to the heart. The coronary arteries supply blood to the heart muscle. When the coronary arteries become narrow or blocked, blood flow to the heart is reduced. This decrease in blood flow to the heart deprives the heart muscle of oxygen. The heart responds to the lack of oxygen by sending out signs in the form of pain called angina.

Atherosclerosis

Atherosclerosis is a condition in which fatty material is deposited along the walls of arteries. This fatty material (often called plaque) thickens, hardens, and may eventually block the arteries. Atherosclerosis of the coronary arteries is the most common cause of angina.

Risk factors

Risk factors for atherosclerosis and angina include:

Family history- Hypertension (High Blood Pressure)- High cholesterol or other fat levels in blood- Inactive lifestyle- Obesity/ overweight/ lack of exercise- Diabetes (High blood sugar)- Cigarette smoking.

Triggers

Physical exertion is the most common trigger for angina.

Others triggers include:

Emotional stress- Extreme cold or heat- Heavy meals- Alcohol consumption and cigarette smoking.

How will you feel?

Chest pain is the most common complaint in angina. However, the symptoms may be different.

For example:

Fullness, uncomfortable pressure, squeezing sensation in the middle of the chest- Tightness, burning, or a heavy weight over your chest- Pain may radiate to your shoulders, neck, arms, upper abdomen, back or jaw. Important Note: Not all chest pain is angina and therefore should always be evaluated by a Physician.

Diagnoses

To diagnose angina, your doctor may use one of more of the following:

Medical History

This includes:

Physical examination- Questions about your symptoms, risk factors, personal history, and family history of any heart disease.

(EKG or ECG) Electrocardiogram

EKG is a test to measure the electrical activity of the heart and provides your doctor with information about your heart rate, rhythm, size of the heart chambers and previous damage to the heart. It is non-invasive and painless and is performed by attaching electrodes to various parts of the body.

Exercise Tolerance Test (Stress EKG or Stress ECG or Stress Test)

A stress EKG is basically an EKG that is performed while the patient is exercising on a treadmill or a stationary bike. It allows your doctor to see how your heart functions under stress and tells him how healthy your heart is.

Nuclear heart scans

This test shows blood flow to the heart and any damage to the heart muscle. A radioactive dye is injected into your bloodstream. A special camera can see the dye and find areas where blood flow is reduced

Stress Echocardiogram

A stress echocardiogram allows your doctor a more visual view of your heart. An echocardiogram creates still and moving pictures of your heart at rest by bouncing sound waves off the heart from a device called a transducer. The waves are then used to create a picture of your heart. During a stress echocardiogram, your doctor will perform an echocardiogram while you are resting and then again after you have exercised on a treadmill or stationary bike. The information allows the doctor to learn more about the muscles, valves and other structures of the heart

Angiography (Cardiac Catheterization)

Angiography is a test that enables your doctor to take x-ray images of the inside of your blood vessels. This procedure is performed by a cardiologist and involves threading a tiny catheter through a small incision into a large artery, usually in your groin. Once the catheter reaches the site of the blood vessel to be viewed, a dye is injected and x-ray images are taken. Angiography enables your doctor to view how blood circulates in the vessels in specific areas of the body

Management

Lifestyle modifications- Angina medications- Surgery.

Lifestyle Modifications

The following life style modifications can help to prevent or lower your risk for heart disease and angina and improve your heart health:

Healthy Diet Choices

eating a low fat, low salt, low cholesterol diet.

Don't Smoke

If you do smoke, talk to your doctor about available options to help you quit. You will immediately lower your risk of heart disease as soon as you quit.

Exercise

increasing your physical activity is a great way to reduce stress, improve sleep, lose weight, and improve your overall sense of well being. Always discuss with your doctor before beginning any new exercise program.

Weight Loss

Being overweight puts extra strain on your heart. Discuss weight loss options with your doctor and follow his advice.

Angina Medications

Along with life style modification, medications may be needed to control symptoms and improve the heart health. More than one medication may be prescribed. Some common angina medications are listed on the left. Move your cursor over the medications to find out more.

Aspirin:

reduces the tendency of small blood cells called platelets to stick together, which helps prevent the formation of a blood clot (thrombosis)

Nitroglycerin (NTG)

This quick acting sublingual tablet or spray relax the arteries of the heart and relieve angina attacks. Long-acting nitrates reduce the frequency of angina attacks. These can be in the form of tablets or patches and are very effective. Their main side effect is headache, but this often disappears once the nitrate has been taken for some weeks Beta blockers work by slowing down the heart rate and decreasing the force of the heart muscle. This reduces the heart's need for oxygen and improves the supply of blood to the heart muscle. Calcium channel blockers reduce the frequency and severity of chest pain. They reduce the muscle tension in the coronary arteries, expanding them and creating more room. They also slightly relax the heart muscle, reducing the heart's need for oxygen and reducing blood pressure.

Surgery

When lifestyle changes and medications are not sufficient to control angina, your doctor may suggest surgery or invasive procedures. The following procedures improve blood flow to the heart to relieve the chest pain and may prevent a heart attack in the future.

Angioplasty

In this procedure, a thin tube is threaded into the coronary arteries via a blood vessel in the groin, in a similar procedure to cardiac catheterization. A small balloon attached to the end of the tube is inflated, which widens the blocked portion of the artery and allows increased blood flow to the affected part of the heart muscle. Angioplasty may be done with or without stenting.

Coronary Artery Bypass Graft CABG surgery

the coronary artery blockage is bypassed with a section of vein, taken from the leg or from the forearm.