| CHIEF DISORDERS OF THE HEART |
Angina
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Angina is a pain or discomfort in the chest that often has a squeezing or pressure-like quality. This discomfort can also be felt in the shoulders, arms, neck, jaws, or back. Anginal pain usually lasts for no more than 2-10 minutes, and is relieved by rest or Nitroglycerin.
Angina (an-JI-nuh or AN-juh-nuh) is a symptom of coronary artery disease. When your heart muscle (myocardium) doesn't get enough oxygen-rich blood, you may have chest pain. Angina is typically described as squeezing, pressure, heaviness, tightness or pain in your chest. Many people with angina say it feels like someone is standing on their chest.
Angina is also called as Angina Pectoris (pectoris means chest).
CAUSES
Angina is usually a symptom of Coronary Artery Disease . It occurs when the blood vessels leading to the heart are blocked. This results in less blood, and therefore less oxygen, reaching the heart muscle. When the heart muscle is deprived of oxygen, chest pain and other symptoms result.
Types of Angina include:
STABLE ANGINA – has a predictable pattern. A person with stable angina can usually predict what type and level of activity will cause angina, and what level and length of discomfort such activity will produce.
For example, a person may often get angina that lasts 3-5 minutes after walking a half-mile up a small incline toward their home. Anginal pain goes away within minutes with rest or the use of a medication called Nitroglycerin. It occurs when the heart's need for blood and oxygen is increased by:
* Exercise, exertion
* Cold weather
* A large meal
* Emotional stress
UNSTABLE ANGINA – is used to describe more unpredictable or severe angina. Chest pain may occur while resting or even sleeping (nocturnal angina), and the discomfort may last longer and be more intense than that of stable angina.
Stable angina becomes unstable when symptoms occur more frequently, last longer, or are precipitated more easily. Unstable angina may be a sign that you are about to have a heart attack. It should be treated as an emergency.
VARIANT or PRINZMETAL'S ANGINA – is usually caused by a spasm of a coronary vessel. It occurs when one is at rest, most often in the middle of the night, and can be quite severe. It may indicate that one may have one of the following conditions:
* Coronary Artery Disease
* Extremely high blood pressure
* Hypertrophic Cardiomyopathy
* Diseases of the heart valves
RISK FACTORS
RISK FACTORS
Major risk factors for Coronary Artery Disease (CAD) include the following:
* Male gender
* Advancing age
* Strong family history of heart disease
* Obesity and overweight
* Smoking
* High blood pressure
* Sedentary lifestyle
* High blood cholesterol (specifically, high LDL cholesterol and low HDL cholesterol)
* Diabetes
Other risk factors for CAD:
* Stress
* Excessive alcohol intake
SYMPTOMS
* Pressure or squeezing chest pain
* Pain in the shoulder(s) or arm(s) (often the left shoulder or arm), or into the jaw
* Weakness
* Sweating
* Nausea
* Shortness of breath
DIAGNOSIS
BLOOD TESTS – to look for certain heart attack markers in the blood; helps determine if one is having angina or an acute heart attack.
ELECTROCARDIOGRAM(ECG, EKG)– records the heart's activity by measuring electrical currents through the heart muscle. This test can reveal evidence of past heart attacks, acute heart attacks, and heart rhythm problems.
ECHOCARDIOGRAM– uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart. Provides information about the structure and function of the heart.
EXERCISE STRESS TEST – records the heart's electrical activity during increased physical activity. May be coupled with echocardiogram. Patients who cannot exercise may be given a medication intravenously that simulates the effects of physical exertion.
NUCLEAR SCANNING – radioactive material (such asa thallium) is injected into a vein and observed as it is absorbed by the heart muscle. Areas with diminished flow, and therefore uptake of the radioactive material, show up as dark spots on the scan.
ELECTRON-BEAM CT SCAN –(coronary calcium scan, heart scan, CT angiography ).–a type of x-ray that uses a computer to make detailed pictures of the heart, coronary arteries, and surrounding structures. This type of CT scan measures the amount of calcium deposits in the coronary arteries and based on that and other health information attempts to determines the risk of heart disease, including heart attacks.
CORONARY ANGIOGRAPHY – X-rays taken after a dye is injected into the arteries; allows the doctor to look for abnormalities (narrowing or blockage) in the arteries.
TREATMENT
NITRATE MEDICATIONS
Nitroglycerin is usually given during an acute attack of angina. It can be given as a tablet that dissolves under the tongue or as a spray. There are also longer-lasting types that can be used to prevent angina.These may be given as pills, or applied as patches or ointments.
BLOOD THINNERS
A small, daily dose of aspirin has been shown to decrease the risk of heart attack. Patients who have had unstable angina or a heart attack may benefit from the addition of warfarin (ie, coumadin), though there is an increased risk of bleeding with this medication.
BETA-BLOCKERS and CALCIUM-CHANNEL BLOCKERS
When used regularly (not as treatment for acute angina), these medications may reduce the occurrence of angina.
CHOLESTEROL-LOWERING MEDICATIONS
These may prevent the progression of coronary artery disease and may even improve existing coronary artery disease.
ANGIOTENSIN-CONVERTING ENZYME (ACE)INHIBITORS and ANGIOTENSIN RECEPTOR BLOCKERS (ARBs)
These medications lower blood pressure and are especially beneficial for patients who had a heart attack in the past. They also decrease the workload on the heart.
SURGERY
Patients with severe angina or unstable, progressing angina may benefit from:
* Coronary artery bypass graft
* Coronary angioplasty
PREVENTION
If one already has angina, he/she can prevent its onset by being aware of the activities or conditions which tend to bring it on.
If one doesn't have angina, preventing the development and/or progression of coronary artery disease may reduce the chance of getting angina.
Steps to prevent coronary artery disease include managing risk factors:
* Maintain a healthy weight.
* Begin a safe exercise program with the advice of the doctor.
* Stop smoking.
* Eat a healthful diet, one that is low in saturated fat and rich in whole grains, fruits, and vegetables.
* Appropriately treat high blood pressure and/or diabetes.
* Appropriately treat abnormal cholesterol levels or high triglycerides .
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| Last Modified :
Tuesday, May 12, 2009 |
Compiled and edited by the Editorial team and
approved by Expert panel of h4heart.com
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