ANGINA
What Is Angina? Angina pectoris, the full name, is chest pain that occurs when not enough
oxygen is supplied to the muscle of the heart.
It is often described as discomfort
rather than pain, that is felt behind the sternum and may radiate to the neck,
jaw, shoulder, or arms. It may be
accompanied by shortness of breath and/or anxiety. Angina occurs when the
heart’s demand for oxygen increases; thus pain is often elicited by physical
exertion or emotional stress.
Typically, anginal pain reaches a peak within minutes or seconds, lasts
up to 15 minutes, and is relieved by rest.
Stable angina is that which
follows a consistent, predictable pattern over a long period of time, without
worsening in severity or frequency. Unstable angina represents disease
progression and is manifested as increasing severity and/or frequency of pain,
and attacks of pain occurring at low levels of exertion or at rest.
What Causes Angina? Angina is generally a
consequence of coronary artery disease, also known as atherosclerosis, or
simply “heart disease.” Atherosclerosis
is a condition that involves fatty build-up and narrowing of the arteries, and
thus limits blood flow through them. When
the heart beats faster or harder, it requires more blood, and diseased coronary
arteries are unable to meet this demand; the result is oxygen deprivation
resulting in angina. The major risk factors for heart disease are (1) high blood pressure (2) high
cholesterol (3) cigarette smoking (4) diabetes mellitus and (5) family history of heart disease or
stroke. Also significant are male
sex, obesity, and sedentary lifestyle.
The debate about alcohol intake continues to rage; there is some
evidence that moderate alcohol intake (1 drink/day) may in fact be protective;
more conclusively, it has been shown that heavy drinking can contribute to
arterial disease.
What Is The Difference Between Angina And A Heart Attack? Stable angina, unstable angina, and a heart attack represent points
on the continuum of heart disease. In
stable angina, the heart’s demand for oxygen is met, except upon exertion. In unstable angina, the coronary arteries
are unable to supply enough blood to the heart even at rest. A heart attack occurs when the oxygen
deprivation is so great that a portion of the heart muscle actually dies. Although angina will not necessarily over
time result in a heart attack, the progression from stable to unstable angina
is a cause for concern.
How Is Angina Diagnosed? Angina is
usually diagnosed based on the patient’s
history. If the pain is described
as pressure, squeezing, or heaviness, and is reliably brought on by exertion
and relieved by rest, the diagnosis of angina is fairly certain. Tests such as an ECG, stress testing, and
angiography may be ordered to confirm the diagnosis or to determine the
severity of disease. An ECG, or electrocardiogram, is a quick and
painless test of the heart’s function using electrodes placed on the
chest. Stress testing involves observation of the patient’s ECG and blood
pressure while he or she exercises on a treadmill or stationary bicycle. In some cases angiography may be performed; this test allows direct visualization
of the coronary arteries to determine the extent of arterial blockage.
With What May Angina Be Confused? Multiple potential
causes of chest pain must be considered when angina is suspected; however, few other conditions have such a characteristic and predictable course.
Other possible causes of chest discomfort include trauma to the chest wall, indigestion,
peptic ulcer disease, hiatus hernia, and gallbladder disease. When chest pain occurs along with gastrointestinal complaints this can
sometimes make for diagnostic uncertainty, as there is sometimes an association between angina and the disorders
just mentioned.
What Is The Treatment For Angina? The most important
element of treatment is management of atherosclerosis, the underlying disease.
Modification of preventable risk factors effectively reduces the
risk of heart attack and stroke. Lifestyle changes such as quitting smoking, eating a low-fat,
high-fibre diet, exercising, and
maintaining a healthy weight are key to reducing blood pressure and cholesterol, and thus slowing the development of atherosclerotic disease. More specifically, the goals of therapy
are to prevent heart damage due to oxygen deprivation, and to minimize symptoms. To this end, drugs such as beta-blockers, calcium channel blockers, and nitrates may be employed. Nitroglycerin is commonly prescribed to prevent or minimize attacks; it is generally administered as a sublingual (under the tongue) tablet or spray, and offers relief within minutes. Up to 3 doses may be taken if the pain is not eliminated. Patients should carry nitroglycerin at all times and should consider
taking a dose prior to exercise as a preventive measure. Angioplasty or coronary
arterial bypass surgery can be very effective in selected cases.
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