DEFINITION
Angina is pain or discomfort in the chest. Often, it causes a feeling of tightness. This discomfort can also be felt in the shoulders, arms, neck, jaw, or back. In general, angina pain lasts no more than two to ten minutes. To relieve it, rest or give nitroglycerin. The types of angina are:
Stable Angina: has predictable features. In general, it is known what causes it and what relieves it. You can also know what its intensity will be.
Unstable Angina: it is more unpredictable or severe. Chest pain can occur while resting or even sleeping (nocturnal angina). The discomfort may persist longer and be more intense than that of stable angina.
Unstable angina may be a sign that you are about to have a heart attack. It should be treated as an emergency.
Variant angina or Prinzmetal's angina: occurs while resting. In most cases, it occurs in the middle of the night. It can be quite serious.
CAUSES
In general, angina is a sign of coronary artery disease (CAD). It occurs when the blood vessels leading to the heart become blocked. The blockage decreases the flow of blood and oxygen to the heart muscle. When the heart muscle lacks oxygen, it causes chest pain and other symptoms.
Stable or unstable angina
Angina occurs when the heart's need for blood and oxygen increases due to:
- exercise, exertion
- Cold weather
- a hearty meal
- emotional tension
Stable angina becomes unstable when symptoms:
- occur more frequently
- last longer
- are more easily produced
Variant angina or Prinzmetal's angina
In general, this type of angina is caused by a spasm of a heart vessel. It may indicate that you have one of the following conditions:
- CAD
- Extreme hypertension
- hypertrophic cardiomyopathy
- Heart valve diseases
In general, this type of angina is caused by a spasm of a heart vessel. It may indicate that you have one of the following conditions:
- CAD
- Extreme hypertension
- hypertrophic cardiomyopathy
- Heart valve diseases
RISK FACTORS
The main risk factors for CAD include:
- Gender: male
- Advanced age
- Proven family history of heart disease
- Obesity and overweight
- Smoking
- High blood pressure
- Sedentary lifestyle
- Elevated blood cholesterol level (specifically, elevated low-density cholesterol (LDL) and low high-density cholesterol (HDL))
- Diabetes
Other risk factors for CAD:
- Stress
- Excessive alcohol intake
SYMPTOMS
oppressive chest pain
- Some people do not feel severe pain
- Elderly people, women, and people with diabetes may be more likely to have atypical or subtle symptoms
- Some people have asymptomatic ischemia and no symptoms of chest pain.
- Chest pain of any kind requires a clinical evaluation to determine its cause.
- Chest pain or discomfort is the hallmark symptom of angina.
The chance of having a heart attack increases when chest pain is severe, when it persists for more than 15 minutes, and when it is accompanied by other symptoms, including:
- Pain in the shoulders or arms or in the jaw
- Weakness
- Sweat
- Nausea
- Shortness of breath
DIAGNOSIS
Tests will be done right away to see if you are having an episode of angina or a heart attack. If you have features of stable angina, other tests may be done to determine the extent of the disease. The test results will be helpful in developing a treatment plan. The doctor will ask about your symptoms and medical history. You will have a physical exam. Tests may include:
Blood tests – to look for certain blood indicators and determine if you have a heart attack
Electrocardiogram (ECG): a recording of the electrical activity of the heart, to look for signs of previous heart attacks, acute heart attacks, or heart rhythm problems
Echocardiogram—high-frequency sound waves (ultrasound) are used to examine the structure and function of the heart
Exercise stress test: records the electrical activity of the heart when it is more demanding
In people who cannot exercise, a drug is used to simulate the effects of physical exertion
Scintigraphy: radioactive material is injected into a vein to highlight areas of low blood flow
Electron-beam computed tomography (coronary calcification scan, cardiac scan, CT angiography): a type of x-ray that uses a computer to make detailed pictures of the heart, coronary arteries, and surrounding structures
Type of C which measures the amount of calcium deposits in the coronary arteries to determine the risk of heart disease or heart attacks.
General guidelines from the American Heart Association (AHA) state that cardiac scans are not appropriate for everyone and are more likely to benefit patients at intermediate risk of CAD
Coronary angiography: contrast dye is injected into the arteries to highlight abnormalities (stenosis or blockage) in the arteries
TREATMENT
Treatments for angina include:
Medicines
Nitroglycerin – usually given during an angina attack as a tablet that dissolves when placed under the tongue or as a spray
Longer lasting types can be used before activity to prevent angina. They can be supplied as tablets or applied as patches or ointments.
Anticoagulants: a small daily dose of aspirin has been shown to reduce the risk of having a heart attack
Some people may benefit from adding warfarin (eg, Coumadin). Taking this medicine puts you at increased risk of bleeding.
Check with your doctor before taking aspirin or warfarin daily.
Beta-blockers and calcium antagonists: they can reduce the appearance of angina.
Cholesterol-lowering drugs: They can prevent the progression of DKA. They can even enhance an existing CAD.
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs): lower blood pressure and workload on the heart.
Surgery
Patients with ongoing severe or unstable angina may benefit from:
- Coronary artery bypass grafting – arteries from other parts of the body are used to bypass clogged coronary arteries
- Coronary angioplasty – uses a balloon to open up clogged arteries
PREVENTION
If you already have angina, you can prevent a flare-up by knowing what causes it. If you don't have angina, preventing CAD from developing can lower your chance of getting the condition. Steps to prevent CAD involve managing risk factors:
- Maintain a healthy weight
- Start a safe exercise program with your doctor's advice.
- Stop smoking.
- Eat a healthy diet. It should be low in saturated fat. In addition, it should be high in whole grains, fruits, and vegetables.
- Treat high blood pressure or diabetes appropriately.
- Treat abnormal cholesterol levels or elevated triglycerides appropriately.
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