ANGINA
(In cases of Angina,
Coronary Artery Disease and Post MI)
DEFINATION : Angina is pain, "discomfort," or pressure
localized in the chest that is caused by an insufficient
supply of blood (ischaemia) to the heart muscle. It is
also sometimes characterized by a feeling of choking,
suffocation, or crushing heaviness.This condition is called
angina pectoris.
CAUSES : Coronary artery disease is by far the most cause
of angina.Blockages in the coronary arteries, called plaques,
prevent enough blood from reaching the heart muscle. Activities
or situations that require increased blood flow to the heart
may cause angina. These include exercise,heavy meal, emotional
stress,extreme temperatures,cigarette smoking and alcohol.
Less common causes of angina include coronary artery spasm
(also called Prinzmetal''s angina),diseases of the heart valves,
heart failure, and abnormal heart rhythms.
RISK FACTORS
The risk factors for angina which can also causeor contribute
to an episode of angina are:
a) Cigarette smoking b) high cholesterol levels(in particular,
high LDL cholesterol and low HDL cholesterol),
c) high blood pressure d) diabetes d) family history of coronary
heart disease before age 55 e) sedentary lifestyle
f) being more than 30% over ideal ideal weight g) stressful life.
SIGNS AND SYMPTOMS : Angina causes a pressing pain or sensation
of heaviness,
usually in the chest area under the breast bone
(sternum).It occasionally is experienced in the shoulder, arm,
neck, or jaw regions.Since episodes of angina occur when the
heart''s need for oxygen increases beyond the oxygen available
from the blood nourishing the heart, the condition is often
precipitated by physical exertion. In most cases, the symptoms
are relieved within a few minutes.Mid sternal pain (under the
breast bone) or slightly to the left chest may radiate to
shoulder,arm,jaw,neck,back or other areas tightness, squeezing,
crushing, burning, choking, or aching pain similar to "gas" or
indigestion,usually not sharply localized precipitated by
activity, stress, exertion usually of short duration, ie.1 to 15
minutes usually relieved by rest and/ or nitroglycerin.
DIAGNOSIS : Physicians can usually diagnose angina based on the
patient''s symptoms and the precipitating factors.However,other
diagnostic testing is often required to confirm or rule out
angina, or to determine the severity of the underlying
heart disease.
The diagnostic procedures include :
1) Electrocardiogram (ECG) 2) Stress test 3) Angiogram
PROGNOSIS : The prognosis for a patient with angina depends on
its origin, type,severity, and the general health of the
individual. A person who has angina has the best prognosis if
he or she seeks prompt medical attention and learns the pattern
of his or hena, such as what causes the attacks, what they
feel like,how long episodes usually last, and whether medication
relieves the attacks.
Sudden death, acute MI(heart attack), or unstable angina may
occur.
COMPLICATIONS :
a)Unstable angina b)acute MI c)Sudden death caused by lethal
arrhythmias
TREATMENT
CONSERVATIVE TREATMENT : Artery disease causing angina is
addressed initially by controlling existing factors placing
the individual at risk.These factors include cigarette smoking,
high blood pressure, high cholesterollevels,and obesity.Angina
is often controlled by medication, most commonly with
nitroglycerin. This drug relieves symptoms of angina by
increasing the diameter of the blood vessels carrying blood
to the heart muscle. In addition, beta blockers or calcium
channel blockers may be prescribed to also decrease the demand
on the heart by decreasing the rate and workload of the heart.
SURGICAL TREATMENT : When conservative treatments are not
effective in the reduction of angina pain and the risk of heart
attack remains high, physicians may recommend angioplasty or
surgery. Coronary artery bypass surgery is an operation in which
a blood vessel (often a long vein surgically removed from the
leg) is grafted onto the blocked artery to bypass the blocked
portion. This newly formed pathway allows blood to flow
adequately to the heart muscle.
Another procedure used to improve blood flow to the heart is
ballon angioplasty. In this procedure, the physician inserts
a catheter with a tiny ballon at the end into a forearm or
groin artery. The catheter is then threaded up into the coronary
arteries and the ballon is inflated to open the vessel in
narrowed sections.
Writer .......DR.B.CHAKRABORTY, M.D., F.R.S.H (London)
PHYSICIAN CARDIOLOGY
SAFDARJUNG HOSPITAL, NEW DELHI.