Coronary
arterial circulation normally supplies sufficient blood to meet oxygen demands of
myocardium.
When one or more of these major arteries of
coronary arterial
circulation becomes severely narrowed by the process of atheroscleresis, the
myocardium receives inadequate blood supply.It may not result in any symptom at
rest.But during increased work load to the heart(e.g.exercise,emotion etc.) an
imbalance arises in between the supply &demand for blood.Such an imbalance
in blood supply precipitates chest pain called as Angina Pectoris. Typically, chest pain occurs during exertion and
pain subsides promptly on resting.
There are three types of Angina Pectoris
1.Chronic stable Angina
2.Unstable Angina
3.Prinzmetal’s Angina
When pain(symptom) is present for long time without change in it’s character,it is called Chronic stable Angina.
When pain(symptom) is present &recently it is progressive in nature,it is called Unstable Angina.
In some patients pain in chest occurs due to spasm of coronary artery without atherosclerosis,such type of angina is called Prinzmetal’s Angina or variant angina.
Risk factors for angina
1.Obesity
2.Hypertension
3.Cigarette smoking
4.Diabetes Mellitus
5.Family history
6.Hyperlipidemias
7.Increasing age
Clinical Features 1.Chest Pain
Substernal chest pain radiation to left shoulder or left jaw. Duration of chest pain is 2-3 min. Chest pain is usually exertional.
2.Palpitation
3.Sweating
Physical examination reveals
- Hypertension
-CCF
-Cardiomegaly
-Cardiac arrhythmias
Investigations 1.Electrocardiography(ECG)
2.Echocardiography
3.Coronary angiograms
4.Blood sugar
5.Blood lipids
Treatment 1.Medical treatment
a.General treatment
-correction of risk factors like HTN, Diabetes
Mellitus, smoking etc.
b.Specific treatment
-low dose aspirin
-Nitrates & B-blockers
-Calcium channel blockers
2. Surgical treatment
-Coronary artery bypass graft (CABG)
3.Percutaneous transluminal Coronary angioplasty(PTCA) in which coronary obstruction is
relieved by inflating a ballonet the site of stenosis.
Prognosis The prognosis of patient with angina pectoris depends upon many factors such as age, number of coronary arteries affected , site of narrowing of coronary arteries, presence or absence of
congestive failure , hypertension,MI,ECG findigs etc.
Early onset of angina before the age of 40 years with a family history of premature cardiac death suggests unfavourable prognosis. Half of all patients die suddenly,an additional third
will die following acute myocardial infarction(MI).CCF accounts for most of the
remainder of deaths.