Understanding Angina Pectoris
Define Angina
Pectoris
Angina pectoris, commonly known as
angina, is chest pain or discomfort caused
by reduced blood flow to the heart
muscle. It's a symptom of coronary artery
disease (CAD)
where the heart doesn't receive enough
oxygen-rich blood. This imbalance
between oxygen supply and demand
typically occurs during physical exertion
or emotional stress.
Causes of Angina Pectoris
The primary cause of angina is coronary
artery disease(CAD). CAD occurs when
plaque builds up in the arteries, narrowing
them and reducing blood flow to the heart.
This condition is known as atherosclerosis.
Signs and Symptoms of Angina
Pectoris
Chest pain or discomfort,
which can feel like pressure,
squeezing, tightness, or burning
……
Shortness of breath, fatigue,
nausea, or sweating in addition
to or instead of chest pain.
Atherosclerosis
Plaque buildup in arteries.
Hardens and narrows vessels.
Restricts blood flow
significantly
Coronary Spasm
Temporary artery narrowing.
Reduces blood flow to heart.
Can occur at any time.
Blood Clots
Can block narrowed arteries.
Worsens blood flow. Leads to
unstable angina.
Angina Manifestation
Angina manifests as discomfort,
heaviness, pressure, aching,
burning, numbness, fullness, or a
squeezing sensation in the chest.
…
It can radiate to arms, neck, jaw,
back, or stomach. This pain occurs
when the heart's demand for
oxygenated blood exceeds the supply
Stable Angina
Predictable chest pain. Occurs
with exertion or stress.
Relieved by rest or medication.
Stable Angina
Unstable Angina
Sudden, worsening chest pain.
Occurs at rest or with minimal
exertion. A medical emergency.
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Unstable Angina
Variant (Prinzmetal's) Angina
• Caused by coronary artery
spasm often occurring at rest or
during sleep.
Diagnostic Approaches
Diagnosis involves a comprehensive
approach. This includes reviewing
medical history, physical
examination, and various diagnostic
tests to assess heart health and
identify underlying causes.
Clinical Assessment
Begins with a detailed patient
history, focusing on the
characteristics of chest pain
(location, duration, triggers,
relieving factors), associated
symptoms, and a physical
examination.
Electrocardiogram (ECG)
A resting ECG may show signs
of ischemia or prior heart attack.
stress ECG (treadmill or bicycle)
is often used to provoke
Ischemia under controlled
conditions.
Cardiac Imaging
Techniques like stress
echocardiography, myocardial
perfusion imaging (MPI), or
Cardiac.
…
MRI can assess heart function,
blood flow, and identify areas of
ischemia.
Coronary Angiography
An invasive procedure that uses
dye and X-rays to visualize the
coronary arteries and identify
blockages or narrowing. It is
considered the gold standard for
diagnosing CAD severity.
Risk Factors for Angina Pectoris
Several factors increase the risk
of developing angina. These
include
Modifiable risk factors and non
modifiable risk factor
Modifiable Risk Factors
High blood pressure
High cholesterol
Smoking
Diabetes
Obesity
Stress
Physical inactivity
Non Modifiable Risk Factors
Family history of heart disease
Age
Male gender (men generally develop
CAD earlier
Post-menopausal women
Life with Angina Pectoris
Living with angina pectoris
requires lifestyle adjustments
and medical management to
control symptoms and
prevent complications. This
includes:
Dietary changes
Exercise
Stress management
Other Lifestyle Changes
Dietary changes
Balanced Diet: Focus on fruits, vegetables,
whole grains, and lean proteins.
Limit Saturated and Hydrogenated
Fats: These fats can contribute to plaque
buildup in arteries.
Reduce Sodium Intake: High sodium can
raise blood pressure, a risk factor for angina.
Choose Low-Fat Dairy: Opt for low-fat
yogurt and milk over high-fat options.
Exercise
Gradual Increase in Activity: Start slowly
and gradually increase exercise intensity and
duration.
Regular Breaks: Incorporate rest periods into
your exercise routine.
Listen to Your Body: If you experience chest
pain or other symptoms during exercise, stop
and rest.
Stress management
Stress Reduction Techniques: Consider
practicing relaxation techniques like deep
breathing, yoga, or meditation.
Connect with Others: Seek support from
friends, family, or support groups.
Engage in Hobbies: Find activities you enjoy
and that help you de-stress.
Other Lifestyle Changes
Quitting Smoking: Smoking significantly increases the
risk of angina and other heart problems.
Moderate Alcohol Consumption: Limit alcohol intake to
moderate levels.
Maintain a Healthy Weight: Obesity can increase the
risk of angina.
Treat Underlying Conditions: Manage conditions like
high blood pressure, high cholesterol, and diabetes, which
can contribute to angina.
Adequate Sleep: Aim for 7-9 hours of sleep daily.
Treatment
Treatment options for angina
pectoris are aimed at relieving
symptoms, slowing disease
progression, and reducing the risk of
heart attack. These include:
Medications
Nitrates: To relieve chest pain by
widening blood vessels.
Beta-blockers: To reduce heart workload
and improve blood flow.
Calcium channel blockers: To relax
blood vessels and reduce blood pressure.
Ant platelet drugs: To prevent blood
clots.
Lifestyle modifications
Crucial for managing symptoms
and preventing progression:
healthy diet, regular exercise,
smoking cessation, weight
management, and stress reduction
Procedures and surgery
Angioplasty: A procedure to
open narrowed or blocked
coronary arteries.
…
Coronary artery bypass
grafting (CABG): Surgery to
bypass blocked sections of
coronary arteries.
Complications of Angina Pectoris
Heart Attack (Myocardial Infarction)unstable
angina can progress to a heart attack if blood
flow to the heart muscle is completely blocked,
leading to tissue damage.
…..
Arrhythmias Ischemic heart
tissue can become irritable, leading
to irregular heart rhythms
(arrhythmias) which can be
dangerous.
……
Heart Failure:-Prolonged or
recurrent
ischemia can weaken the heart muscle
over time, leading to heart failure,
…
Sudden Cardiac Death:-In severe
cases, life-threatening arrhythmias or
extensive heart damage can lead to
sudden cardiac death.
Key points about Angina
Not a heart attack: Angina is temporary, while a heart
attack causes permanent damage to the heart muscle.
Warning sign: Angina can be a warning sign of a heart
attack or other heart problems.
Treatable: With proper management, angina can be
effectively treated and controlled.
Lifestyle changes: Lifestyle changes like quitting
smoking, healthy eating, and exercise can significantly
reduce the risk of angina.
Reference
"Essentials in Stable Angina Pectoris" by Juan Carlos Kaski
"Angina Pectoris" by Louis Peiser
"Angina Pectoris: Management Strategies and Guide to Interventions" by
Thomas B. Graboys and Charles Blatt
"Therapy of Angina Pectoris: A Comprehensive Guide for the Clinician" by
K. Thomas Taylor
"Angina Pectoris: Etiology, Pathogenesis and Treatment" by Alice P. Gallo
and Margaret L. Jones
