Angina Pectoris

Angina Pectoris is a condition which arises due to the lack of oxygen supply to the heart muscle or due to the removal of carbon dioxide and other wastes interferes with the flow of blood and oxygen to the heart. Angina may be more difficult to identify in some elderly patients when they have symptoms such as abdominal pain after eating (due to increased blood demand for digestion) or have back or shoulder pain (which may be thought to be due to arthritis ). In most severe cases, it may occur with minimal effort or at rest. Angina is not typically a sharp pain like that associated with, for example, hitting your thumb, but more of a pressure-like sensation. Although angina pectoris is not a heart attack , it is a sign that someone is at an increased risk of having a heart attack, and should receive medical attention.

Angina occurs most commonly during activity and is relieved by resting. Patients may prefer to remain upright rather than lie down, as increased preload in recumbency increases myocardial work. The amount of activity required to produce angina may be relatively consistent under comparable physical and emotional circumstances or may vary from day to day. The threshold for angina is usually less after meals, during excitement, or on exposure to cold. It is often lower in the morning or after strong emotion; the latter can provoke attacks in the absence of exertion. In addition, discomfort may occur during activity, at rest, or at night as a result of coronary spasm.

Angina Pectoris is a heart related disease in which chest pain or discomfort due to coronary heart disease occurs that involves a tightness, pressure, or squeezing felt in the chest, throat, upper abdomen, or neck that can radiate down the left arm, causing a numbness or tingling. Angina is not typically a sharp pain like that associated with, for example, hitting your thumb, but more of a pressure-like sensation. Once diagnosed, angina pectoris can be treated with medication. Usually this is caused by atherosclerosis of coronary arteries. Angina pectoris is a fairly common condition in men over the age of 50 years (although it can start as young as age 30). In women, it generally starts after the menopause. Men are much more likely than women to experience it before age 60. It may develop weeks, months or even years before a heart attack, or may be experienced only after a heart attack has occurred.

Characteristics of the discomfort in Angina Pectoris

Patients often do not refer to angina as "pain" but as a sensation of tightness, squeezing, burning, pressing, choking, aching, bursting, "gas," indigestion, or an ill-characterized discomfort. It is often characterized by clenching a fist over the mid chest. The distress of angina is rarely sharply localized and is not spasmodic.

Location and radiation of Angina Pectoris

The distribution of the distress may vary widely in different patients but is usually the same for each patient unless unstable angina or myocardial infarction supervenes. In most cases, the discomfort is felt behind or slightly to the left of the mid sternum. When it begins farther to the left or, uncommonly, on the right, it characteristically moves centrally substernally. Although angina may radiate to any dermatome from C8 to T4, it radiates most often to the left shoulder and upper arm, frequently moving down the inner volar aspect of the arm to the elbow, forearm, wrist, or fourth and fifth fingers. Radiation to the right shoulder and distally is less common, but the characteristics are the same. Occasionally, angina may be felt initially in the lower jaw, the back of the neck, the interscapular area, high in the left back, or in the volar aspect of the wrist.

Duration of attacks of Angina Pectoris

Angina is of short duration and subsides completely without residual discomfort. If the attack is precipitated by exertion and the patient promptly stops to rest, it usually lasts less than 3 minutes. Attacks following a heavy meal or brought on by anger often last 15–20 minutes. Attacks lasting more than 30 minutes are unusual and suggest the development of unstable angina, myocardial infarction, or an alternative diagnosis.

Effect of nitroglycerin

The diagnosis of angina pectoris is strongly supported if sublingual nitroglycerin promptly and invariably shortens an attack and if prophylactic nitrates permit greater exertion or prevent angina entirely.

Symptom of of Angina Pectoris

Examination during a spontaneous or induced attack frequently reveals a significant elevation in systolic and diastolic blood pressure, although hypotension may also occur, and may reflect more severe ischemia or inferior ischemia (especially with bradycardia) due to a Bezold-Jarisch reflex. Occasionally, a gallop rhythm and an apical systolic murmur due to transient mitral regurgitation from papillary muscle dysfunction are present during pain only. Supraventricular or ventricular arrhythmias may be present, either as the precipitating factor or as a result of ischemia (see ECG); (see ECG). Common Sign amd symptoms are as follows:

• Feeling pressure in the chest
• Extreme anxiety
• anginal pains may also be experienced in the epigastrium (upper central abdomen), back, neck, jaw, or shoulders
• Dizziness or nausea, and sometimes vomiting
• breathlessness, sweating and nausea
• Difficulty in breathing
• abdominal pain after eating (due to increased blood demand for digestion) or have back or shoulder pain

It is important to detect signs of diseases that may contribute to or accompany atherosclerotic heart disease, eg, diabetes mellitus (retinopathy or neuropathy), xanthelasma, tendinous xanthomas (see photograph), hypertension, thyrotoxicosis, myxedema, or peripheral vascular disease. Aortic stenosis or regurgitation, hypertrophic cardiomyopathy, and mitral valve prolapse should be sought, since they may produce angina or other forms of chest pain.

Causes of Angina Pectoris

The main cause of Angina Pectoris is heart not receiving enough blood. This reduces the amount of blood that can flow through them and thus the amount of oxygen delivered to the heart tissue. The other two main causes of angina are coronary artery spasm, and atherosclerotic plaque buildup which causes critical blockage of the coronary artery. Genetic predisposing factors include being male, having high blood pressure and having a family history of coronary artery disease. Attacks are often triggered by exertion or a sudden adrenergic discharge, and the underlying cause is insufficient blood supply to the heart muscles.

Treatment of Angina Pectoris

Some effective treatment methods are :

• Eat healthy - Stick to a heart-healthy low fat, low sodium, low cholesterol diet.
• Make sure your blood pressure is not high by having regular check ups
• Calcium channel blockers (such as nifedipine and amlodipine ), Isosorbide mononitrate and nicorandil are vasodilators commonly used in chronic stable angina.
• In patients with stable angina, monitoring the pattern over time and becoming aware of what activities tend to trigger an angina episode can be helpful.
• If you or a family member have been diagnosed with angina, you should talk to your doctor about the best treatment options for you.
• Exercise - Moderate, daily exercise provides great benefit, but do not overexert.
• Surgery (coronary artery bypass) or angioplasty might be necessary forms of treatment if there is significant narrowing of the coronary arteries.

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