Understanding Angina: Causes and Treatments

Sep 25, 2024

Lecture on Angina

Introduction to Angina

  • Angina = Chest pain due to limited blood flow to the heart.
  • Indicates a warning sign of inadequate blood supply to heart muscles (myocardium).
  • Prolonged limited blood flow can lead to heart sections dying.

Blood Supply to the Heart

  • Coronary Arteries: Primary source of blood supply to the heart.
    • Left and Right Coronary Arteries originate from the Aorta.
    • Act as main suppliers, branching out to further deliver oxygenated blood.

Left Coronary Artery

  • Branches into the Left Anterior Descending and Left Circumflex arteries.
  • Feeds the left atrium, left ventricle, and interventricular septum.
  • Blockage can lead to reduced cardiac output and heart failure.

Right Coronary Artery

  • Branches into Right Marginal and Right Posterior Descending arteries.
  • Supports the right atrium, right ventricle, and important electrical nodes (SA node, AV node).
  • Blockage can affect heart rhythm (dysrhythmias).

Types of Angina

1. Stable Angina

  • Known as exertional angina, triggered by physical/emotional stress.
  • Due to fatty plaque in arteries causing stiffness and limited dilation.
  • Use of nitroglycerin (vasodilator) for relief.
  • Key characteristics: predictable, short-lived, resolved with rest/nitroglycerin.
  • Troponin levels usually negative; ECG normal at rest but may show changes with exertion.
  • Lifestyle changes recommended: low-fat/low-sodium diet, quit smoking, manage diabetes.

2. Unstable Angina

  • Known as pre-infarction angina, can lead to a myocardial infarction (heart attack).
  • Occurs with minimal activity or at rest.
  • Caused by ruptured plaque leading to clot formation (thrombus).
  • Key characteristics: unexpected, no relief with rest, lasts >15 minutes.
  • Immediate medical treatment required; troponin usually negative; ECG may show transient changes.

3. Variant Angina (Prinzmetal Angina)

  • Caused by vasospasm of coronary arteries.
  • Occurs at rest, often at night or morning.
  • Risk factors: vasoconstrictive drugs, smoking, alcohol, certain vascular disorders.
  • Treated with nitroglycerin and calcium channel blockers.

Diagnostic and Treatment Considerations

  • Troponin levels and ECG for assessing angina.
  • Use of nitroglycerin for stable and variant angina.
  • Medications: beta-blockers, calcium channel blockers, ACE inhibitors, ARBs, and aspirin.
  • Heart catheterization for severe cases.

Lifestyle and Preventative Measures

  • Low-fat, low-sodium diet.
  • Quit smoking; manage blood glucose and blood pressure.
  • Statins for cholesterol management.
  • Antiplatelet therapy to prevent clot formation.

Conclusion: Understanding the types of angina, their causes, and treatment options is crucial for effective management and prevention of further cardiovascular complications.