Angina Pectoris

Definition

• Angina pectoris is chest pain caused by an inadequate supply of oxygen to the heart muscle.
• The pain is typically severe, crushing, and characterized by a feeling of pressure and suffocation behind the breastbone.
• Can accompany or be a precursor to a heart attack.

Causes

• Most common cause: Blockage in the coronary arteries due to plaque deposits.
• Other causes: Inflammation, infection, or injury to coronary arteries.
• Risk factors:
  • Diabetes
  • High blood pressure
  • High cholesterol
  • History of heart disease
  • Sedentary lifestyle
  • Smoking
  • Obesity
  • Age
  • Stress

Types of Angina

1. Stable Angina

   • Regular episodes of pain triggered by physical exertion, smoking, large meals, or extreme temperatures.
   • Caused by narrowed arteries due to accumulated deposits.

2. Unstable Angina

   • Sudden pain that doesn’t go away with rest or medication.
   • Caused by a blood clot that blocks the blood vessel; may lead to a heart attack if not treated.

3. Variant Angina

   • Caused by a spasm in a coronary artery, leading to temporary narrowing.
   • Occurs without any specific triggers.

Signs and Symptoms

• Pain: Described as pressure or fullness in the chest, like a vise squeezing or a heavy weight.
• Pain can spread to neck, arms, shoulders.
• Other symptoms:
  • Shortness of breath
  • Nausea
  • Fatigue
  • Dizziness
  • Sweating
  • Anxiety

Diagnosis

• Electrocardiogram (ECG/EKG): Records electrical signals in the heart.
• Stress Tests: Monitors ECG readings during exercise.
• Echocardiogram: Uses sound waves for heart images.
• Nuclear Stress Test: Measures blood flow to the heart using a radioactive substance.
• Chest X-ray: Checks for other conditions or enlarged heart.
• Blood Tests: Detect heart enzymes indicative of heart damage.
• Coronary Angiography: X-ray imaging of heart blood vessels.
• Cardiac CT Scan: Checks for narrowed arteries or an enlarged heart.
• Cardiac MRI: Provides detailed images of heart structure and vessels.

Treatment

• Lifestyle Changes: First step in managing angina.
• Medications:
  • Nitrates
  • Aspirin
  • Blood clot preventive drugs
  • Beta blockers
  • Statins
  • Calcium channel blockers
  • Blood pressure lowering medications
  • Ranolazine
• Medical Procedures and Surgery:
  • Angioplasty and Stenting: Insertion of a balloon or stent to widen arteries.
  • Coronary Artery Bypass Surgery: Uses a vein/artery from another body part to bypass blocked artery, increasing blood flow and reducing/eliminating angina.
• Suitable for both unstable and non-responding stable angina.

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