Angina Lecture Notes

Introduction to Angina

• Angina refers to chest pain caused by limited blood flow to the heart.
• It signals potential problems with heart blood supply.
• If untreated, it can lead to heart tissue death.

Blood Supply to the Heart

• Coronary Arteries: Supply blood to myocardium.
  • Originate from the aorta, delivering oxygenated blood.
  • Two main arteries: Left Coronary Artery (LCA) and Right Coronary Artery (RCA).

Left Coronary Artery (LCA)

• Feeds the left side of the heart.
• Branches:
  • Left Anterior Descending Artery
  • Left Circumflex Artery
• Supplies:
  • Left atrium
  • Left ventricle
  • Interventricular septum

Right Coronary Artery (RCA)

• Feeds the right side of the heart.
• Branches:
  • Right Marginal Artery
  • Right Posterior Descending Artery
• Supplies:
  • Right atrium
  • Right ventricle
  • Electrical structures (SA node, AV node)

Types of Angina

• Stable Angina: Predictable, occurs with exertion.
• Unstable Angina: Unpredictable, occurs at rest.
• Variant Angina (Prinzmetal's Angina): Caused by vasospasm.

Stable Angina

• Also called Exertional Angina.
• Triggered by physical or emotional exertion.
• Causes:
  • Fatty plaque causing artery stiffness and limited dilation.
• Symptoms:
  • Predictable, short-lived pain (15 minutes or less).
  • Relief with rest or nitroglycerin.
• Four S's to Remember:
  • See it coming (predictable)
  • Short-lived
  • Stops with rest/nitroglycerin
  • Stiff arteries

Nitroglycerin Use

• Vasodilator used to relieve chest pain.
• Administered sublingually or as a spray.
• Monitor blood pressure and chest pain relief.

Unstable Angina

• Also called Pre-infarction Angina.
• Occurs with minimal activity or at rest.
• Causes:
  • Rupture of fatty plaque leading to thrombus formation.
• Symptoms:
  • Unexpected, unaltered by rest, unrelenting, can last more than 15 minutes.
  • Potentially unsurvivable without treatment.
• Four UN's:
  • Unexpected
  • Unaltered
  • Unrelenting
  • Unsurvivable

Variant Angina

• Caused by vasospasms in coronary arteries.
• Occurs at rest, often at night or early morning.
• Treatable with nitroglycerin and calcium channel blockers.

Risk Factors and Management

• Risk Factors:
  • High cholesterol, smoking, diabetes, high blood pressure.
• Management:
  • Low-fat, low-sodium diet.
  • Medications: Beta-blockers, Calcium channel blockers, ACE inhibitors, ARBs, Statins, Antiplatelets (e.g., aspirin).
  • Lifestyle modifications: Smoking cessation, diabetes management.
  • Potential heart catheterization for severe cases.

Conclusion

• Angina is a significant indicator of coronary artery issues and requires appropriate management to prevent progression to myocardial infarction.