Angina pectoris is severe chest pain. It is caused by a lack of blood and therefore oxygen to the heart muscle. The lack of blood is mainly from a spasm of the coronary arteries or and obstruction of the coronary arteries (blood vessels to the heart). Coronary artery disease is the main cause of angina. Angina is derived from the Greek word “ankhon” meaning strangling, pectoris is the Latin word for “chest” – Angina pectoris describes perfectly the syndrome – “a strangled feeling of the chest.”
In the United States there are almost 6.3 million patients with angina pectoris. Angina Pectoris is a more common symptom coronary artery disease in women more than it is in men. Risk factors such as smoking and obesity have made angina pectoris a disease seen primarily in Western Countries.
Chest discomfort is the most commonly reported symptom not an pain. The discomfort is described as burning, tightening, or feeling of choking. Anginal pains can also be felt in the back, neck, shoulders, arms and upper abdomen. Angina episodes can be triggered by emotional stress or over exertion. Cold temperatures and a full stomach can also aggravate an episode.
The sensation of Angina can also be experienced with loss of breath, sweating and upset stomach, lasting up to five minutes. Pallor, nausea and vomiting are known as autonomic symptoms - because they are associated with increased activity of the autonomic nervous system.
An electrocardiogram will not indicate anything if the patient is not experiencing an angina episode – unless there is a history of cardiac issues.
If an ECG is performed during an angina episode a raise or drop in the ST segment of the ECG recording will be present. To ‘force’ these changes a treadmill test may be ordered for the patient. A treadmill test is also referred to as an exercise ECG. A patient will be required to exercise until they are breathless – or pain begins. A one millimeter of flat or down sloping ST in the ECG, at this point, indicates a diagnosis of angina. A treadmill test also can be used to examine markers for myocardial ischemia. This is a blood pressure drop in systolic pressure.
Another test that can be performed is called a thallium scintogram – which is usually performed when a patient is unable to exercise for various reasons. Stress Echocardiography can also be performed when exercise is not an option for the patient.
When a patient is diagnosed with angina pectoris via a non invasive procedure, the next step is to perform a coronary angiogram. A coronary angiogram is a blood vessel x-ray used to determine the source of the angina pectoris. Depending on the results, the doctor will recommend coronary artery bypass graft, treatment with medication or angioplasty. Angioplasty is a surgery to clear blocked blood vessels.
When a patient is diagnosed and hospitalized with unstable angina – recently being referred to as ‘high risk acute coronary syndromes’, resting ischemia ECG or raised cardiac enzymes a coronary angiography is performed almost straight away.
Treatment of angina pectoris is mainly directed at pain relief, reduction of recurring episodes and slowing of the progression of the disease which in some cases can lead to heart attacks and death.
One aspirin ingested at 75mg to 100 mg per day is recommended to all patients with a stable angina pectoris. Nitroglycerin tablets that are short acting are used for the pain relief of angina pectoris. Vasodilators and calcium channel blockers are used for chronic stable angina. Vasodilators are agents that expand blood vessels – this decreases flow impedance and blood pressure. A vasodilator, called an ACE inhibitor relieves symptoms and provides a better prognosis for the disease.
Identifying risk factors for future hear disease is necessary for patients with angina pectoris. The identification process involves cholesterol, diabetes and blood pressure testing and monitoring. Patients who smoke are encouraged to stop. Overweight patients are encouraged to loose weight and adopt healthier behaviors.
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