Angina pectoris

Angina pectoris is a central chest tightness or heaviness due to myocardial ischemia, which is brought on by exertion and relieved by rest.

Pathophysiology:

Myocardial ischemia develops when coronary blood supply decrease to meet myocardial oxygen demand. During myocardial ischemia, ATP is converted to adenosine, which causes arteriolar dilating and cause anginal pain mainly by stimulating the A1 receptors in cardiac afferent nerve.

Causes:

1. Coronary atherosclerotic lesion
2. Coronary spasm
3. Syndrome X
4. Systemic inflammatory or collagen vascular disease
5. Ventricular hypertrophy
6. Severe anemia
7. Structural abnormalities of the coronary arteries

Risk Factor:

• Smoking, alcohol and high lipid diet
• Diabetes mellitus
• Hypercholesterolemia
• Stationary life style

Symptoms:

1. Chest pressure, heaviness ,tightening squeezing and aching pain
2. Pain radiate to left shoulder and jaw
3. Sweating
4. Heartburn, weakness, nausea, vomiting
5. difficulty to breath
6. Restlessness
7. Faintness

Types of angina:

1. Stable angina: Induced by exercise ,relived by rest or nitroglycerine
2. Unstable angina: Angina of increasing frequency or severe occurs on minimal exertion or at rest but not relived by nitroglycerine.
3. Variant angina: Caused by coronary spasm. Relived by nitroglycerine.

Diagnosis:

 

Diagnosis relies on complete history and tests:

1. ECG: Simple test shows usually normal, but may show ST depression, flat or inverted T wave. ECG must needed any patient complain chest pain to exclude myocardial infraction.
2. Stress Testing:  During exercise EKG or echocardiography taken .This test show abnormalities.
3. Chest x-ray: To exclude heart failure and pulmonary disease.
4. Blood and serum test for risk factors like anemia , hypercholesterolemia  ,infections, thyrotoxicosis
5. Coronary Angiography and cardiac catheterization: It is for diagnosis as well as therapeutic propose.

Management:

• Alteration of life style: stop smoking, exercise, weight loss.
• Modified risk factor: hypertension, diabetes.
• Drugs for symptoms: Spray or sublingual nitrates.
• Prophylaxis: regular oral nitrates eg. Isosorbide mononitrate 10-30mg twice a day*.
• Aspirin: 75-150 mg per day.
• Beta blocker: unless contraindicated (asthma, COPD).
• Calcium antagonist : Amlodipine 5mg per day,diltiazem 90-180mg twice a day *(* day=24 hour)
• If total cholesterol >5 mmol/L give statin eg. Simvastin 10-40 mg per oral at night.
• Surgery: Angioplasty and coronary bypass surgery.
• Unstable angina requires admission and urgent treatment.

Conclusion:

Angina pectoris is a chest pain caused by decrease oxygen supply to the heart muscle .ECG ,stress test and blood test are important in the diagnosis of angina .It is managed with rest, medication and surgery.

References:

1. Harrison’s Principles of Internal Medicine, 17^th edition.
2. Oxford handbook of clinical medicine, 7th edition.
3. Davidson’s Principles and Practice of Medicine, 20th Edition
4. emedicine.medscape.com
5. medicinenet.com
6. labtestsonline.org
7. healthscout.com
8. emedicinehealth.com
9. americanheart.org

Related posts:

1. HELLP Syndrome

Filed Under: Medicine

Tags: Angina pectoris, featured, Heart Failure, Heart pain, management of angina, what cause the chest pain, what is angina pectoris