” Angina is a type of chest pain caused by reduced blood flow to the heart .”
1.] It is characterized by paroxysmal (a severe attack or a sudden increase in intensity of the disease) pain in the substernal or precordial region of the chest which is aggravated by an increase in the demand of the heart and relived by a chest decrease in the work of heart.
2.] Precordial chest discomfort variously described as constricting, squeezing, chocking or knife like.
3.] The transient period in angina pectoris is of 15 sec. – 15 min.
4.] The pain radiates to the left arm, neck, jaw or right arm.
5.] There are 3 overlapping clinical pattern of angina pectoris with some difference in their pathogenesis :-
- Stable or typical angina.
- Unstable or crescendo angina.
- Prinzmetal’s or variant angina.
1.] Angina symptoms include chest pain and discomfort, possibly described as pressure, squeezing, burning or fullness.
2.] Other symptoms that may have angina are :-
- Shortness of breath.
1.] Angina is caused by reduced blood flow to your heart muscles.
2.] When heart muscles were not getting enough oxygen, it causes a condition called ischemia.
3.] The most common cause of reduced blood flow to our heart muscles is coronary heart disease [CAD].
4.] During time of low oxygen demand – when you are resting, for example your heart muscles mays till be able to function on the reduced amount of blood flow untill without triggering angina symptoms.
5.] But when we increase the demand of oxygen such as when we exercise, angina can result.
CHARACTERISTICS OF STABLE OR TYPICAL ANGINA :-
- It develops when our heart works harder, such as when we exercise or climb stairs.
- Lasts for short time, perhaps for five minutes or less.
- Disappear sooner if we rest or use our angina medication.
- Can usually be predicted and the pain is usually similar to previous chest pain we had.
CHARACTERISTICS OF UNSTABLE OR CRESCENDO ANGINA :- [MEDICAL EMERGENCY]
- Occurs even at rest.
- Is a change in your usual pattern of angina.
- It is unexpected.
- It is usually more severe and lasts longer than stable angina, maybe 30 min. or longer.
- May not disappear with rest or use of angina medication.
- Might signal a heart attack.
- This syndrome sometimes referred as preinfraction angina or acute coronary insufficiency.
CHARACTERISTICS OF VARIANT OR PRINZMETAL’S ANGINA :-
- Usually happens when we are resting.
- It is often severe.
- May be relived by angina medication.
- Prinzmetal’s angina generally respond to promptly to vasodilators such as nitroglycerin and calcium channel blockers.
If lifestyle changes alone don’t help your angina, you may need to take medications. These may include:
- Nitrates : Nitrates are often used to treat angina. Nitrates relax and widen your blood vessels, allowing more blood to flow to your heart muscle. You might take a nitrate when you have angina-related chest discomfort, before doing something that normally triggers angina (such as physical exertion) or on a long-term preventive basis. The most common form of nitrate used to treat angina is nitroglycerin tablets, which you put under your tongue.
- Aspirin : Aspirin reduces the ability of your blood to clot, making it easier for blood to flow through narrowed heart arteries. Preventing blood clots can also reduce your risk of a heart attack. But don’t start taking a daily aspirin without talking to your doctor first.
- Clot-preventing drugs : Certain medications such as clopidogrel (Plavix), prasugrel (Effient) and ticagrelor (Brilinta) can help prevent blood clots from forming by making your blood platelets less likely to stick together. One of these medications may be recommended if you can’t take aspirin.
- Beta blockers : Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. As a result, the heart beats more slowly and with less force, thereby reducing blood pressure. Beta blockers also help blood vessels relax and open up to improve blood flow, thus reducing or preventing angina.
- Statins : Statins are drugs used to lower blood cholesterol. They work by blocking a substance your body needs to make cholesterol. They may also help your body reabsorb cholesterol that has accumulated in plaques in your artery walls, helping prevent further blockage in your blood vessels. Statins also have many other beneficial effects on your heart arteries.
- Calcium channel blockers : Calcium channel blockers, also called calcium antagonists, relax and widen blood vessels by affecting the muscle cells in the arterial walls. This increases blood flow in your heart, reducing or preventing angina.
- Blood pressure-lowering medications : If you have high blood pressure, diabetes, signs of heart failure or chronic kidney disease, your doctor will likely prescribe a medication to lower your blood pressure. There are two main classes of drugs to treat blood pressure: angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs).
- Ranolazine (Ranexa) : Ranexa can be used alone or with other angina medications, such as calcium channel blockers, beta blockers or nitroglycerin.
MULTIPLE CHOICE QUESTIONS [MCQs] :-
1.] What is angina pectoris ?
a. Pain below the chest
b. Low blood pressure
c. Chest pain caused by coronary heart disease
d. None of the above
2.] How many versions of angina pectoris are there ?
3.] Which of these can cause angina ?
a. Old age
d. All of the above
4.] Which of the following are used for the treatment of angina ?
a. Beta blockers
d. All of the above
5.] Which is the most common type of angina ?
a. Unstable angina
b. Coital angina
c. Stable angina
d. Micro vascular angina
6.] Myocardium is deprived of O2 causing chest pain ?
a. Angina pectoris
b. Incompetent valve
c. Valvular itinosis
7.] Angina pectoris is a painful, squeezing sensation throughout the chest and around the heart ?
8.] Angina occurs what organ doesn’t get enough de – oxygenated blood ?
9.] What procedure is taken when a patient has angina pectoris ?
b. Coronary artery bypass surgery
d. All of the above
10.] Is the condition of angina pectoris is life – threatening ?
1.] (c) chest pain caused by coronary heart disease
2.] (b) two
5.] (c) stable angina
6.] (a) angina pectoris
8.] (c) heart
1.] Textbook Of Pathology By Harsh Mohan; 7th edition; Page no. 405 – 409.
2.] Robbin’s Basic Pathology; 5th edition; Page no. 528.