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Angina PectorisAngina Pectoris or just angina refers to a pain in the centre of the chest which comes from the heart.What is angina pectoris? Angina pectoris is the name given to a tight pain felt in the chest that occurs when insufficient oxygen is being carried in the blood to the muscles of the heart. ‘Stable’ angina pectoris usually occurs when the demand for oxygen cannot be met during exertion. ‘Unstable’ angina pectoris can occur at any time, including at rest. Angina pectoris is a fairly common condition in men over the age of 50 years (although it can start as young as age 30). In women, it generally starts after the menopause. What causes angina pectoris and who is at risk? Angina is the result of coronary artery disease, which is the main cause of death in the western world. Hard deposits (known by doctor as ‘atheromatous plaques’) line the inside of the arteries in the heart, the coronary arteries, narrowing them. This reduces the amount of blood that can flow through them and thus the amount of oxygen delivered to the heart tissue. The risk factors for coronary artery disease are both inherited and due to lifestyle. Genetic predisposing factors include being male, having high blood pressure and having a family history of coronary artery disease. Risks due to lifestyle include smoking, high fat intake with high blood cholesterol levels and obesity. An increased blood flow to the heart is needed in many instances, such as during exercise, sex or stressful or emotional situations. In such situations the narrowed coronary arteries cannot deliver enough blood to the heart to cope with the increased demand for oxygen. This is ‘stable’ angina. ‘Unstable’ angina is so-called because it can strike at any time even when resting. It can be caused by the formation of a blood clot (thrombus) within a coronary artery or by spasmodic contraction of the artery, further compromising the blood supply to the heart. This type of angina, although less common than stable angina, is very serious and needs urgent treatment at hospital. What are the common symptoms and complications of angina pectoris ? The symptoms of angina pectoris include:
Angina can be confused with a heart attack. However, unlike a heart attack, the pain from angina usually goes away in 15 minutes or less with rest. If you’ve never had this type of pain before, don’t try to diagnose yourself: call your doctor at once. If the pain continues or gets worse, call an ambulance.  How do doctors recognise angina pectoris? If you have this sort of pain, after an examination your doctor may refer you to a hospital for an ‘exercise ECG’ (electrocardiogram). This measures the electrical activity of the heart while at rest and then when the heart is under strain during exercise. From the results the doctors will be able to tell if you have coronary artery disease. If the angina does not get any better after treatment with drugs, an X- ray examination of the arteries of the heart may be performed (coronary angiography) to see how narrowed they are. What is the treatment for angina pectoris? Self-care action plan changing certain habits will cut down the risk of getting coronary artery disease or making it worse:
By far the most important things you can do are to stop smoking and watch your weight and your blood pressure. If angina has previously been diagnosed, see your doctor if the attacks become more frequent, last longer, feel different or more painful than normal, or if chest pain wakes you from sleep. Medicines Attacks of stable angina may be prevented and treated by nitrate drugs, which increase the flow of blood to the heart muscle. Sometimes, other drugs may be used, such as beta blockers or calcium channel blockers, which reduce the work done by the heart and help lower the blood pressure. Surgery Although medication can control the symptoms of angina, it cannot cure the condition. If attacks become more severe, frequent and longer, you may need coronary angioplasty or coronary artery bypass surgery to increase the blood supply to the heart muscle. Coronary angioplasty is a procedure in which a doctor will pass a long, thin tube containing a deflated balloon into one of the arteries in the upper leg. Using a video X-ray as a guide, the tube is passed up to the clogged coronary artery where the balloon is inflated to open up the obstruction so more blood can flow through it. This is called revascularisation. The procedure usually gives relief from angina, but about 10–15 percent of patients relapse and get pain again within six months. It is these patients who may need coronary bypass surgery, in which a vein from the leg is used to replace the clogged artery in the heart. Transmyocardial laser revascularisation (in which a laser beam is fired through the beating heart muscle) is an alternative to heart bypass surgery or angioplasty. It is used in people who have severe coronary artery disease that does not respond to, or is not amenable to, other treatments. In the past, chest surgery was needed to position a catheter within the heart so that the laser could be delivered to it. More recently, a procedure called percutaneous transmyocardial revascularisation (PTMR) was developed, in which the laser passes through an artery in the leg to the heart's lower left chamber (the left ventricle). It is not known how laser revascularisation works. The laser burns tiny holes in the heart muscle wall and it was originally thought that these allowed more blood to flow into the muscle wall, stimulating new growth of blood vessels. However, it is now known that the holes soon close up, leaving only a scar. Lasers can also be used to vaporise (destroy) the plaques in arteries, but this approach benefits fewer than one percent of cases. Complementary therapy A variety of complementary medical treatments are used to reduce levels of stress. However, there is no conclusive research evidence to prove that any complementary medicines (eg homeopathic medicines and herbal remedies) are beneficial and do not have harmful effects. What is the outcome of angina pectoris? There are many measures that you can take to reduce the risks of getting angina. The effect that angina has on how you live varies enormously. Some people are able to lead normal lives, apart from restrictions on strenuous exercise. Others, however, may become severely disabled. You are here: Home >> Articles >> Angina |
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