Angina Pectoris

Summary

This video explains the relationship between angina and coronary artery disease and reviews various diagnostic tests that may be performed to assess the patient’s condition. Medications and surgical treatments are covered, along with the differences between stable and unstable angina, including how to identify angina patterns.

Details

• When the heart isn't getting enough blood it produces a chest pain called Angina Pectoris. Angina is a serious condition, but there are steps you can take to treat angina and maybe even keep it from occurring.
• Symptoms:
  • Angina starts as an aching, tightening or squeezing discomfort in the chest, that may spread to the neck, jaw, left arm or back.
  • Sweating
  • Shortness of breath
  • Indigestion
  • Nausea

• Physiology of Angina:
  • The heart is a muscle, and it needs blood containing oxygen and nutrients to work properly.
    • It gets it from large blood vessels, called coronary arteries.
    • The harder the heart pumps, the more oxygen-rich blood it needs.
  • If the heart doesn't get enough oxygen, angina sets in.
  • The main cause of angina is coronary artery disease.
    • This disease causes fat and other materials, called plague, to gradually build up on the walls of the coronary arteries.
    • The arteries narrow, reducing the supply of blood to the heart.
  • There are two main types of angina: Stable Angina, and Unstable Angina
• Stable Angina:
  • The most common type of Angina.
  • It occurs at times when the heart needs more oxygen, and the reduced blood flow cannot meet that demand.
  • Activities that can increase the hearts demand for oxygen include:
    • Certain physical activities
    • Extreme temperatures
    • Smoking
    • Eating large meals
    • Stress and other emotions
• Unstable angina:
  • Occurs without any cause or trigger.
  • Causes:
    • The arteries have become so narrow that the heart cannot get enough blood, even at rest.
    • Plaque on the walls of the arteries has broken off, causing a blockage.
  • Unstable angina needs to be treated right away or it can quickly lead to a heart attack, which can cause permanent heart damage.

• To check out your angina symptoms, your doctor will usually recommend a complete physical exam.
• A resting electrocardiogram or ECG, which provides basic information about your heart.
• X-rays to check for other conditions that could cause symptoms similar to angina.
• A stress test, which shows how your heart reacts to the demand for more oxygen:
  • Usually involves an exercise ECG.
  • For some patients stress tests substituting medications for exercise may be recommended.
• A thallium test, where a small amount of radioactive thallium is injected into a blood vessel and absorbed by the heart. If some areas of the heart get less thallium, a coronary artery may be blocked.
• An angiography, which is also called coronary catheterization:
  • In this procedure the doctor carefully advances a small flexible tube, called a catheter, into the coronary arteries and injects a liquid that shows up on x-rays.
  • When seen on x-ray, the liquid outlines the coronary arteries and reveals any blockages.

• Goals treating Angina:
  • Relieving angina symptoms.
  • Avoiding episodes if possible.
  • Slowing the development of coronary artery disease.
• Medications:
  • There are four main types of Angina medication:
  1. Nitrates relax the coronary arteries, so more blood and oxygen can flow to the heart.
  2. Beta blockers slow the heart rate, decreasing its demand for oxygen.
  3. Calcium channel blockers keep the coronary arteries relaxed, while also helping reduce the heart's workload.
  4. Blood thinners, which can prevent the formation of blood clots, that can lead to a heart attack and/or stroke.
  • Most patients are prescribed nitrates in the form of a nitroglycerin tablet that is placed under the tongue.
    • It can be taken before exertion to prevent angina, or at the onset of an attack.
    • If the first tablet does not relieve the angina symptoms, take a second and a third if necessary, five minutes apart.
    • If the symptoms still aren't relieved, call your doctor or go to the nearest emergency room.
  • Some medications may cause side effects:
    • If you experience: headaches, dizziness, fatigue, swelling in the legs, or constipation, let your doctor know.
    • Do not stop taking your medications unless your doctor advises you to stop.
  • Talk to your doctor before taking any new prescriptions or over-the-counter medications since they could affect your angina medications.
  • You should also develop a system to help you keep track of your medications, like pill boxes labeled with the times and days of the week medications should be taken.
• Monitoring your Angina patterns:
  • In each individual case of stable angina, the triggers and symptoms are the same.
  • Learning your pattern may help relieve and control angina episodes.
  • You should learn this information:
  1. What activities and conditions trigger your angina?
  2. What symptoms do you have?
  3. How long does an episode of angina last?
  4. What do you do to relieve an episode?
  • A sudden change in the pattern of your angina could signal unstable angina or even a heart attack.
  • Alert your healthcare team immediately if you notice: symptoms suddenly getting worse, an episode that lasts longer then usual, or one that cannot be relieved.
  • You should never be afraid to call 911, or go to the hospital if you feel your angina is getting worse.
• Other procedures that may be recommended:
  • Angioplasty:
    • It involves inserting a tiny balloon into the obstructed artery and inflating it. This usually decreases the obstruction.
    • During this procedure, a small metal device, called a stent may be inserted. It pushes the plaque even further against the artery wall. This stent will stay in place permanently, acting like a scaffold to keep the artery propped open, reducing the risk that it will narrow again.
  • Coronary artery bypass surgery:
    • A vessel taken from the leg, arm, or chest, is grafted onto a part of the coronary artery beyond the narrowed, or blocked portion of the artery.
    • This new pathway bypasses the obstruction, increasing blood flow to the heart.

• The best thing you can do to prevent the advancement of coronary artery disease is to maintain a healthy lifestyle.
• Reduce your risk factors:
  • Risk Factors are the things that can cause and increase the damage to your heart:
    • Abnormal cholesterol levels
    • Smoking and second hand smoke
    • High blood pressure
    • An inactive lifestyle
    • Being overweight
    • Diabetes
    • Stress
  • Work with your healthcare team to find out which factors you are most at risk for.
  • Most risk factors can be controlled by making some lifestyle adjustments:
    • Increasing your physical activity
    • Making healthier food choices
    • Quitting smoking
    • Finding ways to reduce stress in your life
• Making lifestyle adjustments:
  • Start slowly, taking each day as it comes.
  • Don't get discouraged by setbacks.
  • Stay committed.
  • Attend cardiac rehabilitation:
    • It can help you develop the skills you will need to properly care for your heart and live a healthy life.
    • It's also a great opportunity to work and share with others learning to make similar adjustments.

Angina is a serious condition. But with proper treatment and lifestyle adjustments you can manage your angina, deal with your heart disease, and lead a full and productive life.