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Angina
Contributor: Admin
Angina is a chest pain or irritation that occurs when there is a lack of blood flow to the heart. Angina can be hazardous to your health, so it is important to take notice to chest pain your experiencing, know what is normal for you, teach yourself how to check, manage it, and understand when you need to get medical care.
Types of Angina:
Stable angina. The pain is predictable and present only during hard work or extreme stress, fading away slowly.
Unstable angina. This may signal an impending heart attack. Unstable angina is angina pain that is different from your regular angina pain or pain that occurs while at rest. The angina may occur more frequently, more easily at rest, feel more severe, or last longer. Although this type of angina can often be relieved with oral medications (medicine taken by mouth), it is unstable and may progress to a heart attack. Usually more intense medical treatment or a procedure is required.
Prinzmetal's angina. This is when angina occurs when you’re resting, when sleeping, or when exposed to cold temperatures. In these cases, the symptoms are caused by decreased blood flow to the heart's Muscle or from spasm of the coronary artery. The majority of people with this type of angina also have coronary artery disease. These spasms occur close to the blockage.
Causes : When blood flow to an area of the heart is decreased, it impairs the delivery of oxygen and vital nutrients to the heart Muscle cells. When this happens, the heart Muscle must use alternative, less efficient forms of fuel so that it can perform its function of pumping blood to the body. The byproduct of using this less efficient fuel is a compound called lactic Acid that builds up in the Muscle and causes pain.
Symptoms
Common symtoms:
• Are often described as pressure, squeezing, burning, or tightness in the chest
• Usually start in the chest behind the breastbone
• May also occur in the arms, shoulders, neck, jaw, throat, or back
• May feel like indigestion
Stable Angina :
The pain or discomfort:
• Occurs when the heart must work harder, usually during physical exertion
• Is expected, and episodes of pain tend to be alike
• Usually lasts a short time (5 minutes or less)
• Is relieved by rest or angina medicine
• May feel like gas or indigestion
• May feel like chest pain that spreads to the arms, back, or other areas
Unstable Angina :
The pain or discomfort:
• Often occurs at rest, while sleeping at night, or with little physical exertion
• Is unexpected
• Is more severe and lasts longer (as long as 30 minutes) than episodes of stable angina
• Is usually not relieved with rest or angina medicine
• May get continuously worse
• May signal that a heart attack will happen soon
Variant Angina
The pain or discomfort:
• Usually occurs at rest and during the night or early morning hours
• Tends to be severe
• Is relieved by angina medicine
Diagnosis
To find out if you have angina, your doctor will:
• Do a physical exam
• Ask about your symptoms
• Ask about your risk factors and your family history of coronary artery disease (CAD) or other Heart disease
Sometimes, your doctor can diagnose angina by noting your symptoms and how they occur. Your doctor may order one or more tests to help make a diagnosis of angina. The tests your doctor may order include:
• EKG (electrocardiogram). This test measures the rate and regularity of your heartbeat. Some people with angina have a normal EKG.
• Stress Test. Some heart problems are easier to diagnose when your heart is working harder and beating faster than when it's at rest. During stress testing, you exercise (or are given medicine if you are unable to exercise) to make your heart work harder and beat faster while heart tests are performed. During exercise stress testing, your Blood pressure and EKG readings are monitored while you walk or run on a treadmill or pedal a bicycle.
• Other heart tests, such as nuclear heart scanning or echocardiography, also can be done at the same time. These would be ordered if your doctor needs more information than the exercise stress test can provide about how well your heart is working.
• If you are unable to exercise, a medicine can be injected through an IV into your bloodstream to make your heart work harder and beat faster, as if you are exercising on a treadmill or bicycle. Nuclear heart scanning or echocardiography is then usually done.
• During nuclear heart scanning, radioactive tracer is injected into your bloodstream, and a special camera shows the flow of blood through your heart and arteries. Echocardiography uses sound waves to show blood flow through the chambers and valves of your heart and to show the strength of your heart Muscle.
• Your doctor also may order two newer tests along with stress testing if more information is needed about how well your heart works. These new tests are magnetic resonance imaging (MRI) and positron emission tomography (PET) scanning of the heart. MRI shows detailed images of the structures and beating of your heart, which may help your doctor better assess if parts of your heart are weak or damaged. PET scanning shows the level of chemical activity in different areas of your heart. This can help your doctor determine if enough blood is flowing to the areas of your heart. A PET scan can show decreased blood flow caused by disease or damaged muscles that may not be detected by other scanning methods.
• Chest x ray. A chest x ray takes a picture of the organs and structures inside your chest. These include your heart, lungs, and blood vessels.
• Nuclear heart scans. This test provides your doctor with moving pictures of the blood passing through your heart's chambers and arteries and shows the level of blood flood to the heart Muscle. A small amount of a radioactive tracer is injected into your bloodstream through a vein, usually in your arm. A special camera is placed in front of your chest to show where the tracer lights up in healthy heart Muscle and where it doesn't light up (in heart Muscle that has been damaged or has a blocked artery).
• There are different types of nuclear heart scans. Most scans have two phases—taking pictures of the heart at rest and while it is beating faster (called a stress test), although sometimes only a rest scan is done. Many heart problems show up more clearly when your heart is stressed than when it is at rest. By comparing the nuclear heart scan of your heart at rest to your heart at "stress," your doctor can determine if your heart is functioning normally or not.
• Echocardiogram. This test uses sound waves to create a moving picture of your heart. Echocardiogram provides information about the size and shape of your heart and how well your heart chambers and valves are functioning. The test also can identify areas of poor blood flow to the heart, areas of heart Muscle that are not contracting normally, and previous injury to the heart Muscle caused by poor blood flow.
• There are several different types of echocardiograms, including a stress echocardiogram. During this test, an echocardiogram is done both before and after your heart is stressed either by having you exercise or by injecting a medicine into your bloodstream that makes your heart beat faster and work harder. A stress echocardiogram is usually done to find out if you have decreased blood flow to your heart (coronary artery disease).
• Cardiac catheterization. A thin flexible tube (catheter) is passed through an artery in the groin (upper leg) or arm to reach the coronary arteries. Your doctor can determine pressure and blood flow in the heart's chambers, collect blood samples from the heart, and examine the arteries of the heart by X ray.
• Coronary angiography. This test is done during cardiac catheterization. A dye that can be seen by x ray is injected through the catheter into the coronary arteries. Your doctor can see the flow of blood through your heart and the location of blockages.
Treatment
• medicine
• cardiac rehabilitation
• Reason for treatment:
• lifestyle changes
• Take rest breaks, if angina comes on with exertion.
• Keep away from large meals and rich foods that leave you feeling stuffed, if angina comes on after a heavy meal.
• Keep away from situations that make you upset or stressed, if angina comes on with stress. Learn techniques to handle stress that can't be avoided.
• Eat a healthy diet to prevent or reduce high Blood pressure, high blood cholesterol, and obesity
• Stop smoking
• Be physically active, as directed by your doctor
• Lose weight, if you are overweight or obese.
Reasons for treatment:
• Reduce the frequency and severity of symptoms
• Prevent or lower the risk of heart attack and death
