| Angina | |||||
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Angina is chest pain that happens when the heart does not get an adequate supply of blood (and therefore oxygen).
Angina occurs as a symptom of myocardial ischemia (also known as coronary artery disease). This occurs when the coronary (heart) arteries that supply blood and oxygen to the heart have an impaired function.
Angina is due to a temporary reduction in the flow of blood to a part of the heart muscle and will not cause damage to the heart itself.
Angina is known medically as angina pectoris.
There are three main types of angina:
- Stable angina - the most common type of angina; brought on by physical exertion and relieved by rest of angina medication and follows a regular pattern of pain for 1-3 mins (but not longer than 10 mins, when you should see your doctor to advise of the change in symptoms)
- Unstable angina - irregular pattern, may be brought about by physical exertion or even when just resting; pain is more frequent, more severe and may last longer (up to 30 mins) and may indicate a heart attack is about to occur
- Variant angina - also called Prinzmetals angina, is not very common but affects more women than men; pain occurs without warning, often while resting and even at night
People who have angina already should get medical help immediately if any of the following are experienced :
- being woken in the night by angina symptoms
- symptoms that are more severe than normal
- symptoms that occur more often than normal
- symptoms that last longer than normal
These may signal that there is a high risk of heart attack very soon.
- Breathlessness or a choking feeling
- Feeling sick or exhausted
- Pressure or a squeezing pain in the chest
- Pain may also occur in the shoulders, arms, neck, jaw, or back
- The pain from angina may also feel like indigestion
Angina is mostly caused by coronary artery disease.
The coronary arteries supply blood, oxygen and nutrients to the heart and if these arteries are blocked or become narrowed due to heart disease and the heart is not able to get enough oxygen to work properly and the pain of angina ensues.
A less common reason for angina is due to spasms of the coronary arteries.
Apart from an underlying heart problem, angina can also be caused by the following:
- Anaemia
- Exercise
- Fast or abnormal heart rhythms (arrhythmia)
- High or prolonged stress
- Inflammation or infection of the coronary arteries
- Intense emotional outbursts
There are some factors which make angina more likely:
- Diabetes
- Family history of heart attack and heart disease
- High blood pressure
- High cholesterol levels
- Little or no physical activity
- Males
- Middle aged or older
- Overweight or obese
- Smoking
Treatment of angina is separated into medication that provide immediate relief, medications that prevent long-term symptoms and medications that prevent worsening of coronary artery disease:
Medication for immediate relief
- Glyceryl Trinitrate (GTN) - effective in controlling the painful symptoms of angina very quickly but only last a short time; it works to dilate (open up) the coronary arteries so that there is a better blood supply to the heart
Medications that prevent long-term symptoms
- Beta-blockers - the first choice treatment to prevent angina as these class of drugs make the heart beat slower and with less force to prevent symptoms of angina
- Long acting nitrates - open up the coronary arteries to improve blood supply to the heart; similar to GTN but their effects last longer, although they are slower in action
- Calcium channel blockers - open up the coronary arteries to improve blood supply to the heart; some of these drugs make the heart beat slower and with less force to prevent symptoms of angina
- Potassium channel activators - open up the coronary arteries to improve blood supply to the heart
Medications that prevent worsening of coronary artery disease
- Statins - lower blood cholesterol levels to lower the risk of blocked and narrowed arteries
- Anti-platelets - reduce the 'stickiness' of platelets (the type of proteins in blood that help it to clot), so preventing clotting, reducing risk of heart attack
- Angioplasty - surgery to open up a coronary artery, where a wire with a sausage-shaped balloon is placed in a large artery in the body and is guided to the the narrowed section of a coronary artery to open it up when the balloon has air blown into it
- Coronary artery bypass graft (CABG) - surgery to bypass an artery blockage with healthy blood vessel segments (grafts) taken from other parts of the body
- Anticoagulants - strong medication to thin the blood and are especially used in the case of breaking up existing blood clots or to prevent future clots from happening
- Angina is common - it affects about 1 in 50 people
- Angina, while not a serious condition, does signify that a potentially serious heart condition is underlying the pain and should be thoroughly investigate
- Having angina increases the risk of having a heart attack
- A variety of tests can be done to diagnose angina
references
- Krum H, Jelinek MV, Stewart S, Sindone A, Atherton JJ, Hawkes AL. Guidelines for the prevention, detection and management of people with chronic heart failure in Australia 2006 - Position Statement. MJA 2006; 185 (10): 549-556, accessed 21 August 2007
- Osiecki, Henry. The Physician's Handbook of Clinical Nutrition. 6th edition, 2001, BioConcepts Publishing
- Osiecki, Henry, The Nutrient Bible 2002, BioConcepts Publishing
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