Angina (heart-related chest pain)

 

 

Angina is a medical term for pain or discomfort in the chest when there is decreased blood supply to the heart muscles. Angina is a symptom of an underlying blockage in the coronary arteries that supply blood to the heart.

 

 

Common causes and risk factors are:

 

1. The commonest cause of poor blood supply to the heart muscles is accumulation of fat inside the coronaries called atherosclerosis.

2. Diseases of coronaries like embolus (an unattached blood clot causing blockage), inflammation of arteries, a spasm in the arteries, Kawasaki disease and congenital abnormalities can also cause angina pain.

3. Other heart diseases like hypertrophic cardiomyopathy (thickening and loosening of heart muscles), severe aortic valve disease, etc. are some of the rare causes.

4. Factors like emotional stress, cold weather, and obesity can act as a triggering factor.

5. Men have a higher risk than women.

6. Men older than 45 and women older than 55 years of age are at a high risk.

7. Modifiable risk factors include high blood pressure, high cholesterol levels in blood, type 2 diabetes, cigarette smoking, sedentary lifestyle, and stress.

 

 

There are many variants of angina.

 

1. Stable angina/angina pectoris: It is the most commonly occurring left sided or central chest pain. It is caused due to strenuous physical activity or stress and usually pain reduces when patient rests.

2. Unstable angina: It is an acute condition. It can occur even when you are resting or eating. The pain is more severe and often recurring.

3. Prinzmetal's angina: It is also referred as variant angina, angina inversa or Prinzmetal's variant angina. It is rare type of angina pain, which almost always occurs when a patient is at rest. It may be more painful and lasts longer than other types of angina. It usually occurs at night or early morning.

4. Microvascular angina: This type of angina is a symptom of coronary microvascular disease.

Patients describe angina pain as feeling of tightness or crushing weight in the central chest region radiating to arms, neck, jaw, back, or stomach region. Pain can also be accompanied by breathlessness, confusion, anxiety, profuse perspiration, and nausea. This pain usually lasts a few minutes, arises suddenly, and stops when you rest.
Chest pain that lasts only a few seconds is usually not angina, but you should visit the doctor as soon as possible as it may be a warning of heart attack.

 

 

1. Doctor will be able to diagnose angina depending on the symptoms described by the patients.

2. They may carry out some basic investigations like resting electrocardiogram (ECG), chest x-ray, and blood test like troponin I or creatine phosphokinase-MB (CPK-MB). Further testing like echocardiography, coronary angiogram, stress ECG, CT-scan, or MRI of chest, CT angiography, etc. may also be advised as per patient’s condition.

 

 

If the patient is diagnosed with angina, the doctor will start with initial drug therapy to stabilize the symptoms. Common line of treatment includes aspirin, beta blockers, nitroglycerin and morphine sulfate orally while maintaining oxygen saturation.

If the patient is not stabilized with medical therapy, surgical procedures like angioplasty or bypass operation [coronary artery bypass graft (CABG)] will be advised.
Lifestyle modifications like stop smoking, healthy diet and exercise will be advised by your doctor 

 

 

Cardiovascular disease is the leading cause of death and is responsible for one of every three deaths in the world.