ANGINA PECTORIS

What is Angina Pectoris?

Angina pectoris, commonly known as Ischemic chest pain is a cardiovascular disease/ disorder. In medical term, Angina pectoris is a Latin phrase meaning “Strangling in the chest” respectively. We often don’t realize that why suddenly heart attacks occur, Angina is a warning sign that leads to heart attack that we may ignore. This is the reason why we should know about basic disorders that may lead one to sudden death. Angina pectoris is a condition in which flow of blood to the heart is not able to meet the metabolic demands of the heart for oxygen.

Let us first see, why do we need oxygen for the heart?

Each and every cell or organ in the human body needs the supply of oxygen to perform their respective functions. Since blood travels through each organ, resulting the amount of nutrients and oxygen lowers The Heart is continuously pumping the blood so that the low oxygen saturated blood (deoxygenated blood) gets converted into oxygenated blood ( Rich in oxygen and nutrients).

Angina pectoris conditions occurs due to the blocked or narrowed coronary arteries makes the supply of blood to the heart difficult which leads to the myocardium tissue death hence the pain in the middle of chest occurs.

Why and how Angina Pectoris occurs?

Atherosclerosis ( narrowing of artery ):

As the coronary artery supplies blood to the heart muscle. The lipid molecule (fats) gets deposited in the linings of the coronary artery.. which then slows the flow of blood within the artery.

Due to this heart does not get enough blood to pump. Check out our post "ATHEROSCLEROSIS" for more information.

Thrombus formation (Blockage):

The lipid molecules (fats) which have been deposited in the inner linings of the coronary artery, break and get in the middle of the artery leading to blood clot. This blood clot causes obstruction and blocks the flow of blood.

Thrombus formation always takes place but the human body has its own repair system. Another reason for thrombus formation is the coronary artery may have inflammation due to this the inner lining of endothelial tissue cannot produce Nitric oxide and prostacyclin. The endothelial tissues release them to prevent thrombosis.

Vasospasm: This is the sudden constriction or narrowing of the coronary artery.

Symptoms:

A pressing, squeezing, or crushing pain, usually in the chest under your breastbone.
Pain that may also occur in your upper back, both arms, neck, or ear lobes.
Chest pain that spreads to your arms, shoulders, jaw, neck, or back.
Shortness of breath.
Weakness.
heaviness in your chest
Tiredness (fatigue) [1]

What are causes of Angina Pectoris?

Age: Angina is very common for the age group for Women: above 55 , Men: above 45.
Atherosclerosis
Smoking, drinking, diabetes mellitus
High blood pressure- damages the arteries.
High cholesterol
Excess intake of fat or salt
Often having heavy meals
Emotional stress
Family history for coronary artery diseases/ disorders.
Blocked artery
Coronary artery spasm
Micro vascular constriction
Obesity- due to heavy weight the demand for oxygen increases leading to classical angina. Also causes atherosclerosis due to heavy weight (fats).
Sedentary lifestyle or overworking.

Types of Angina Pectoris:

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Stable/classical angina:

This condition occurs by narrowing of the coronary artery due to atherosclerosis. Also happens when the demands of oxygen in the heart increases due to physical exertion, mental stress, emotional stress etc. Hence it is also said to demand ischemia.

Unstable angina/Supply ischemia:

This is a condition that occurs by thrombus formation (blood clot) within a coronary artery. Since thrombus causes obstruction in the blood supply, hence it is said to be supply ischemia.

Causes for thrombus formation: Lipid molecules, High cholesterol, Fats deposition in the arteries.
Symptoms: Severe chest pain lasts for a long duration The pain stays even if you rest, and may not be relieved even after consuming medications.

Variant angina:

It is a condition that occurs due to Vasospasm in the coronary artery.

Causes: Emotional stress, Dysfunctional coronary vascular endothelium.

It mainly occurs during the night and lasts even if you rest.

Diagnosis:

Electrocardiogram
Stress test
Echocardiogram
Chest-x ray
Coronary angiography
MRI, CT-scan
Holter monitoring
Positron emission tomography (PET) scan
blood test - Fats, cholesterol
Cardiac enzymes: These enzyme’s secretion increases in the heart as the demand of oxygen increases. These diagnostic tests help to conclude - Troponin, CKMB, Myoglobin, C-reactive protein, homocysteine.

Treatment:

Medical management:

These are some classes of drugs which are used to against angina pectoris

Nitrates: It works as vasodilator (Nitroglycerin)
Antiplatelet and anticoagulant drugs: It works by preventing the platelet, clot formation in arteries. (Aspirin, heparin, clopidogrel)
Beta blockers: It works by blocking the adrenaline secretions which leads to heart relaxation. Also lowers the BP. (Propranolol, metoprolol, atenolol)
Calcium channel blockers: It works by blocking the calcium ions which causes vasoconstriction. (Nifedipine, amlodipine)
Cholesterol lower agents: It works by altering the levels of cholesterol. (Statins)

Surgical management of angina pectoris

Conditions in which medications are not responding properly, then the surgery needs to be done.

Coronary artery bypass surgery ( CABG).
Percutaneous transluminal coronary angioplasty (PTCA).
Atherectomy.

Prevention:

Angina pectoris can be prevented by changing lifestyles.
Maintain cholesterol in the body.
Maintain high blood pressure.
Exercise and have a healthy diet regularly.
Maintain blood-glucose level if you have diabetes.
Avoid food that contains fats
Do a full body checkup and undergo blood tests every 6 months.

We often don’t realize that why suddenly heart attacks occurs, Angina is a warning sign that leads to heart attack that we may ignore. This is the reason why we should know about basic disorders that may lead one to sudden death.

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