10.19.2011
ANGINA PECTORIS
Posted on 9:56 PM by know about heart
Angina pectoris:
Angina pectoris, commonly known as angina, is severe chest pain due to ischemia (an inadequate supply of blood and oxygen to a portion of the myocardium; it typically occurs when there is an imbalance between myocardial oxygen supply and demand.) of the heart muscle, generally due to obstruction or spasm of the coronary arteries (the heart’s blood vessels).
Types:
1. Stable/typical angina: Not in rest, but in exertion. Effort-related chest discomfort is the hallmark of stable angina. The reproducibility of the pain and its relationship to physical exertion and emotion are the most important features of the history. Main cause is atherosclerosis.
2. Unstable angina: It is angina of recent onset or increasing severity, duration, or frequency. Pain may occur on minimal exertion or at rest. It occurs due to rupture, fissuring, or ulceration of atherosclerotic plaque or mural thrombus. Unstable angina is a medical emergency because if untreated it may culminate in myocardial infarction.
3. Prinzmetal/variant angina: May be at rest, but no atherosclerosis. This is due to coronary vasospasm.
Some special types of angina:
1. Crescendo angina: It is a specific type of unstable angina where attacks are progressively more frequent each day.
2. Nocturnal/decubitus angina: May occur because of increased venous return produced by lying down or when anti-anginal preparation which are commonly taken in the morning, loss their efficacy. It usually indicates severe coronary disease.
Differences between angina and oesophageal pain:
| Traits | Angina | Oesophageal pain |
| 1) Site | Retrosternal | Retrosternal or epigastric |
| 2) Precipitating factor | By exertion | Worsened by exertion but often present at other times |
| 3) Relation with rest | Rapidly relieved by rest | Not rapidly relieved by rest |
| 4) Relation with nitrates | Rapidly relieved by nirates | Often relieved by nirates |
| 5) Radiation | Radiates to arms and jaw | Sometimes radiates to arm of back |
| 6) Relation with sleep | Seldom wakes patient from sleep | Often wakes patient from sleep |
| 7) Duration | Typical duration2-10 minutes | Variable duration |
Differences between angina and MI:
| Traits | Angina | MI |
| 1) Relieving factors | By rest, nitrates | Not relieved by rest and nitrates |
| 2) Severity | Mild or moderate | Severe (may be silent) |
| 3) Anxiety | Absent or mild | Severe |
| 4) Sympathetic activity | Not increased | Increased |
| 5) Associated symptoms | No nausea, vomiting | Nausea and vomiting are common |
RISK FACTOR OF ANGINA:
- Family history of premature coronary heart disease( CHD)
- Hypertension
- Metabolic syndrome
- Tobacco abuse
- Diabetes mellitus
- Male gender
- Advanced age
- Obesity etc.
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