Angina (patient information)
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What is angina?
Angina is chest pain or discomfort that occurs when your heart muscle does not get enough blood. It may feel like pressure or a squeezing pain in your chest. You may also feel pain in your shoulders, arms, neck, jaw or back. Sometimes it may feel like indigestion. Not as a disease, angina is one of symptoms of coronary artery disease (CAD), the most common type of heart disease. CAD happens when a fatty substance called [plaque] builds up in the arteries that supply blood to the heart, reducing blood flow. Thus, people cannot get enough oxygen-rich blood and angina occurs.
What are symptom of angina?
Angina itself is the most important syptom of coronary artery disease. It is the signal of myocardium ischemia. There are other symptoms accopanying with angina as following,
- Chest pain: It always focus on precordial region or behind sternum. Not all chest pain is related to coronary artery disease.
- Feeling of chest pressure: Some people feel chest pressure just like a huge stone on your chest or like a rope stringing your chest.
- Feeling of indigestion: Loss of appetite, [nausea] or [vomitting] may occur in part patient.
- Pain in shoulders,arms,jaw or back: It is always accompanying with chest pain or discomfort.
Other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell his/her doctor so that problems can be diagnosed and treated as early as possible.
Who is at risk of angina?
Studies have found a number of factors that may induce Angina. The risk factors of coronary artery disease are as the same as Angina. It concludes bad lifestyle and cardiovascular diseases risk factors. Some you can change and some you cannot change.
Risk factors you can change
- Cigarette smoking: Cigarette somking has a close relationship with many cardiovascular diseases. Smokers' risk of developing coronary heart disease is 2–4 times than that of nonsmokers. Besides, it is also a powerful independent risk factor for sudden cardiac death in patients with coronary heart disease; smokers have about twice the risk of nonsmokers. Furthermore, cigarette smoking acts with other risk factors to greatly increase the hazard for coronary heart disease. People who smoke seem to have a higher risk of death from coronary heart diseases (and possibly stroke) but these risk isn't as great as cigarette nonsmokers'.
- High blood cholesterol: As blood [cholesterol] rises, so does risk of coronary heart disease. A person's cholesterol level is greatly affected by diet.
- Stress: Clinical researches demonstrate that stress may be a contributing factor for coronary artery disease. People under stress may overeat, start smoking or smoke more than they otherwise would. These behavior may increase the risk of incidence of cardiovascular diseases.
- Weight: Overweight and fat, especially body mass index(BMI) higher than 28 are risk factor for angina. Controlling weight is an available way to decrease the incident of Angina.
- High blood pressure: Patients with Hypertension seem to have a higher risk to develope coronary artery disease. This is because that Hypertension decrease the reserve of coronary arteries.
- Diabetes mellitus: Like Hypertension, patients with Diabetes mellitus seem to have a higher risk to develope coronary artery disease. Because Diabetes mellituS damage both coronary arteries and [myocardial capillary vessels].
- Drinking too much alcohol: Data has demonstrated too much alcohol damage your arteries and myocardium.
Risk factors that you cannot change
- Age: People being older than 65 years or more have more probobility to develope to coronary artery disease than younger.
- Gender: Male is an independent risk factor to develope to coronary artery disease than female. Post-menopause women also have greater probobility than younger women.
- Heredity: Person with a family history of cardiovascular diseases is more likely to develope to coronary artery disease than people without family history.
- Race: African Americans are at a higher risk than other races.
Diagnosis
Some health problems may cause the similar symptoms with Angina. So people with any of those symptoms should go to see the doctor to be diagnosed and treated as early as possible.
- Electrocardiogram: This is the most important and painless procedure in which a healthcare professional will measure the electrical activity of your heart to find whether there are any heart abnormalities or irregular heart beats.
- Echocardiogram: This is a painless test to identify whether some areas of your heart are not contracting normally.
- Several blood tests: Blood tests such as CK-MB Test and Troponins Test can be done by your doctor to determine whether or not your heart is damaged.
- Coronary angiography: This is an imaging test that involves the injection of a special dye into your coronary arteries so that visible images can be seen on x rays to show the inside of your coronary arteries and to determine whether or not there is any obstruction of blood flow.
- Stress testing: The test is done when you are exercising. This makes it easier for doctors to diagnosis heart disease.
When to seek urgent medical care?
People with cardiovascular diseases family history or bad life-style should go to the doctor to follow-up. When one has the following symptoms, he/she need to seek urgent medical care:
- Persistent and severe chest pain
- Sudden drop in blood pressure
- Shortness of breath
- Angina or chest pain accompanying with sweating or nausea or discomfort in shoulders, arms, jaws, neck or abdomen
These symptoms suggest that the person need to go to hospital to verify whether there are acute coronary syndrome(ACS) or not.
Treatment options
Patients with angina have many treatment options. The options include general therapy, medications, percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). The choice of treatment depends mainly on symptoms and the stenosis degree of coronary arteries. Your doctor can describe your treatment choices, the expected results of each, and the possible side effects. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.
General therapy:
- Controlling your weight and waistline
- Giving up smoking and alcohol
- Doing some exercises regular
- Managing stress
Medications:
- Anti-platlet drugs: Clinical trials demonstrate that aspirin 75 mg to 100 mg per day is beneficial for all patients with stable angina that have no problems with its use. Patients with peptic ulcer can select other anti-platelet drugs such as clopidogrel or prasugrel under the direction of the doctors.
- Beta blockers: Beta blockers can reduce the effect of excitement/physical exertion on heart rate and force of contraction, dilation of blood vessels and decrease the toxicity of catecholamine on myocardium. Usual drugs used in angina are β1-selective agents such as Betaxolol, Bisoprolol, Esmolol, Metoprolol and Nebivolo. Patients with asthma, severe conduction block or severe heart failure are not appropriate for beta blockers. You should take these type of medicines under doctor's direction.
- Nitrates
- Calcium-channel blockers
- Angiotensin converting enzyme inhibitor (ACEI): Angiotensin converting enzyme inhibitor (ACEI) is widely used in cardivascular diseases. This includes a large group of drugs, such as Enalapril (Vasotec/Renitec), Ramipril (Altace/Tritace/Ramace/Ramiwin), Quinapril (Accupril), Perindopril (Coversyl/Aceon), Lisinopril (Lisodur/Lopril/Novatec/Prinivil/Zestril) and Benazepril (Lotensin). They can improve symptoms and prognosis of heart failure by several ways. Uasual side effects include dry cough and angioedema. Patients who can not tolerate cough are often switched to angiotensin II receptor antagonist. Patients with renal artery stenosis on both sides or severe renal impairment are not appropriate for angiotensin converting enzyme inhibitor (ACEI).
- Statins
Percutaneous coronary intervention (PCI):
- Coronary artery disease is the disease that blockages in the coronary arteries restrict the blood supply to the heart muscle. Removing these blockages in coronary artery can improve overall coronary flow and myocardial perfusion, then improve the symptoms of angina. The procedure is usually performed in the cardiac catherization lab. A catheter, a very small tube with a tiny deflated balloon on the end, is inserted through an incision in the groin area and pushed through to the diseased artery. Then the balloon is inflated to push open the artery. The balloon is removed once the artery has been fully opened. A stent may be placed during the procedure to keep the blood vessel open. Clinical trials have demonstrated that percutaneous coronary intervention (PCI) is a very effective and safe procedure to reopen blocked vessels and can improve the patient's condition.
coronary artery bypass grafting (CABG):
- These are surgeries to expand coronary arteries or to place stents in coronary arteries or to improve blood supply to coronary arteries.
Diseases with similar symptoms
Other health problems may also cause similar symptoms. Go to see your doctor to verify your diseases as early as possible.
- Shortness of breath: This is needed to discriminate from respiratory system diseases such as pneumonitis, pulmonary tuberculosis, etc.
- Indigestion: This symptom should be discriminated from digestive system diseases such as gastritis, peptic ulcer, etc.
- Pain in shoulders, arms, jaw or back: Your doctor may discriminate from scapulohumeral periarthritis, teeth diseases and etc.