Angina pectoris -
Chest pain is
discomfort or pain that you feel anywhere along the front of your body
between your neck and upper abdomen.
Angina is a type of
heart-related chest pain. This pain occurs because your heart is not
getting enough blood and oxygen. Angina pain can be similar to the pain
of a heart attack.
It's the middle of the night or maybe the
beginning of a busy workday when you suddenly feel
pain in your chest. You may try to ignore it at
first, but the pain has you scared and worried.
Could you be having a
heart attack? Should you go to
the emergency room? Chest pain is one of the most common reasons
people call for emergency medical help.
Fortunately, chest pain doesn't always signal a
heart attack. Often it's unrelated to any heart
problem. But even if the chest pain you experience
has nothing to do with your cardiovascular system,
the problem may still be important - and worth the
time spent in an emergency room to have it
cases, the cause of angina is coronary atherosclerosis (thickening of
the arteries supplying blood to the heart). These arteries supply the
cardiac muscle with blood and therefore oxygen and nutrients. Narrow
coronary arteries reduce the blood flow to the heart muscle. This is
usually noticed at times when the heart muscle needs more blood supply,
such as during exercise.
The heart, when it increases its workload, will receive too little
oxygen which causes pain in the heart. In severe cases this can also
happen when the heart is at rest.
Angina can be aggravated by other illnesses including:
sustained fast heartbeat.
anaemia (thin blood).
heart valve diseases, such as severe aortic stenosis - a narrowing
of the outflow valve of the heart.
thickening of the heart muscle - hypertrophy - which can occur in
patients with high blood pressure over several years.
rarely, a severe spasm of a coronary artery can occur even when the
patient has relatively minor coronary atherosclerosis.
Atherosclerosis affects many people in developed countries. It may start
as early as your 20s and increases with age.
Numerous 'risk factors' are known to be associated with the development
family history of atherosclerosis.
Hypercholesterolaemia - a high content of (LDL) cholesterol in the
Hypertension (high blood pressure).
Diabetes Type 1 and Type 2.
of regular exercise.
symptoms typically occur in connection with physical exertion or
psychological stress. They are often worse in cold or windy weather, and
sometimes after big meals.
squeezing or heavy pressing sensation on the chest.
sense of heaviness or numbness in the arm, shoulder, elbow or hand
(usually on the left side).
constricting sensation in the throat.
discomfort can radiate into both arms, jaw, teeth, ears, stomach or
between the shoulder blades.
Increased shortness of breath on exercise.
severe unstable angina can be associated with the same symptoms at
something to eliminate the risk factors mentioned.
a varied and healthy diet; leafy vegetables, unprocessed cereals,
low-fat, high-fibre products. Avoid saturated fats.
smoking. Your doctor or pharmacist will be able to provide advice
about stop smoking programmes and smoking cessation products.
weight, if you are overweight.
Exercise more (a half-hour walk each day is much better than nothing
you suffer from diabetes Type 1 or Type 2, or high blood pressure
maintain treatment for these conditions.
Follow your GP's advice.
diagnosis is often based on the presence of typical symptoms, medical
history and the immediate effect of glyceryl trinitrate spray or tablets
under the tongue to relieve chest pains.
When available, a resting ECG performed during an episode of pain is
In addition, your doctor can give you an exercise test on a treadmill or
exercise bike (a stress test) to determine if the heart muscle is the
source of the pain. This test is usually done by a specialist in a
In many cases, an examination of the coronary arteries (a coronary
angiogram) will be required. This consists of an injection of a contrast
medium (dye) into the circulation through plastic tubes introduced into
the main artery in the groin. The coronary arteries will then show up on
X-ray pictures. This examination will be done in hospital as a day-case
can the doctor do?
First and foremost, he or she can help identify and reduce the
patient's risk factors, particularly in the treatment of high
cholesterol and blood pressure that are not responding to lifestyle
Prescribe medicines for relief of angina.
Refer the patient for further examinations by a cardiologist.
required, the cardiologist may arrange for an interventional
procedure to dilate (open up) a narrowed coronary artery
(angioplasty), or a bypass operation, where an internal artery and
superficial vein from the leg are joined to the coronary artery to
bypass the obstruction to blood flow.
Coronary artery atherosclerosis, can sometimes lead to a
coronary thrombosis when a coronary narrowing (plaque) ruptures. This
may lead to an acute coronary syndrome such as unstable angina (severe
angina at rest) or myocardial infarction (blockage of the coronary
artery leading to heart muscle damage).
But the number of future attacks and hospitalizations can be reduced if
the blood supplied to the heart can be restored to an adequate level.
This can be done either by balloon dilatation (angioplasty) or in
certain cases by a bypass operation.
Aspirin (in low dose): reduces the tendency of small
blood cells called platelets to stick together, which helps prevent the
formation of a thrombosis.
Glyceryl trinitrate (GTN tablets or spray) relax the arteries of
the heart and relieve angina attacks.
Long-acting nitrates reduce the frequency of angina attacks.
Beta-blockers block the effect of the hormone adrenaline so that
the pulse is slowed and the blood pressure lowered. This reduces
the heart's need for oxygen and improves the supply of blood to
the heart muscle. They are also important in protecting the
heart after heart attacks.
Calcium-channel blockers reduce the muscle tension in the
coronary arteries, expanding them and creating more room. They
also slightly relax the heart muscle, reducing the heart's need
for oxygen and reducing blood pressure.
Potassium-channel activators reduce the muscular tension in the
blood vessel walls, expanding them and improving the flow of
blood and the supply of oxygen.
Several medicines may be needed to control symptoms and improve
the condition without side effects from the treatment itself. In
this way, the medicine is tailored to each patient's individual
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provided for general medical education purposes only and
is not meant to substitute for the independent medical
judgment of a physician relative to diagnostic and
treatment options of a specific patient's medical
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decision made or action taken in reliance upon the
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