Angina Pectoris
Angina (angina pectoris) refers to a temporary chest pain that is caused by not
enough blood getting to the heart. It may be a feeling of tightness, heaviness, dull
discomfort, numbness (خدر), burning, pressure, or crushing pain (ألم انضغاطي) that is
usually felt behind the breastbone. It can also spread to the arms, neck, and jaw.
Exercise, eating, or stress often brings on angina. Not all chest pain is that of
angina; only your doctor can make the proper diagnosis.
It is a sense of discomfort arising in the myocardium as a result of ischemia without
infarction, also it implies severe chest pain and discomfort.
Angina attack is not a heart attack. In a heart attack a portion of the heart receives
little or no oxygen for a longer period of time. Without oxygen, that portion of the
heart muscles dies. If angina is untreated a heart attack could happen.
Angina requires prompt attention by a doctor when the condition first develops or,
later, if the usual pattern of attacks changes.
If your angina pain does not go away after you have taken three sublingual
nitroglycerin tablets within ten minutes, seek emergency medical care. The symptoms
of a heart attack are usually stronger than those of angina. Signs that a person is
having a heart attack and should get emergency attention include: pain lasting more
than 30 minutes, sweating, nausea, shortness of breath, severe anxiety, fatigue.
Most people who suffer a fatal heart attack do so because they did not get help soon
enough. So, if you think you are having a heart attack, contact your doctor, call an
ambulance, or get to a hospital immediately. Do not hesitate (تتردد) to seek help; it is
always better to be safe than sorry.
Patients have a reproducible pattern of angina associated with certain level of physical
activity is called to have chronic stable angina or exertional angina. Patients with
unstable angina have changes in their anginal intensity, frequency or duration.
Both stable and unstable angina reflect Atherosclerotic narrowing of coronary
arteries, vasospasmic angina occur in patients without coronary heart disease and
this due to spasm of the coronary arteries of the heart that decrease blood flow.
Coronary artery disease is the leading cause of death and angina is the first clinical
sign of this problem.
Pathophysiology:
Heart muscle is not like other muscles in the body, it does not act without the
presence of oxygen. With out oxygen, the heart ceases energy production and at
the end the heart stop pumping.
Atherosclerotic plaques that obstruct coronary artery and there for obstruct oxygen
supply.
Myocardial oxygen supplies and demand:
In the presence of imbalance between oxygen supply and demand, angina appears as
a result of this imbalance. This imbalance results from coronary artery stenosis, which
prevent oxygen from reaching all capillaries of the heart in order to match a demand.
Platelet aggregation and thrombosis play a role in anginal mechanism.
Oxygen demand is determined by the workload of the heart (contractility, heart rate,
systolic wall force) these represents most of oxygen demand in the heart. When the
extra demand of oxygen is placed upon the heart, myocardial extraction increases
slightly by unknown mechanism.
Recent studies show that the only cause of angina is atherosclerosis which decrease
oxygen supply to the heart, but about 10% of angina patients have no
Atherosclerotic coronary disease and the severity of angina symptom does no
correlated with coronary obstruction.
Platelet aggregation and the formation of thrombi is important pathophysiologic
mechanism in the ischemic heart diseases including angina syndromes. Platelets
aggregate and produce a granular content. That increases aggregation in the
arteries.
Characteristics of angina pectoris:
Quality:
- Sensation of pressure on the chest.
- Burning sensation.
- Feeling of tightness.
- Feeling of constriction over the larynx or a trachea.
Location:
- Over the sternum or very near to it.
- Occasionally limited to the left shoulder and the arm.
- Limited to the lower jaw.
Duration:
0.5-30Min
Precipitating factors:
- Related to exercise.
- Lifting the arms above the head.
- Cold environment.
- Walking against the wind
- Walking after a large meal
- Emotional factors
Radiation:
- The upper of the left arm
- Left shoulder
- Jaw (sometimes)
Risk factors:
-Hyperlipidemia including:
(The Triglycerides, LDL, and VLDL).
-Hypertension
-Smoking
-Obesity
-Family history of heart diseases
-Chronic emotional stress
-Oral contraceptives
-Sedentary life style.
-Age and sex (in male more than in female).
Types of angina:
*Stable angina:
The most common form.
Stress, heavy meal, and exercise may precipitate chest discomfort, and rest and
nitroglycerine relieve it.
*Unstable angina:
It is a new onset angina. Its occurrence is at rest for the first time, it is characterized
by pattern changes (in frequency, and duration). It decreases in response to rest or
nitroglycerine
It is a dangerous case and it needs a physician visit.
Classical or exertional angina (stable angina)
Physical exertion, especially after a meal, in cold weather or walking against the wind,
provokes this type of pain. And also aggravated by anger or excitement, the pain go
rapidly when the cause finished (in not more than 3 min.). Usually, pain is more easily
provoked in the early morning than the later in the day. There are five grades of
angina effort classified as the following:
Grade I Ordinary physical activity does not cause angina (strenuous physical
activity provokes angina).
Grade II Slight limitations of ordinary physical activity (climbing more than one
flight of stairs or walking uphill provokes angina).
Grade III Marked limitation of ordinary physical activity (walking on the level or
climbing one flight of stairs provokes angina).
Grade IV In ability to carry on any physical activity(angina may be present at
rest).
Variant angina (Prinzmetal's)
This type of angina occurs at rest, especially at night or in the early morning, it is
rarely induced by exertion.
This type of angina appears mostly in women and the pain is more severe and more
prolonged than in classical angina, it causes ECG elevation of ST segment develop[ed
during the pain. It is usually caused by spasm of coronary artery stenosis .
-Coronary artery spasm and the decrease of blood flow precipitates this type of
angina.
-It occurs at rest, pain may disrupt sleep.
-Calcium channel blockers are the most effective drugs in this case, rather than beta-
blockers. Nitroglycerin may not provide relief in this case.
Characteristic patient complaints include squeezing, pressure, sharp pain, burning,
indigestion-like discomfort, these complaints commonly move to the arms, legs, neck,
shoulders and back.
Angina (angina pectoris) refers to a temporary chest pain that is caused by not
enough blood getting to the heart. It may be a feeling of tightness, heaviness, dull
discomfort, numbness (خدر), burning, pressure, or crushing pain (ألم انضغاطي) that is
usually felt behind the breastbone. It can also spread to the arms, neck, and jaw.
Exercise, eating, or stress often brings on angina. Not all chest pain is that of
angina; only your doctor can make the proper diagnosis.
It is a sense of discomfort arising in the myocardium as a result of ischemia without
infarction, also it implies severe chest pain and discomfort.
Angina attack is not a heart attack. In a heart attack a portion of the heart receives
little or no oxygen for a longer period of time. Without oxygen, that portion of the
heart muscles dies. If angina is untreated a heart attack could happen.
Angina requires prompt attention by a doctor when the condition first develops or,
later, if the usual pattern of attacks changes.
If your angina pain does not go away after you have taken three sublingual
nitroglycerin tablets within ten minutes, seek emergency medical care. The symptoms
of a heart attack are usually stronger than those of angina. Signs that a person is
having a heart attack and should get emergency attention include: pain lasting more
than 30 minutes, sweating, nausea, shortness of breath, severe anxiety, fatigue.
Most people who suffer a fatal heart attack do so because they did not get help soon
enough. So, if you think you are having a heart attack, contact your doctor, call an
ambulance, or get to a hospital immediately. Do not hesitate (تتردد) to seek help; it is
always better to be safe than sorry.
Patients have a reproducible pattern of angina associated with certain level of physical
activity is called to have chronic stable angina or exertional angina. Patients with
unstable angina have changes in their anginal intensity, frequency or duration.
Both stable and unstable angina reflect Atherosclerotic narrowing of coronary
arteries, vasospasmic angina occur in patients without coronary heart disease and
this due to spasm of the coronary arteries of the heart that decrease blood flow.
Coronary artery disease is the leading cause of death and angina is the first clinical
sign of this problem.
Pathophysiology:
Heart muscle is not like other muscles in the body, it does not act without the
presence of oxygen. With out oxygen, the heart ceases energy production and at
the end the heart stop pumping.
Atherosclerotic plaques that obstruct coronary artery and there for obstruct oxygen
supply.
Myocardial oxygen supplies and demand:
In the presence of imbalance between oxygen supply and demand, angina appears as
a result of this imbalance. This imbalance results from coronary artery stenosis, which
prevent oxygen from reaching all capillaries of the heart in order to match a demand.
Platelet aggregation and thrombosis play a role in anginal mechanism.
Oxygen demand is determined by the workload of the heart (contractility, heart rate,
systolic wall force) these represents most of oxygen demand in the heart. When the
extra demand of oxygen is placed upon the heart, myocardial extraction increases
slightly by unknown mechanism.
Recent studies show that the only cause of angina is atherosclerosis which decrease
oxygen supply to the heart, but about 10% of angina patients have no
Atherosclerotic coronary disease and the severity of angina symptom does no
correlated with coronary obstruction.
Platelet aggregation and the formation of thrombi is important pathophysiologic
mechanism in the ischemic heart diseases including angina syndromes. Platelets
aggregate and produce a granular content. That increases aggregation in the
arteries.
Characteristics of angina pectoris:
Quality:
- Sensation of pressure on the chest.
- Burning sensation.
- Feeling of tightness.
- Feeling of constriction over the larynx or a trachea.
Location:
- Over the sternum or very near to it.
- Occasionally limited to the left shoulder and the arm.
- Limited to the lower jaw.
Duration:
0.5-30Min
Precipitating factors:
- Related to exercise.
- Lifting the arms above the head.
- Cold environment.
- Walking against the wind
- Walking after a large meal
- Emotional factors
Radiation:
- The upper of the left arm
- Left shoulder
- Jaw (sometimes)
Risk factors:
-Hyperlipidemia including:
(The Triglycerides, LDL, and VLDL).
-Hypertension
-Smoking
-Obesity
-Family history of heart diseases
-Chronic emotional stress
-Oral contraceptives
-Sedentary life style.
-Age and sex (in male more than in female).
Types of angina:
*Stable angina:
The most common form.
Stress, heavy meal, and exercise may precipitate chest discomfort, and rest and
nitroglycerine relieve it.
*Unstable angina:
It is a new onset angina. Its occurrence is at rest for the first time, it is characterized
by pattern changes (in frequency, and duration). It decreases in response to rest or
nitroglycerine
It is a dangerous case and it needs a physician visit.
Classical or exertional angina (stable angina)
Physical exertion, especially after a meal, in cold weather or walking against the wind,
provokes this type of pain. And also aggravated by anger or excitement, the pain go
rapidly when the cause finished (in not more than 3 min.). Usually, pain is more easily
provoked in the early morning than the later in the day. There are five grades of
angina effort classified as the following:
Grade I Ordinary physical activity does not cause angina (strenuous physical
activity provokes angina).
Grade II Slight limitations of ordinary physical activity (climbing more than one
flight of stairs or walking uphill provokes angina).
Grade III Marked limitation of ordinary physical activity (walking on the level or
climbing one flight of stairs provokes angina).
Grade IV In ability to carry on any physical activity(angina may be present at
rest).
Variant angina (Prinzmetal's)
This type of angina occurs at rest, especially at night or in the early morning, it is
rarely induced by exertion.
This type of angina appears mostly in women and the pain is more severe and more
prolonged than in classical angina, it causes ECG elevation of ST segment develop[ed
during the pain. It is usually caused by spasm of coronary artery stenosis .
-Coronary artery spasm and the decrease of blood flow precipitates this type of
angina.
-It occurs at rest, pain may disrupt sleep.
-Calcium channel blockers are the most effective drugs in this case, rather than beta-
blockers. Nitroglycerin may not provide relief in this case.
Characteristic patient complaints include squeezing, pressure, sharp pain, burning,
indigestion-like discomfort, these complaints commonly move to the arms, legs, neck,
shoulders and back.
Cardiovascular Diseases
 |  |
Angina Pectoris