Angina
Pectoris
Dr. Fawaz
Akhras Dr.
Hassan Chamsi Pasha
Coronary heart disease, the biggest killer in affluent countries, is
also one of the most preventable causes of death, since dietary habits and
smoking are major causes. Coronary heart disease affects the heart's own blood vessels, the
"Coronary Arteries".
What are the
Coronary Arteries?
The coronary arteries are the vessels which supply blood to the heart
muscle itself. This supply is carried in the right and left coronary arteries,
which are the first vessels to leave the aorta ( the body's main artery) as it
emerges from the heart. Almost as soon as it branches off the aorta, the left
coronary artery splits into two big branches so there are in effect, three
coronary arteries: the right and the two branches of the left. They go on to
completely encircle and penetrate the
heart supplying blood to every part of it.
What is
Angina?
Angina occurs when some part of the heart requires more oxygen than it
can get from the blood reaching it through the coronary arteries. Narrowing of
the coronary blood vessels prevent sufficient blood and oxygen getting to the
heart muscle. This relative lack of blood produces the typical central chest
pain of angina which spreads to the arms (usually the left arm) shoulders or
neck. It is usually brought on by exertion or excitement and relieved with
rest. It is often described as a sensation of pressure on the chest. Typically
the pain develops at the same stage in daily activities, for example, at the
same point on a flight of stairs. A prolonged and usually more severe attack of
angina may be due to heart attack, therefore medical advice should be sought
promptly.
What are the
causes of Angina?
The commonest cause is hardening and narrowing of the coronary arteries
"atherosclerosis" which reduces their capacity to carry sudden
increase in flow when the person
is exercising or is under stress. Other causes of angina include:
1. Coronary artery spasm, in which sudden narrowing of
the blood vessels occurs and lasts only for a short time but returns to normal
with no permanent obstruction.
2. Aortic
stenosis (narrowing of the aortic valve).
3. Abnormal
heart rhythm.
Rare causes of
angina include severe anemia and thyrotoxicosis.
How is the
diagnosis of angina made?
Your doctor will ask for few tests including E.C.G. and exercise test. The E.C.G. performed at rest may be entirely
normal, but may show evidence of previous damage.
He may also ask for blood tests to look for underlying cause such as
anemia, thyrotoxicosis or hypercholesterolemia (high cholesterol in the blood).
Coronary angiography (visualizing the coronary arteries by a special x-ray
examination) may also be performed (for more details see the chapter on Cardiac
Catheterization).
How is angina
treated?
Attacks of angina can be treated with nitroglycerin tablets (G.T.N.)
put under the tongue and allowed to dissolve. The pain usually settles within few minutes. If
you have angina you are advised to
carry these tablets in your pocket. Your doctor may prescribe
"nitrate" tablets similar in action to the tablets you put under your
tongue but have a longer duration of action. These tablets increase the flow of
blood through the heart muscle and improve blood flow around the body. However,
these tablets may cause headaches because they dilate the vessels of the brain
as well. Other drugs which can be prescribed include beta blockers, calcium
channel blockers and aspirin. If hypertension is also discovered during
examination, drugs may be given to control high blood pressure. If your blood
cholesterol is found high you will be advised to adhere to a low fat, low
cholesterol diet. Drugs which reduce your cholesterol may have to be used later.
Do I need to
change my lifestyle?
The answer is yes. If you are a smoker you should give up smoking
immediately because nicotine and carbon monoxide contribute to further progression of coronary artery
disease and make your symptoms worse. If you are overweight you should loose
weight. You need to have a more
healthy diet and undertake regular exercise.
I still have
angina attacks despite taking my medication, doctor?
You have to realize that drug therapy can control the symptoms of angina
but it does not cure the disorder. If you still get angina attacks despite drug
treatment and if there is angiographic evidence of advanced narrowing of
coronary arteries, coronary angioplasty (dilating the narrowing in the coronary
artery with a balloon) or coronary artery bypass surgery may be performed to
restore a good blood flow to the
heart muscle. Fortunately modern treatment has made a considerable impact on
angina in terms of preventing symptoms and improving survival.
What is
unstable angina?
If your angina attacks
become more severe, more frequent or more prolonged or occurring at rest with decreasing response to GTN tablets then you have what
is called "unstable angina".
You need to seek a medical advice immediately with a view of admission into hospital to have further assessment and
intensive treatment.