Angina Pectoris

Introduction:
Angina pectoris is the medical term for chest pain or discomfort due to coronary heart disease. Angina is a symptom of a condition called myocardial ischemia. It occurs when the heart muscle (myocardium) doesn’t get as much blood (hence as much oxygen) as it needs. This usually happens because one or more of the heart’s arteries (coronary blood vessels that supply blood to the heart muscle) is narrowed or blocked. Insufficient blood supply is called ischemia.Angina also can occur in people with valvular heart disease, hypertrophic cardiomyopathy (this is an enlarged heart due to disease) or uncontrolled high blood pressure.
Causes,Risk Factors:
When the heart muscle has to work harder, it needs more oxygen. Symptoms of angina occur when the coronary arteries are narrowed or blocked by hardening of the arteries (atherosclerosis), or by a blood clot.
The most common cause of angina is coronary heart disease (CHD). Angina pectoris is the medical term for this type of chest pain.
The risk factors for coronary heart disease include:

Diabetes
Family history of coronary heart disease before age 50
High blood pressure
High LDL cholesterol and low HDL cholesterol
Male gender
Not getting enough exercise
Obesity
Over Smoking
Excessive Use of Fats.

Other causes of angina include:

Abnormal heart rhythms
Anemia
Coronary artery spasm (also called Prinzmetal’s angina)
Heart failure
Heart valve disease
Hyperthyroidism.
Over Mental Stress.

Symptoms:
The most common symptom is chest pain that occurs behind the breastbone or slightly to the left of it. The pain of stable angina usually begins slowly and gets worse over the next few minutes before going away.
The pain may feel like tightness, heavy pressure, squeezing, or crushing pain. It may spread to the:

Arm (usually the left)
Back
Jaw
Neck
Shoulder

Other symptoms of angina include:

A feeling of indigestion or heartburn
Dizziness or light-headedness
Nausea, vomiting, and sweating
Palpitations
Shortness of breath
Unexplained tiredness after activity (more common in women)

Complications:

Heart attack(Myocardial Imfarction)
Sudden death caused by abnormal heart rhythms (arrhythmias)
Unstable angina
CCF

Signs and Tests:
Your health care provider will perform a physical exam and measure your blood pressure. The following tests may be done to diagnose or rule out angina:

Coronary angiography
Coronary risk profile (special blood tests)
ECG
Exercise tolerance test (stress test or treadmill test)
Stress echocardiogram
Thallium stress test

There are two types of Angina:
Stable Angina
Unstable Angina.
What is Stable Angina?
People with stable angina (or chronic stable angina) have episodes of chest discomfort that are usually predictable. They occur on exertion (such as running to catch a bus) or under mental or emotional stress. Normally the chest discomfort is relieved with rest, nitroglycerin or both.
People with episodes of chest discomfort should see their physician for an evaluation. The doctor will evaluate the person’s medical history and risk factors, conduct a physical exam, order a chest X-ray and take an electrocardiogram (ECG).
Treatment:
The options for treating angina include medications and surgery.
Medicines used to treat angina include:

Nitroglycerin
Blood thinners, including aspirin and clopidogrel (Plavix)
Cholesterol-lowering drugs
Blood pressure medicines, including calcium channel blockers, beta blockers, and angiotensin-converting enzyme (ACE) inhibitors

Ranolazine (Ranexa) is a relatively new medicine approved for the treatment of chronic angina. The drug is for patients who do not respond to traditional angina treatment. It should be used in combination with other medication.
Some patients may need surgery to help improve the flow of blood through the coronary arteries, such as:

Angioplasty
Coronary artery bypass grafting (CABG)

Recent studies show that angioplasty with stenting does not help you live longer than medicine alone. However, it can reduce angina or other symptoms of coronary artery disease.
Angioplasty with stenting can be a life-saving procedure if you are having a heart attack.
What is Unstable Angina:
In people with unstable angina, the chest pain is unexpected and usually occurs while at rest. The discomfort may be more severe and prolonged than typical angina or be the first time a person has angina. The most common cause is reduced blood flow to the heart muscle because the coronary arteries are narrowed by fatty buildups (atherosclerosis). An artery may be abnormally constricted or partially blocked by a blood clot. Inflammation, infection and secondary causes also can lead to unstable angina. In a form of unstable angina called variant or Prinzmetal’s angina, the cause is coronary artery spasm.
Unstable angina is an acute coronary syndrome and should be treated as an emergency.
They’re at increased risk for:

acute myocardial infarction (heart attack).
severe cardiac arrhythmias. These may include ventricular tachycardia and fibrillation.
cardiac arrest leading to sudden death.

Prevention:
The best way to prevent angina is to lower your risk for coronary heart disease:

Control blood pressure, diabetes, and cholesterol
Lose weight if you are overweight
Stop smoking

Reducing risk factors may prevent the blockages from getting worse, and can make them less severe, which reduces angina pain.
If you have one or more risk factors for heart disease, talk to your doctor about possibly taking aspirin or other medicines to help prevent a heart attack. Aspirin therapy (75 mg – 325 mg a day) or a drug called clopidogrel may help prevent heart attacks in some people.