Angina
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Angina is the chest pain or tightness that occurs when the blood oxygen supply to an area of the heart muscle does not meet the needs or demands of the work it is doing in pumping blood around the body. | |
- It is an indicator of coronary artery disease caused by the build up of fatty deposits in coronary blood vessels supplying blood to the heart muscle, which results in their narrowing.
- Angina is usually felt as a squeezing, pressure, heaviness, tightening, or aching across the chest, particularly behind the breastbone. This pain often spreads to the neck, jaw, arms, back, or even the teeth.
- Patients may also complain of indigestion, heartburn, weakness, sweating, nausea, cramping, and shortness of breath.
Angina attacks are caused when the heart needs more oxygen than the coronary blood vessels are able to supply. In most cases, the lack of blood supply to the heart muscle is due to a narrowing of the arteries of the heart caused by disease. Angina usually occurs during exertion, severe emotional stress, or after a heavy meal. During these periods, the heart muscle demands more blood oxygen than the narrowed coronary arteries can deliver.
Angina does not lead to permanent damage to the heart but it is a serious condition because it is an indicator of underlying coronary artery disease, which in some people can progress to cause a heart attack, and death. It affects everyday life because it limits the amount of exercise you can perform; even walking or climbing stairs can become a problem and emotional stress can also bring on an attack.
Angina attacks typically last from 1 to 15 minutes. Several attacks may be experienced during the period of a week. Angina may occur in different forms in which attacks can happen over different periods of time.
- Chronic (long-lasting) stable angina is brought on by exercise and can be predicted to happen regularly over months or even years.
- Unstable angina is different because it can happen when you are resting. It can follow on from stable angina but is a more serious condition because within a short time, of hours or weeks, it can signal a future heart attack.
- Variant and microvascular (smallest vessels) angina is rare and can happen when there is no coronary artery disease. In this case, angina is due to abnormal control of the amount of narrowing (relaxation) of the blood vessels that reduce the blood flow to the heart.
Angina is currently treated with medicines that aim to reduce or prevent symptoms. These are usually given together with advice on lifestyle changes to control risk factors such as stopping smoking, controlling weight and checking cholesterol levels. Other medicines to control high blood pressure should be taken as directed because they may help with symptoms and further reduce risk. In some cases, a heart specialist might recommend surgery to bypass the narrowed arteries in the heart, or to widen the narrow arteries using a small balloon (called an angioplasty).
- Medicines called nitrates are useful in preventing and reducing the frequency and intensity of episodes in patients with chronic angina. They work by relaxing and widening the blood vessels and allow more blood flow.
- Medicines called beta-blockers are taken to prevent and relieve angina by blocking (inhibiting) the effect of chemicals produced in the body called adrenaline and noradrenaline, on the heart.
- Adrenaline is a hormone (chemical signal carried in the blood) whose levels are increased during exercise and stress. Noradrenaline, released from nerves in the heart, acts to speed up heart rate and increase force of the beats.
- Inhibiting adrenaline and noradrenaline decreases the heart rate, lowers the blood pressure, and reduces the pumping force of the heart muscle, all of which reduce the heart muscle's demand for oxygen.
- Medicines called calcium-channel blockers relieve angina by widening (dilating) blood vessels, so lowering blood pressure.
- They do this by preventing calcium from entering blood vessels causing them to relax and widen.
- Reducing blood pressure has the effect of reducing the pumping force of the heart muscle, thereby reducing muscle oxygen needs (demand).
- They are also useful because, by the same way, they widen (dilate) coronary blood vessels and allow more blood to flow to the heart muscle.
- High blood pressure, high-fat diet, lack of exercise, smoking and stress are all implicated in the cause of angina in relation to coronary artery disease.
- In a smaller number of cases, angina may result from such things as heart valve disease, arrhythmias and diseases of heart muscle, which affect the blood supply to heart muscle in other ways.
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