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What is angina?
ANGINA PECTORIS ("ANGINA") IS A recurring
pain or discomfort in the chest that happens when some part of the heart
does not receive enough blood. It is a common symptom of coronary heart
disease (CHD), which occurs when vessels that carry blood to the heart
become narrowed and blocked due to atherosclerosis
Angina feels like a pressing or squeezing pain,
usually in the chest under the breast bone, but sometimes in the
shoulders, arms, neck, jaws, or back. Angina is usually precipitated by
exertion. It is usually relieved within a few minutes by resting or by
taking prescribed angina medicine.
What brings on angina?
Episodes of angina occur when the heart's need for
oxygen increases beyond the oxygen available from the blood nourishing
the heart. Physical exertion is the most common trigger for angina.
Other triggers can be emotional stress, extreme cold or heat, heavy
meals, alcohol, and cigarette smoking.
Does angina mean a heart attack is about to
happen?
An episode of angina is not a heart attack. Angina
pain means that some of the heart muscle in not getting enough blood
temporarily--for example, during exercise, when the heart has to work
harder. The pain does NOT mean that the heart muscle is suffering
irreversible, permanent damage. Episodes of angina seldom cause
permanent damage to heart muscle.
In contrast, a heart attack occurs when the blood flow
to a part of the heart is suddenly and permanently cut off. This causes
permanent damage to the heart muscle. Typically, the chest pain is more
severe, lasts longer, and does not go away with rest or with medicine
that was previously effective. It may be accompanied by indigestion,
nausea, weakness, and sweating. However, the symptoms of a heart attack
are varied and may be considerably milder.
When someone has a repeating but stable pattern of
angina, an episode of angina does not mean that a heart attack is about
to happen. Angina means that there is underlying coronary heart disease.
Patients with angina are at an increased risk of heart attack compared
with those who have no symptoms of cardiovascular disease, but the
episode of angina is not a signal that a heart attack is about to
happen. In contrast, when the pattern of angina changes--if episodes
become more frequent, last longer, or occur without exercise--the risk
of heart attack in subsequent days or weeks is much higher.
A person who has angina should learn the pattern of
his or her angina--what cause an angina attack, what it feels like, how
long episodes usually last, and whether medication relieves the attack.
If the pattern changes sharply or if the symptoms are those of a heart
attack, one should get medical help immediately, perhaps best done by
seeking an evaluation at a nearby hospital emergency room.
Is all chest pain "angina?"
No, not at all. Not all chest pain is from the heart,
and not all pain from the heart is angina. For example, if the pain
lasts for less that 30 seconds or if it goes away during a deep breath,
after drinking a glass of water, or by changing position, it almost
certainly is NOT angina and should not cause concern. But prolonged
pain, unrelieved by rest and accompanied by other symptoms may signal a
heart attack.
How is angina diagnosed?
Usually the doctor can diagnose angina by noting the
symptoms and how they arise. However one or more diagnostic tests may be
needed to exclude angina or to establish the severity of the underlying
coronary disease. These include the electrocardiogram (ECG) at rest, the
stress test, and x- rays of the coronary arteries (coronary "arteriogram"
or "angiogram").
The ECG records electrical impulses of the heart.
These may indicate that the heart muscle is not getting as much oxygen
as it needs ("ischemia"); they may also indicate abnormalities
in heart rhythm or some of the other possible abnormal features of the
heart. To record the ECG, a technician positions a number of small
contacts on the patient's arms, legs, and across the chest to connect
them to an ECG machine.
For many patients with angina, the ECG at rest is
normal. This is not surprising because the symptoms of angina occur
during stress. Therefore, the functioning of the heart may be tested
under stress, typically exercise. In the simplest stress test, the ECG
is taken before, during, and after exercise to look for stress related
abnormalities. Blood pressure is also measured during the stress test
and symptoms are noted.
A more complex stress test involves picturing the
blood flow pattern in the heart muscle during peak exercise and after
rest. A tiny amount of a radioisotope, usually thallium, is injected
into a vein at peak exercise and is taken up by normal heart muscle. A
radioactivity detector and computer record the pattern of radioactivity
distribution to various parts of the heart muscle. Regional differences
in radioisotope concentration and in the rates at which the
radioisotopes disappear are measures of unequal blood flow due to
coronary artery narrowing, or due to failure of uptake in scarred heart
muscle.
The most accurate way to assess the presence and
severity of coronary disease is a coronary angiogram, an x-ray of the
coronary artery. A long thin flexible tube (a "catheter") is
threaded into an artery in the groin or forearm and advanced through the
arterial system into one of the two major coronary arteries. A fluid
that blocks x-rays (a "contrast medium" or "dye") is
injected. X-rays of its distribution show the coronary arteries and
their narrowing.
How is angina treated?
The underlying coronary artery disease that causes
angina should be attacked by controlling existing "risk
factors." These include high blood pressure, cigarette smoking,
high blood cholesterol levels, and excess weight. If the doctor has
prescribed a drug to lower blood pressure, it should be taken as
directed. Advice is available on how to eat to control weight, blood
cholesterol levels, and blood pressure. A physician can also help
patients to stop smoking. Taking these steps reduces the likelihood that
coronary artery disease will lead to a heart attack.
Most people with angina learn to adjust their lives to
minimize episodes of angina, by taking sensible precautions and using
medications if necessary.
Usually the first line of defense involves changing
one's living habits to avoid bringing on attacks of angina. Controlling
physical activity, adopting good eating habits, moderating alcohol
consumption, and not smoking are some of the precautions that can help
patients live more comfortably and with less angina. For example, if
angina comes on with strenuous exercise, exercise a little less
strenuously, but do exercise. If angina occurs after heavy meals, avoid
large meals and rich foods that leave one feeling stuffed. Controlling
weight, reducing the amount of fat in the diet, and avoiding emotional
upsets may also help.
Angina is often controlled by drugs. The most commonly
prescribed drug for angina is nitroglycerin, which relieves pain by
widening blood vessels. This allows more blood to flow to the heart
muscle and also decreases the work load of the heart. Nitroglycerin is
taken when discomfort occurs or is expected. Doctors frequently
prescribe other drugs, to be taken regularly, that reduce the heart's
workload. Beta blockers slow the heart rate and lessen the force of the
heart muscle contraction. Calcium channel blockers are also effective in
reducing the frequency and severity of angina attacks.
What if medication fails to control angina?
Doctors may recommend surgery or angioplasty if drugs
fail to ease angina or if the risk of heart attack is high. Coronary
artery bypass surgery is an operation in which a blood vessel is grafted
onto the blocked artery to bypass the blocked or diseased section so
that blood can get to the heart muscle. An artery from inside the chest
(an "internal mammary" graft) or long vein from the leg (a
"saphenous vein" graft) may be used.
Balloon angioplasty involves inserting a catheter with
a tiny balloon at the end into a forearm or groin artery. The balloon is
inflated briefly to open the vessel in places where the artery is
narrowed. Other catheter techniques are also being developed for opening
narrowed coronary arteries, including laser and mechanical devices
applied by means of catheters.
Can a person with angina exercise?
Yes. It is important to work with the doctor to
develop an exercise plan. Exercise may increase the level of pain-free
activity, relieve stress, improve the heart's blood supply, and help
control weight. A person with angina should start an exercise program
only with the doctor's advice. Many doctors tell angina patients to
gradually build up their fitness level--for example, start with a
5-minute walk and increase over weeks or months to 30 minutes or 1 hour.
The idea is to gradually increase stamina by working at a steady pace,
but avoiding sudden bursts of effort.
What is the difference between
"stable" and "unstable" angina?
It is important to distinguish between the typical
stable pattern of angina and "unstable" angina.
Angina pectoris often recurs in a regular or
characteristic pattern. Commonly a person recognizes that he or she is
having angina only after several episodes have occurred, and a pattern
has evolved. The level of activity or stress that provokes the angina is
somewhat predictable, and the pattern changes only slowly. This is
"stable" angina, the most common variety.
Instead of appearing gradually, angina may first
appear as a very severe episode or as frequently recurring bouts of
angina. Or, an established stable pattern of angina may change sharply;
it may by provoked by far less exercise than in the past, or it may
appear at rest. Angina in these forms is referred to as "unstable
angina" and needs prompt medical attention.
The term "unstable angina" is also used when
symptoms suggest a heart attack but hospital tests do not support that
diagnosis. For example, a patient may have typical but prolonged chest
pain and poor response to rest and medication, but there is no evidence
of heart muscle damage either on the electrocardiogram or in blood
enzyme tests.
Are there other types of angina?
There are two other forms of angina pectoris. One,
long recognized but quite rare, is called Prinzmetal's or variant
angina. This type is caused by vasospasm, a spasm that narrows the
coronary artery and lessens the flow of blood to the heart. The other is
a recently discovered type of angina called microvascular angina.
Patients with this condition experience chest pain but have no apparent
coronary artery blockages. Doctors have found that the pain results from
poor function of tiny blood vessels nourishing the heart as well as the
arms and legs. Microvascular angina can be treated with some of the same
medications used for angina pectoris.
Natural Treatments:
For easing the pain of angina, some
doctors recommend both a low-fat diet and these nutrients.
NUTRIENTS, DAILY AMOUNTS, and APPLICATIONS
MEDICAL ALERT!
- If you have angina, you should be under a doctor's care.
People who have heart or kidney problems should not take magnesium
supplements without medical supervision.
Selenium in doses exceeding 100 micrograms daily should be taken
only under medical supervision.
If you are taking anticoagulants, you should not take vitamin E
supplements.
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