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Angina disease (ischemic chest pain) : Symptoms, Causes, Diagnosis and Treatment

What is Angina disease?

Angina is a type of chest pain caused by reduced blood flow to the heart. Angina (an-JIE-nuh or AN-juh-nuh) is a symptom of coronary artery disease.

Angina, also called angina pectoris, is often described as squeezing, pressure, heaviness, tightness or pain in your chest. Some people with angina symptoms say angina feels like a vise squeezing their chest or a heavy weight lying on their chest. Angina may be a new pain that needs to be checked by a doctor, or recurring pain that goes away with treatment.

Although angina is relatively common, it can still be hard to distinguish from other types of chest pain, such as the discomfort of indigestion. If you have unexplained chest pain, seek medical attention right away.

Types

There are several types of angina.

Stable or chronic angina

Stable angina occurs when the heart is working harder than usual, for instance, during exercise. It has a regular pattern and can be predicted to happen over months or even years. Rest or medication relieves symptoms.

Unstable angina

Unstable angina does not follow a regular pattern. It can occur when at rest and is considered less common and more serious because rest and medication do not relieve it. This version can signal a future heart attack within a short time ? hours or weeks.

Variant and microvascular angina

Variant or Prinzmetal?s angina and microvascular angina are rare and can occur at rest without any underlying coronary artery disease. This angina is usually due to abnormal narrowing or relaxation of the blood vessels, reducing blood flow to the heart. It can be relieved by medicine.

Angina disease is also known as ischemic chest pain. Angina disease belongs under the category of Chest disease. Stable or chronic angina or Angina Pectoris, Unstable angina, Variant and microvascular angina are some common types of Angina disease. Generally Male, Female are the victim of the Angina disease. Seriousness of this disease is Serious.

Symptoms of Angina disease are :

  • Squeezing
  • Feeling of heaviness or pressure in chest
  • Feeling of fullness in chest
  • Burning
  • Lingering discomfort
  • upset stomach
  • Dizziness
  • Shortness of breath
  • aches and pains
  • Body aches are a common symptom of many conditions. The flu is one of the most well-known conditions that can cause body aches. Aches can also be caused by your everyday life, especially if you stand, walk, or exercise for long periods of time.

    You may just need rest and some treatment at home to relieve your body aches. But some aches, especially ones that last a long time, may mean that you have an underlying condition. In these cases, you may need to see your doctor for a diagnosis. They can create a long-term treatment plan to can relieve your aches and other associated symptoms.

  • sweating
  • Excessive sweating is when you sweat more than you might expect based on the surrounding temperature or your activity level or stress. Excessive sweating can disrupt daily activities and cause social anxiety or embarrassment.

    Excessive sweating, or hyperhidrosis (hi-pur-hi-DROE-sis), can affect your entire body or just certain areas, particularly your palms, soles, underarms or face. The type that typically affects the hands and feet causes at least one episode a week, during waking hours.

  • Vomiting
  • Vomiting, or throwing up, is a forceful discharge of stomach contents. It can be a one-time event linked to something that doesn?t settle right in the stomach. Recurrent vomiting may be caused by underlying medical conditions.

    Frequent vomiting may also lead to dehydration, which can be life-threatening if left untreated.

  • Nausea
  • Nausea and vomiting are common signs and symptoms that can be caused by numerous conditions. Nausea and vomiting most often are due to viral gastroenteritis ? often mistakenly called stomach flu ? or the morning sickness of early pregnancy.

    Many medications can cause nausea and vomiting, as can general anesthesia for surgery. Rarely, nausea and vomiting may indicate a serious or even life-threatening problem.

  • Fatigue/weakness
  • Weakness

    Weakness is when strength is decreased and extra effort is needed to move a certain part of the body or the entire body. Weakness is due to loss of muscle strength. Weakness can be a big part of why cancer patients feel fatigue.

    Fatigue

    Fatigue is an extreme feeling of tiredness or lack of energy, often described as being exhausted. Fatigue is something that lasts even when a person seems to be getting enough sleep. It can have many causes, including working too much, having disturbed sleep, stress and worry, not having enough physical activity, and going through an illness and its treatment.

    Causes

    Angina disease can be caused due to:

    Angina is most frequently the result of underlying coronary artery disease. The coronary arteries supply the heart with oxygen-rich blood. When cholesterol aggregates on the artery wall and hard plaques form, the artery narrows.

    This means:

    • It is increasingly difficult for oxygen-rich blood to reach the heart muscle as the arteries become too narrow.
    • Damage to the arteries from other factors, such as smoking and high levels of fat or sugar in the blood, can cause plaques to build up where the arteries are damaged.
    • These plaques narrow the arteries or may break off and form blood clots that block the arteries.

    The actual angina attacks are the result of this reduced oxygen supply to the heart. Common triggers include:

    • physical exertion
    • severe emotional stress
    • a heavy meal
    • exposure to extreme temperatures
    • smoking may trigger angina attacks

    Unstable angina is often caused by blood clots that partially or completely block an artery. Larger blockages may lead to heart attacks. As blood clots form, dissolve, and form again, angina can occur with each blockage.

    Variant angina occurs when an artery experiences a spasm that causes it to tighten and narrow, disrupting the blood supply to the heart. This can be triggered by exposure to cold, stress, medicines, smoking, or cocaine use.

    What kind of precaution should be taken in Angina disease?

    You can help prevent angina by making the same lifestyle changes that might improve your symptoms if you already have angina. These include:

    • Quitting smoking.
    • Monitoring and controlling other health conditions, such as high blood pressure, high cholesterol and diabetes.
    • Eating a healthy diet and maintaining a healthy weight.
    • Increasing your physical activity after you get your doctor's OK. Aim for 150 minutes of moderate activity each week. Plus, it's recommended that you get 10 minutes of strength training twice a week and to stretch three times a week for five to 10 minutes each time.
    • Reducing your stress level.
    • Limiting alcohol consumption to two drinks or fewer a day for men, and one drink a day or less for women.
    • Getting an annual flu shot to avoid heart complications from the virus.

    Treatment for the Angina disease

    Diagnosis:

    The preliminary diagnosis of angina usually is made by the patient's history. The health care professional needs to understand what symptoms the patient is experiencing and may ask similar questions in a variety of ways to gain that understanding. This may be a frustrating process for both patient and professional because the symptoms of angina can range from classic to vague.

    Part of the history will be to assess risk factors for heart disease. These include high blood pressure, high cholesterol, diabetes, family history, and smoking. Histories of stroke (cerebrovascular accident or CVA) or peripheral artery disease (PAD) are both risk factors since the mechanism of these diseases, hardening of the arteries or atherosclerosis are the same as for heart disease.

    There are other diseases that can cause chest pain, abdominal pain, shortness of breath, sweating, and nausea and vomiting. Questions may be asked to determine whether other possibilities other than angina exist. Pulmonary embolism, pneumonia, aortic aneurysm, gastroesophageal reflux disease (GERD), peptic ulcer disease, and gallbladder disease are bit a few of the potential causes of symptoms other than angina.

    Physical examination will help narrow the potential list of diseases but in of itself, will not make the formal diagnosis.

    This is the time that the health care professional has to make a clinical decision as to the source of symptoms. If the tentative or provisional diagnosis is angina, a further decision has to be made whether it is stable or unstable.

    With stable angina, a defined exercise will bring on the symptoms and rest will make it better. For example, a patient gets chest discomfort after walking 2 miles and it gets better with 5 minutes of rest. The pain pattern is constant and the amount of exercise required to bring on the symptoms has not been getting shorter. Often a patient with known angina will take a nitroglycerin pill to resolve the pain and it does so promptly.

    Unstable angina usually happens at rest, wakens the patient at night, or comes on with minimal activity. These are times when the heart muscle is not being asked to work harder and yet angina symptoms may be present. Unstable angina is a potential warning sign of impending heart attack. There may be a transition from stable to unstable and the patient may describe decreasing amounts of exertion needed to bring on the angina symptoms.

    Over time, a patient with angina may have their symptoms brought on by less and less activity. This progression needs to be monitored closely by both patient and doctor. The frequency of nitroglycerin use may be a clue that a coronary artery might be getting critically narrow increasing the risk of heart attack.

    If angina is the major consideration, then an electrocardiogram (EKG) is usually performed. The electrical signal tracing of the heart can be interpreted to decide if heart muscle is damaged. The initial EKGs most important function is to decide if the patient is in the midst of suffering a heart attack or myocardial infarction (MI). This is a medical emergency.

    If the EKG does not show a new heart attack and if the patient has stable symptoms, the next step depends upon the situation. Blood tests may be done to check cardiac enzymes. These are chemicals (troponin, CPK, myoglobin) contained in heart muscle cells that may leak into the bloodstream if the cell is injured. If the chemicals are not detected, then the presumption is that if the pain is due to ASHD, critical narrowing has not caused heart muscle damage. However, the tests need to be done and interpreted based upon the clinical situation.

    With a stable EKG, resolved symptoms, and concern still present that the patient has angina, tests to image the heart may be considered. These may include one or more of the following: stress tests, nuclear imaging, echocardiogram, cardiac CT scan, and heart catheterization. The decision as to what test is most appropriate depends upon the patient, their symptoms, underlying health, risk factors, and the level of concern of the health care professional.

    A physician who is suspicious of angina will order one or more of the following tests:

    • Electrocardiogram (EKG): Records electrical activity of the heart and can detect when the heart is starved of oxygen.
    • Stress test: Blood pressure readings and an EKG while the patient is increasing physical activity.
    • Chest X-ray: This enables the doctor to see structures inside the chest.
    • Coronary angiography: Dye and special X-rays to show the inside of coronary arteries.
    • Blood tests: These check fat, cholesterol, sugar, and protein levels.

    Treatment:

    There are many options for angina treatment, including lifestyle changes, medications, angioplasty and stenting, or coronary bypass surgery. The goals of treatment are to reduce the frequency and severity of your symptoms and to lower your risk of a heart attack and death.

    However, if you have unstable angina or angina pain that's different from what you usually have, such as occurring when you're at rest, you need immediate treatment in a hospital.

    Medications

    If lifestyle changes alone don't help your angina, you may need to take medications. These may include:

    • Nitrates. Nitrates are often used to treat angina. Nitrates relax and widen your blood vessels, allowing more blood to flow to your heart muscle. You might take a nitrate when you have angina-related chest discomfort, before doing something that normally triggers angina (such as physical exertion) or on a long-term preventive basis. The most common form of nitrate used to treat angina is nitroglycerin tablets, which you put under your tongue.
    • Aspirin. Aspirin reduces the ability of your blood to clot, making it easier for blood to flow through narrowed heart arteries. Preventing blood clots can also reduce your risk of a heart attack. But don't start taking a daily aspirin without talking to your doctor first.
    • Clot-preventing drugs. Certain medications such as clopidogrel (Plavix), prasugrel (Effient) and ticagrelor (Brilinta) can help prevent blood clots from forming by making your blood platelets less likely to stick together. One of these medications may be recommended if you can't take aspirin.
    • Beta blockers. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. As a result, the heart beats more slowly and with less force, thereby reducing blood pressure. Beta blockers also help blood vessels relax and open up to improve blood flow, thus reducing or preventing angina.
    • Statins**.** Statins are drugs used to lower blood cholesterol. They work by blocking a substance your body needs to make cholesterol. They may also help your body reabsorb cholesterol that has accumulated in plaques in your artery walls, helping prevent further blockage in your blood vessels. Statins also have many other beneficial effects on your heart arteries.
    • Calcium channel blockers. Calcium channel blockers, also called calcium antagonists, relax and widen blood vessels by affecting the muscle cells in the arterial walls. This increases blood flow in your heart, reducing or preventing angina.
    • Blood pressure-lowering medications. If you have high blood pressure, diabetes, signs of heart failure or chronic kidney disease, your doctor will likely prescribe a medication to lower your blood pressure. There are two main classes of drugs to treat blood pressure: angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs).
    • Ranolazine (Ranexa). Ranexa can be used alone or with other angina medications, such as calcium channel blockers, beta blockers or nitroglycerin.

    Medical procedures and surgery

    Lifestyle changes and medications are frequently used to treat stable angina. But medical procedures such as angioplasty, stenting and coronary artery bypass surgery may also be used to treat angina.

    • Angioplasty and stenting. During an angioplasty ? also called a percutaneous coronary intervention (PCI) ? a tiny balloon is inserted into your narrowed artery. The balloon is inflated to widen the artery, and then a small wire mesh coil (stent) is usually inserted to keep the artery open.

      This procedure improves blood flow in your heart, reducing or eliminating angina. Angioplasty and stenting is a good treatment option if you have unstable angina or if lifestyle changes and medications don't effectively treat your chronic, stable angina.

    • Coronary artery bypass surgery. During coronary artery bypass surgery, a vein or artery from somewhere else in your body is used to bypass a blocked or narrowed heart artery. Bypass surgery increases blood flow to your heart and reduces or eliminates angina. It's a treatment option for both unstable angina as well as stable angina that has not responded to other treatments.

    • External counterpulsation (ECP). With ECP, blood pressure-type cuffs are placed around the calves, thighs and pelvis to increase blood flow to the heart. ECP requires multiple treatment sessions. The American College of Cardiology, American Heart Association and other heart organizations say ECP may help reduce symptoms in people with refractory angina.

    Possible complication with Angina disease

    The chest pain that occurs with angina can make doing some normal activities, such as walking, uncomfortable. However, the most dangerous complication is a heart attack.

    References:

    1 https://www.mayoclinic.org/diseases-conditions/angina/symptoms-causes/syc-20369373 2 https://www.webmd.com/heart-disease/heart-disease-angina#3-6 3 https://www.medicalnewstoday.com/articles/8886 4 https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain 5 https://www.medicinenet.com/angina_symptoms/article.htm 6 https://medlineplus.gov/ency/article/000198.htm

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