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What Is Angina? (an-JI-nuh or AN-juh-nuh)

 

Angina:-

is chest pain or discomfort that occurs when your heart muscle does not get enough blood. Angina may feel like pressure or a squeezing pain in your chest. 

The pain may also occur in your shoulders, arms, neck, jaw, or back. It may also feel like indigestion. 

Angina is a symptom of coronary artery disease (CAD), the most common type of heart disease. CAD occurs when plaque builds up in the coronary arteries. This buildup of plaque is called atherosclerosis. 

As plaque builds up, the coronary arteries become narrow and stiff. Blood flow to the heart is reduced. This decreases the oxygen supply to the heart muscle.

Types of Angina

1.      There are 3 types of angina-stable, unstable, and variant (Prinzmetal's). 

2.      It is very important to know the differences among the types.

Stable angina. Stable angina is the most common type. It occurs when the heart is working harder than usual.

         There is a regular pattern to stable angina.

         After several episodes, you learn to recognize the pattern and can predict when it will occur.

         The pain usually goes away in a few minutes when you rest or take your angina medicine.

         Stable angina is not a heart attack but makes it more likely that you will have a heart attack in the future.

Unstable angina

         Unstable angina is a very dangerous condition that requires emergency treatment. 

         It is a sign that a heart attack could occur soon. Unlike stable angina, it does not follow a pattern. It can occur without physical exertion and is not relieved by rest or medicine.

Variant angina

         Variant angina is rare. 

         It usually occurs at rest. 

         The pain can be severe and usually occurs between midnight and early morning. 

         It is relieved by medication.

         Not all chest pain or discomfort is angina. 

         Chest pain or discomfort can be caused by a heart attack, lung problems (such as an infection or a blood clot), heartburn, or a panic attack. However, all chest pain should be checked by a doctor.

Other Names for Angina

         Angina pectoris

         Stable or common angina

         Unstable angina

         Variant angina

         Prinzmetal's angina

         Coronary artery spasms

         Acute coronary syndrome

What Causes Angina?

Angina is caused by reduced blood flow to an area of the heart. This is most often due to coronary artery disease (CAD). Sometimes, other types of heart disease or uncontrolled high blood pressure can cause angina.

In CAD, the arteries that carry oxygen-rich blood to the heart muscle are narrowed due to the buildup of fatty deposits called plaque. 

This is called atherosclerosis. Some plaque is hard and stable and leads to narrowed and hardened arteries. Other plaque is soft and is more likely to break open and cause blood clots. 

The buildup of plaque on the inner walls of the arteries can cause angina in two ways: By narrowing the artery to the point where the flow of blood is greatly reduced By forming blood clots that partially or totally block the artery.

Stable Angina

Physical exertion is the most common cause of pain and discomfort from stable angina.

Severely narrowed arteries may allow enough blood to reach the heart when the demand for oxygen is low (such as when you are sitting). But with exertion like walking up a hill or climbing stairs, the heart works harder and needs more oxygen. 

Other causes include:

         Emotional stress

         Exposure to very hot or cold temperature

         Heavy meals

         Smoking.

         Unstable Angina

Unstable angina is caused by blood clots that partially or totally block an artery. If plaque in an artery ruptures or breaks open, blood clots may form. This creates a larger blockage. The clot may grow large enough to completely block the artery and cause a heart attack.

Blood clots may form, partly dissolve, and later form again. Chest pain can occur each time a clot blocks an artery.

Variant Angina:

Variant angina is caused by a spasm in a coronary artery. The spasm causes the walls of the artery to tighten. This narrows the artery, causing the blood flow to the heart to slow or stop. Variant angina may occur in persons with and without CAD. 

Other causes of spasms in the arteries that supply the heart with blood are:

         Exposure to cold

         Emotional stress

         Medications (vasoconstricting) that constrict or narrow blood vessels

         Cigarette smoking

         Cocaine use.

Who Gets Angina?

Over 6 million people in the U. S. have angina. People with coronary artery disease (CAD) or who have had a heart attack are more likely to have angina.

Unstable angina occurs more often in older adults. Variant angina is rare. It accounts for only about 2 out of 100 cases of angina. 

People with variant angina are often younger than those with other forms of angina.

What Are the Common Signs and Symptoms of Angina?

The pain or discomfort of angina:

         Is often described as pressure, squeezing, burning, or tightness in the chest

         Usually starts in the chest behind the breastbone

         May also occur in the arms, shoulders, neck, jaw, throat, or back

         May feel like indigestion.

         Some people say that angina discomfort is hard to describe or that they can't tell exactly where the pain is coming from. 

Symptoms such as nausea, fatigue, shortness of breath, sweating, light- headedness, or weakness may also occur.

Symptoms vary based on the type of angina:

Stable Angina

The pain or discomfort:

         Occurs when the heart must work harder, usually during physical exertion

         Is expected, and episodes of pain tend to be alike

         Usually lasts a short time (5 minutes or less)

         Is relieved by rest or angina medicine

         May feel like gas or indigestion

         May feel like chest pain that spreads to the arms, back, or other areas.

Unstable Angina

The pain or discomfort:

         Often occurs at rest, while sleeping at night, or with little physical exertion

         Is unexpected

         Is more severe and lasts longer (as long as 30 minutes) than stable angina episodes

         Is usually not relieved with rest or angina medicine

         May get continuously worse

         May signal that a heart attack will happen soon.

Variant Angina

The pain or discomfort:

         Usually occurs at rest and during the night or early morning hours

         Tends to be severe

         Is relieved by angina medicine.

         Chest pain that lasts longer than a few minutes and is not relieved by rest or angina medicine may mean you are having-or are about to have-a heart attack. Get emergency help right away.

How is Angina Diagnosed?

To find out if you have angina, your doctor will:

         Do a physical exam

         Ask about your symptoms

         Ask about your risk factors and your family history of coronary artery disease (CAD) or other r heart disease.

         Sometimes, your doctor can diagnose angina by noting your symptoms and how they occur. 

         Your doctor may order one or more tests to help make a diagnosis of angina. 

The tests your doctor may order include:

         EKG or ECG (electrocardiogram). This test measures the rate and regularity of your heartbeat. Some people with angina have a normal EKG.

         Exercise stress test. This test shows how well your heart pumps at higher workloads when it needs more oxygen. EKG and blood pressure readings are taken before, during, and after exercise to see how your heart responds to exercise. 

         The first EKG and blood pressure reading are done to get a baseline. Readings are then taken while you walk on an exercise treadmill, pedal a stationary bicycle, or receive medicine to make your heart beat faster. 

         The test continues until you reach a heart rate set by your doctor. The exercise part is stopped if chest pain or a very sharp rise in blood pressure occurs. Monitoring continues for 10 to 15 minutes after exercise or until your heart rate returns to baseline.

         Chest x-ray. A chest x-ray takes a picture of the organs and structures inside your chest. These include your heart, lungs, and blood vessels.

         Nuclear heart scan. This test shows blood flow to the heart and any damage to the heart muscle. A radioactive dye (technetium or thallium) is injected into your bloodstream. 

         A special camera can then see the dye and find areas where there is less blood flow. Nuclear heart scans are often taken while you are at rest and again after exercise. If you cannot exercise, a medication is given to increase the workload of the heart. 

The before-and-after exercise scans are compared.

         Echocardiogram. This test uses sound waves to create a picture of the heart. The picture is more detailed than an x-ray image. The test shows how well your heart chambers fill with blood and pump it to the rest of the body. 

         An echocardiogram also can help identify areas of poor blood flow to the heart, areas of heart muscle that are not contracting normally, and previous injury to the heart muscle caused by poor blood flow. An echocardiogram can also be used with a stress test.

         Cardiac catheterization. A thin flexible tube (catheter) is passed through an artery in the groin or arm to reach the coronary arteries. Your doctor can determine pressure and blood flow in the heart's chambers, collect blood samples from the heart, and examine the arteries of the heart by x-ray.

         Coronary angiography. This test is done during cardiac catheterization. A dye that can be seen by x-ray is injected through the catheter into the coronary arteries. Your doctor can see the flow of blood through the heart and see where there are blockages.

Your doctor may also order blood tests, such as:

         A fasting lipoprotein profile to check your cholesterol levels.

         Fasting glucose test to check your blood sugar level.

         C-reactive protein (CRP) test. This blood test measures CRP, a protein in the blood that shows the presence of inflammation. Inflammation is the body's response to injury. High levels of CRP may be a risk factor for CAD.

         A test to check for low hemoglobin in your blood. Hemoglobin is the part of red blood cells that carries oxygen to all parts of your body.

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