Angina Pectoris is the medical jargon applied to Chest Pain. Angina means pain (intense pain) and Pectoris means chest. In order to avoid confusion, it is used only for chest pain due to cardiac causes specificaRead more...
Angina Pectoris is the medical jargon applied to Chest Pain. Angina means pain (intense pain) and Pectoris means chest. In order to avoid confusion, it is used only for chest pain due to cardiac causes specifically stable angina.
Chest pain, palpitations, sweating and anxiety following physical exertion. It would be relieved after some time or at rest.
Any activity that demands the heart to work harder results in the precipitation of an episode of angina. Some of the factors are as follows:
Vivid dreams(nocturnal angina)
Cardiac Features causing Angina are:
Any factors that cause disparity between the demand and supply of heart muscle blood supply and work results in angina pectoris.
Cardiac Work
Heartrate
BP
Myocardial contractility
Left ventricular hypertrophy
Valve disease e.g.aortic stenosis
Evaluation of angina involves putting the patient under stress and identify if an angina can be precipitated. Following are some of the possible investigations:
Post-infarct angina
Pooreffort tolerance
Ischaemia at low workload
Leftmainor three vessel disease
Poor LV function
Predictable exertional angina
Good effort tolerance
Ischaemia only at high workload
Single- vessel or two -vessel disease
Good LV function
Careful assessment of the likely extent and severity of arterial disease
The identification and control of risk factors such as smoking, hypertension and hyperlipidaemia
The use of measures to control symptoms
The identification of high-risk patients for treatment to improve life expectancy.
Antiplatelet drugs like aspirin, clopidogrel which prevent the aggregation of platelets and hence the formation of any thrombus or embolus is prevented.
Antianginal drugs like nitrates, beta blockers, calcium channel blockers, nicorandil, ivabradine. These drugs act by either increasing the blood flow through the coronary arteries or decreasing the work load of the heart. Both of these help in Angina Pectoris.
The prognosis of coronary artery disease is related to the number of diseased vessels and the degree of left ventricular dysfunction. A patient with single-vessel disease and good left ventricular function has an excellent outlook (5-year survival > 90%), whereas a patient with severe left ventricular dysfunction and extensive three-vessel disease has a poor prognosis (5-year survival < 30%) without revascularisation. Spon-taneous symptomatic improvement due to the develop-ment of collateral vessels is common.
Aim for ideal bodyweight
Take regular exercise(exercise upto, but not beyond, the point of chest discomfort is beneficial and may promote collateral vessels)
Avoid severe unaccustomed exertion, and vigorous exercise after a heavy meal or in very cold weather
Take sublingual nitrate before undertaking exertion that may induce angina.