Angina Pectoris

The coronary arteries supply oxygen-rich blood to the heart, hence it is imperative to ensure their normal functioning. However, sometimes, the coronary artery(s) may get blocked due to the buildup of fat and other substances like calcium, waste materials, and fibrin on the inner surfaces of the blood vessel, causing the restricted flow of oxygenated blood to the heart. This is the main cause behind a group of heart diseases, known as coronary heart diseases. Angina is a condition that is indicative of underlying coronary heart disease and its occurrence is quite common globally, with more than ten million cases occurring in India per year! This article attempts to discuss the types, causes, and symptoms of angina, along with the treatment methods employed to combat the serious condition.

What is Angina Pectoris?

Angina pectoris is a type of chest pain that may be a symptom of underlying coronary heart disease which is caused due to restricted flow of oxygen to the heart. It is a fairly common problem globally and is referred to as ischemic heart pain. Although most cases of angina are non-lethal, some forms of angina may be life-threatening.

Images Coming soon

Types of Angina Pectoris

• Stable Angina.

  • Also known as typical angina, it is the most common form of angina.

  • It is caused by restricted flow of blood to the heart, due to atherosclerosis of the coronary arteries.

  • It is known to be triggered by increased levels of stress or exertions due to physical activities, and the condition alleviates while resting.

  • It lasts for a short duration, probably less than 5 minutes.

  • The pain is not as severe and is relievable by medications such as nitroglycerin.

• Unstable Angina.

  • It is one of the signs of Acute Coronary Syndrome and is a severe form of angina.

  • The pain is sudden or unpredictable and is said to radiate to arms and shoulders.

  • It occurs when the atherosclerotic artery is blocked by the bursting of the plaque, resulting in thrombosis or clot in the artery.

  • It is not a result of exertion or any stress, since it occurs during rest or normal levels of physical activities.

  • Lasts for about 20 minutes.

  • It is a medical emergency, unlike stable angina. Professionals may use drugs like aspirin or clopidogrel, which must be administered within the next half an hour. Supplemental oxygen must be given as well.

• Variant Angina.

  • Also known as Prinzmetal angina, the occurrence of this type of angina is quite rare.

  • It is not due to atherosclerosis, but due to vasospasms.

  • It entails a temporary restriction of blood flow and causes pain while at rest.

  • It is known to occur between midnight and early mornings.

  • Treatable by calcium-based medications, nitrates and changes in lifestyle.

• Microvascular Angina.

  • A symptom of Coronary Microvascular Dysfunction (CMD), it restricts the flow of blood in the smaller coronary artery vessels.

  • It is a non-obstructive type of coronary disease, caused by spasms in the tiny arteries of the heart.

  • The pain usually lasts about 10 minutes.

  • Microvascular angina is more common in women, especially the ones with irregular menopausal symptoms.

Signs and Symptoms of Angina Pectoris

• Chest aches.

• Dizziness.

• Sweats.

• A feeling of heaviness in the chest.

• A squeezing sensation in the chest.

• Shortness of breath.

Causes of Angina Pectoris

Angina pectoris, like other coronary heart diseases, is a condition caused by a build-up of plaque in the coronary arteries. Angina is commonly a result of −.

• High levels of LDL cholesterol.

• High blood pressure.

• Smoking.

• Use of drugs like cocaine.

• Overweight and obese conditions.

• Diabetes .

• Anaemia.

• Physical inactivity.

• Age factor is also at play, common among individuals who are 45 years old or more.

Diagnosis of Angina Pectoris

• Angiography.

  • Coronary angiography is a procedure done to obtain an X-Ray of the coronary arteries. An angiogram helps diagnose atherosclerosis and coronary artery diseases like angina.

  • For the procedure, a catheter is introduced into the artery near the groin or in the arm. The catheter is guided up into the coronary artery, its position being displayed on the computer screen.

  • The catheter then injects a special dye (contrast dye composed of iodine) into the artery to help visualize the arteries on the X-Ray films.

Images Coming soon

• Electrocardiogram.

  • Electrocardiography or an electrocardiogram test (ECG) detects the electrical waves the heart makes. It is one of the fastest and simplest non-invasive tests to evaluate the functioning of the heart.

  • It involves attaching sensors known as electrodes to the legs, arms and chest of the patient. The electrodes are connected via lead wires to an output system known as the electrocardiogram recording machine.

  • The ECG evaluates how fast the heart is beating, its electrical activity, the rhythmic patterns, etc, which indicate the overall health of the heart.

  • An abnormal ECG may indicate a possible heart attack, ischemia risks or arrhythmia.

Images Coming soon

Angina Pectoris Treatment

• In the case of stable angina, improved lifestyle habits such as improved nutrition to reduce the blood cholesterol levels and reduced smoking habits are recommended.

• Unstable angina is first assessed by the procedure of cardiac catheterization, to identify the location of the blockage by using coronary angiography. Once the blockage has been identified, one can opt for treatments depending on the extent of seriousness −.

  • Angioplasty− also known as percutaneous coronary intervention, it is the procedure of widening the blocked arteries using a balloon catheter to allow easy blood flow. Often to keep them propped open, a stent is used, which is permanently inserted into the artery to prevent them from closing up again.

    Images Coming soon

  • Atherectomy− involves the removal or “debulking” of the plaque by using a catheter. This procedure may be enough in its own right, but sometimes it can be followed with angioplasty with a stent.

  • Bypass Surgery− This procedure entails paving a new route for the blood, so that it may detour from the blockage in the coronary artery. It is also known as open-heart surgery and involves grafting of blocked arteries. These grafts are taken from other vessels and are used to redirect the blood so that it may go around (bypass) the blocked artery. Depending on the number of arteries blocked, the number of grafts required may vary. The grafts can be taken from any part of the body, such as the leg, arm, wrists, and chest.

    Images Coming soon

Conclusion

• Angina is a symptom of coronary heart disease, characterized by a tightness or squeezing pain in the chest.

• An angina attack may be of four kinds, depending on the cause (atherosclerosis or spasm) and the time duration of the attack.

• Stable angina is the most common form of angina, while unstable angina demands immediate medical attention.

• Risk factors of angina include blood cholesterol levels, blood pressure, age, smoking, weight, etc.

• Diagnosis of angina includes angiography and electrocardiography procedures.

• Treatment options include lifestyle changes, medications, and surgical treatments like angioplasty, and bypass surgery in extreme cases of unstable angina.

FAQs

Q1. Is unstable angina the same as a heart attack?

Ans. No. unstable angina may be a warning symptom of a heart attack in the future due to necrosis of the heart cells owing to lack of blood flow to the heart.

Q2. How does smoking cause angina?

Ans. The chemical substances within cigarettes are known to increase plaque formation and clotting of blood in the arteries, leading to Acute Coronary Syndrome which includes unstable angina and heart attack.

Q3. What is meant by LDL cholesterol?.

Ans. LDL stands for low-density lipoprotein, high levels of which lead to atherosclerosis and developing greater risk of coronary artery diseases. Hence, LDL cholesterol is also known as bad cholesterol.

Q4. What are the risks associated with angioplasty?

Ans. Angioplasty may cause damage to the arteries of the heart, it may also lead to an allergic reaction due to the contrast dye used. In very few cases, angioplasty may lead to heart attack or death.

Q5. How does nitroglycerine work to control angina attacks?

Ans. Nitroglycerin (NTG) works as a vasodilator and helps widen the coronary arteries, facilitating the easy flow of oxygenated blood to the heart.