Angina

Types of Angina:

1. Stable Angina:
   • Most common type of angina.
   • Occurs predictably during physical exertion or stress when the heart requires more oxygen, such as during exercise or emotional stress.
   • Short duration, usually lasting a few minutes.
   • Often relieved by rest or medications like nitroglycerin.
   • Typically not a sign of an impending heart attack, but it signals that there is underlying heart disease.
2. Unstable Angina:
   • More dangerous and unpredictable.
   • Can occur at rest or with minimal physical activity.
   • Lasts longer and may be more intense.
   • Not relieved by rest or usual medications.
   • May be a sign of an impending heart attack and requires immediate medical attention.
3. Variant Angina (Prinzmetal’s Angina):
   • Caused by a spasm in a coronary artery, leading to a temporary reduction in blood flow.
   • Typically occurs at rest, often in the early morning.
   • Can be severe, but often responds to medications that relieve the spasm (such as calcium channel blockers).

Symptoms of Angina:

• Chest pain or discomfort, often described as:
  • A pressure, tightness, squeezing, or burning sensation in the chest.
  • Pain may radiate to the arms (especially left arm), neck, jaw, shoulders, or back.
• Shortness of breath or difficulty breathing.
• Nausea, sweating, or dizziness.
• Fatigue or weakness.
• Angina often occurs during physical exertion or emotional stress and typically goes away with rest.

Causes of Angina:

Angina occurs when the coronary arteries, which supply the heart with oxygen-rich blood, become narrowed or blocked. The narrowing can be due to:

• Atherosclerosis: The buildup of fatty deposits (plaque) on the artery walls.
• Coronary artery spasm: A temporary tightening or narrowing of the arteries that can restrict blood flow.

Conditions that can lead to angina include:

• Coronary artery disease (CAD).
• High blood pressure (hypertension).
• High cholesterol.
• Diabetes.
• Smoking.
• Stress or emotional strain.

Risk Factors for Angina:

Several risk factors increase the likelihood of developing coronary artery disease and angina:

• Age: Men over 45 and women over 55 are at higher risk.
• Family history of heart disease.
• Smoking.
• High blood pressure.
• High cholesterol levels.
• Diabetes.
• Physical inactivity.
• Obesity.
• Excessive alcohol consumption.
• Stress and poor mental health.

Diagnosis of Angina:

To diagnose angina and determine the underlying cause, a healthcare provider may perform:

• Physical examination and review of symptoms.
• Electrocardiogram (ECG): Measures the electrical activity of the heart and may show signs of ischemia (lack of blood flow).
• Stress test: Monitors the heart’s response to physical activity or medication that simulates exercise.
• Echocardiogram: Uses sound waves to create an image of the heart’s chambers and blood flow.
• Coronary angiography (angiogram): An invasive test that uses dye and X-rays to visualize the coronary arteries and identify blockages.
• Blood tests: To check for heart damage or risk factors like high cholesterol and blood sugar.

Treatment for Angina:

Treatment for angina aims to reduce symptoms, prevent a heart attack, and improve blood flow to the heart. Treatments may include:

Medications:

1. Nitrates (e.g., nitroglycerin):
   • Help relax and widen blood vessels, improving blood flow and relieving pain.
2. Beta-blockers:
   • Lower heart rate and blood pressure, reducing the heart’s workload.
3. Calcium channel blockers:
   • Help relax and widen blood vessels, improving blood flow.
4. Aspirin:
   • Helps prevent blood clot formation, which can worsen heart disease.
5. Statins:
   • Lower cholesterol levels to reduce the buildup of plaque in arteries.
6. Antiplatelet drugs (e.g., clopidogrel):
   • Help prevent blood clots that can worsen artery blockage.

Lifestyle Changes:

• Diet: A heart-healthy diet (low in saturated fats, cholesterol, and salt) can help manage cholesterol and blood pressure.
• Exercise: Regular physical activity can help improve heart health and manage risk factors.
• Quit smoking: Smoking cessation is crucial to reduce the risk of heart disease and angina.
• Stress management: Reducing stress through techniques like meditation, deep breathing, or therapy.

Procedures:

• Angioplasty: A procedure in which a balloon is used to open up narrowed coronary arteries, often followed by the placement of a stent to keep the artery open.
• Coronary artery bypass grafting (CABG): A surgery that creates new routes (bypasses) for blood to flow to the heart, bypassing blocked coronary arteries.

When to Seek Medical Attention:

• Sudden, severe chest pain: Particularly if it lasts for more than a few minutes or is not relieved by rest or medication.
• Pain that radiates to the arm, neck, jaw, or back.
• Shortness of breath, sweating, nausea, or dizziness.
• Angina that becomes more frequent or severe (indicating worsening coronary artery disease).
• If you experience unstable angina, you should seek emergency medical attention immediately.

Prevention:

• Regular check-ups: Monitor blood pressure, cholesterol, and blood sugar levels.
• Healthy lifestyle: Eat a balanced diet, exercise regularly, and avoid smoking.
• Manage stress and practice relaxation techniques.
• Medications: Take prescribed medications to manage risk factors like high blood pressure, high cholesterol, or diabetes.