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Definition

Angina pectoris is a term that describes chest pain caused bymyocardial ischemia - a condition in which the amount of oxygen

getting to the heart muscle is insufficient. It usually occurs on exertion

and is relieved by rest. Angina generally is a symptom of coronary

artery disease. In most severe cases, it may occur with minimal effort or

at rest.

Description

Angina pectoris is a common manifestation of coronary artery disease.

The pain is caused by reduced blood flow to a segment of heart muscle

(myocardial ischemia). It usually lasts for only a few minutes, and an

attack is usually quickly relieved by rest or drugs (such as nitroglycerin).Also, it is possible to have myocardial ischemia without experiencing

angina.

Typically, angina is described as a "pressure" or "squeezing" pain that

starts in the center of the chest and may spread to the shoulders or

arms (most often on the left side, although either or both sides may beinvolved), the neck, jaw or back. It is usually triggered by extra demand

on the heart: exercise, an emotional upset, exposure to cold, digesting

a heavy meal are common examples.

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smoking

sedentary lifestyle

high blood pressure, or hypertension

high blood fats or cholesterol

hypercholesterolemia

diabetes

family history of premature ischemic heart disease

Men are at higher risk than women.

Symptoms

Classic or typical angina occurs predictably with physical exertion or

strong emotional reactions, and goes away just as predictably with rest.

Starting immediately behind the sternum (breast bone), the pain may

radiate to the left arm and shoulder or up to the jaw.

Most people describe the pain as a kind of squeezing pressure,

tightness or heaviness.

There may be anxiety, increased or irregular heart rate, paleness and

cold sweat, and a feeling of doom. The symptoms are like the ones for a

heart attack.

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In some instances, chest pain results from other types of heart

problems, including diseases that affect the heart muscle itself or the

valves that control blood flow through the heart. Occasionally, ulcers,

gallstones, abnormal contractions of the esophagus or severe anxiety

and panic attacks can cause chest pain. However, if you do experience

these symptoms, your best plan of action is to get immediate help. Stop

doing whatever is causing the symptoms and call 911. Lie down with

your head slightly elevated. If you are not allergic to it, take one adult

aspirin.

Diagnosis

Diagnosis of angina is based upon the classic history of chest pain on

exertion and by means of tests, demonstrating the presence of

coronary artery disease.

Treatment

In most instances, drugs are recommended for the treatment of angina

before surgery is considered. The major classes of drugs used to treat

angina include the following:

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Nitrates. These come in several forms: nitroglycerine tablets to be

slipped under the tongue during or in anticipation of an attack;

ointment to be absorbed through the skin; long-acting medicated skin

discs; or long-acting tablets. The latter three forms are used mostly toprevent rather than relieve attacks. The nitrates work by reducing the

oxygen requirements of the heart muscle.

Beta-blocking Drugs. These agents act by blocking the effect of the

sympathetic nervous system on the heart, slowing heart rate,

decreasing blood pressure, and thereby, reducing the oxygen demandof the heart. Recent studies have found that these drugs also can

reduce the chances of dying or suffering a recurrent heart attack if they

are started shortly after suffering a heart attack and continued for two

years.

Calcium-channel Blocking Drugs. These drugs are prescribed to treatangina that is thought to be caused by coronary artery spasm. They can

also be effective for stable angina associated with exercise. All muscles

need varying amounts of calcium in order to contract. By reducing the

amount of calcium that enters the muscle cells in the coronary artery

walls, the spasms can be prevented. Some calcium-channel blocking

drugs also decrease the workload of the heart and some lower the

heart rate as well