ANGINA PECTORIS

 

INTRODUCTION: Angina pectoris is a clinical syndrome characterized by paroxysms of pain or a feeling of pressure in the anterior chest. The cause is insufficient coronary blood flow, resulting in an inadequate supply of oxygen to meet the myocardial demand. Angina is usually a result of atherosclerotic heart disease and is associated with a significant obstruction of a major coronary artery. Factors affecting anginal pain are physical exertion, exposure to cold, eating a heavy meal, or stress or any emotion-provoking situation that increases blood pressure, heart rate, and myocardial workload. Unstable angina is not associated with the above and may occur at rest.

CLINICAL MANIFESTATIONS: Pain varies from a feeling of indigestion to a choking or heavy sensation in the upper chest ranging from discomfort to agonizing pain. The patient with diabetes mellitus may not experience severe pain with angina. Angina is accompanied by severe apprehension and a feeling of impending death. The pain is usually retrosternal, deep in the chest behind the upper or middle third of the sternum. Discomfort is poorly localized and may radiate to the neck, jaw, shoulders, and inner aspect of the upper arms (usually the left arm). A feeling of weakness or numbness in the arms, wrists, and hands, as well as shortness of breath, pallor, diaphoresis, dizziness or lightheadedness, and nausea and vomiting, may accompany the pain. Anxiety may occur with angina. An important characteristic of anginal pain is that it subsides when the precipitating cause is removed or with nitroglycerin.

ASSESSMENT AND DIAGNOSTIC METHODS: Evaluation of clinical manifestations of pain and patient history. Electrocardiogram changes (12-lead ECG), stress testing, blood tests. Echocardiogram, nuclear scan, or invasive procedures such as cardiac catheterization and coronary angiography.

MEDICAL MANAGEMENT: The objectives of the medical management of angina are to decrease the oxygen demand of the myocardium and to increase the oxygen supply. Medically, these objectives are met through pharmacologic therapy and control of risk factors. Alternatively, reperfusion procedures may be used to restore the blood supply to the myocardium. These include PCI procedures (eg, percutaneous transluminal coronary angioplasty [PTCA], intracoronary stents, and atherectomy) and coronary artery bypass graft (CABG).

PHARMACOLOGIC THERAPY: Nitrates, the mainstay of therapy (nitroglycerin). Beta-adrenergic blockers (metoprolol and atenolol). Calcium channel blockers/calcium ion antagonists (amlodipine and diltiazem). Antiplatelet and anticoagulant medications (aspirin, clopidogrel, heparin, glycoprotein [GP] IIb/IIIa agents [abciximab, tirofiban, eptifibatide]). Oxygen therapy.

RELATED;

1. ARTERIOSCLEROSIS  

2. BETA BLOCKERS  

3. CHAMBERS AND CIRCULATION THROUGH THE HEART

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