Definition:
Angina (chest pain) is the result of myocardial ischemia (improper blood flow through the vessels supplying the heart) caused by the imbalance of blood supply and oxygen demand of the heart. Myocardial ischemia can result from atherosclerosis (decreased area inside vessels for blood to flow) of the coronary vessels, coronary artery spasm, or decreased oxygen-carrying capacity of blood. It is an indicator for heart disease. Risk factors include: Syndrome X, collagen vascular diseases, cardiomyopathy, carboxyhemoglobin/anemia, congenital defects, smoking, diabetes, high cholesterol, hypertension, obesity, and metabolic syndrome.
Symptoms:
- Chest pain/discomfort - pressure or heaviness, squeezing, burning
- Back, neck, chest, jaw, shoulders also can have pain
- Does not change with cough or breathing
- Usually brought on by exertion, eating, cold, stress
- Lasts 1-5min and relieved by nitroglycerin
Diagnosis:
- Normal physical exam unless there are other causes
- Levine sign (patient's fist clenched over sternum)
- NYHA classification
- Class I - ordinary physical activity does not cause symptoms
- Class II - ordinary physical activity does cause symptoms
- Class III - comfortable at rest, but less than ordinary activities cause symptoms
- Class IV - symptomatic at rest
- Graded exercise stress test - with or without echocardiography or myocardial perfusion tests
- Stress echocardiography - evaluate changes in heart wall motion during exercise
- Myocardial perfusion study - evaluate perfusion defects
- ECG - look for ST-segment changes
- Coronary angiography - to assess coronary arteries for blockage
Treatment:
- Stop smoking!
- Treat diabetes, hypertension, obesity, and high cholesterol
- Exercise training to improve blood flow
- Aspirin daily to thin blood
- Sublingual nitroglycerin for symptomatic episodes
- Beta-blockers and calcium-channel blockers for prevention of ischemia
- Intra-aortic balloon pump for unstable angina not controlled by medications
- Surgery
