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What is Angina and what are common Angina Mistakes?
Angina is a fairly common type of chest pain that results from
less than adequate blood supply to the heart muscles.
Common causes of angina
Common causes of angina include several types of coronary artery
diseases. Common types of coronary artery disease include
aortic stenosis, hypertension, and hypertrophic cardiomyopathy.
People with normal arteries can still suffer from angina.
The heart normally receives its blood supply from the coronary
arteries during the relaxation phase of a heart muscle contraction
(the pumping action of the heart). When the heart needs more blood,
the vessels dilate. But, when plaque lines the vessels, they cannot
dilate. They lose their flexibility. Therefore, disorders involving
the condition of the coronary vessels cause low blood oxygen levels
and poor circulation. An obstruction of the blood vessels results
in a decrease in the blood supply to the heart muscles. This is
called ischemia.
What does an angina attack feel like?
Most people experience angina pain behind the sternum (breast
bone) or just to the left. The angina pain commonly radiates to
the left shoulder/upper arm. Then it travels to the left elbow,
wrist and fingers. Angina pain may radiate to the right shoulder,
neck, jaw or just above the stomach area. Patients say that angina
pain is NOT sharp like a knife, but is felt in terms of a burning,
pressing, aching, or pressure as experienced with gas or indigestion.
Angina attacks may come on slowly or quickly. Usually the duration
of an angina attack is less than 5 minutes, but can last as long
as 15 to 20 minutes. Longer angina episodes may occur after experiencing
an extreme emotional outburst or eating a large meal due to the
extra demands placed on the heart.
Angina pain usually is accompanied by any or all of these signs
and symptoms:
- difficulty breathing
- pale face/skin
- sweating
- faintness
- heart palpitations
- dizziness
- digestive disturbances.
Why is angina so painful?
When the coronary artery is closed off (occluded), heart cells
become deprived of blood supply within only 10 seconds. In several
minutes, the heart decreases its pumping action. Subsequently,
oxygen and glucose cannot feed the muscle. The cells then convert
to a different kind of metabolism: anaerobic metabolism. This kind
leaves lactic acid as a waste product. The heart muscle becomes
less healthy and needs to work harder as it rids itself of the
lactic acid. (This is like an extreme case of muscle cramping after
doing too many sit-ups.)
Diagnosis of Angina
Your doctor may choose to use tests or x-rays to properly evaluate
the condition of the heart muscles. An electrocardiogram (ECG)
is a heart-monitoring test conducted while a patient is at rest
or on a treadmill/bike during exercise. An angiogram is an x-ray
test that allows the doctor to identify blocked arteries in a patient
who has been injected with a dye-like substance that defines blood
vessels in the heart. Other various radiology tests can be used
to evaluate the heart muscle for areas of ischemia (poor blood
supply to heart tissue).
Angina Risk Factors
There are some precipitating factors a patient should be able
to recognize in order to successfully prevent an episode of angina:
- Exertion - When the patient's level of physical energy is overly
strenuous
- Emotion - When the patient's level of emotion becomes
overwhelming
- Exposure - When either the patient's blood supply
is decreased or the heart's need for more oxygen is increased,
angina can occur.
Types of Angina
Stable Angina
Once diagnosed, Stable Angina is a condition that the patient
is able to manage. By understanding the pattern of onset and duration,
the patient can respond to the signs and symptoms by using relieving
factors such as rest and medication. This type of angina is reasonably
predictable given certain stressors.
Unstable Angina
Unstable Angina is very unpredictable condition and can unexpectedly
occur at night.
Prinzmetal's Angina
Prinzmetal's Angina has the classic signs/symptoms of
angina, but happens at rest - usually in the early hours of the
day. This may be due to coronary artery spasms.
Nocturnal Angina
Nocturnal Angina is thought to be associated associated
with REM (rapid eye movement) - a phase of deep sleep.
Intractable Angina
Intractable Angina is chronic and incapacitating. Unfortunately,
this type of angina does not respond well to treatment.
Post-Infarction Angina
After a heart attack/MI (myocardial infarction) the residual damages
can result in episodes of Post-Infarction Angina.
Angina Treatment
The goals for treatment include:
1. relieving the acute attacks
2. preventing future attacks in order to preclude a heart attack
3. prevent coronary artery disease
4. resolve angina before actual heart damage occurs.
The following medications may be recommended by your doctor for
treating angina:
Nitroglycerine - This drug reduces the oxygen requirements on
the heart by dilating the blood vessels, decreasing blood pressure
and the ventricular wall tension. Nitroglycerin pills are placed
under the patient's tongue at onset of angina symptoms.
Beta Blockers - This drug reduces the oxygen requirements on the
heart by blocking complex factors affecting how the heart contracts.
Calcium Channel Blockers - This drug is used in combination with
other drugs. This type of drug is involved in the electrical activity
of the heart cells and contraction of the vessels.
Antiplatelet Medicine - i.e., Aspirin - It is said that in unstable
angina, use of Aspirin can reduce the chances of a heart attack
and therefore reduce mortality by 50 percent.
What can the patient do?
The American Heart Association recommends that a person seek prompt
medical treatment for chest pain episodes. Additionally, the American
Heart Association encourages people to work to reduce their coronary
heart disease risk by lifestyle modifications. Daily exercise and
weight management along with blood pressure management will go
a long way to maximize cardiac circulation and prevent angina.
Look at the statistics!
Stop smoking - reduces angina risk by 37 percent
Reduce cholesterol by 10 percent - reduces angina risk by 20 percent
Reduce blood pressure -especially the diastolic measure (bottom
number) by 6 points - reduces angina risk by 10 percent
What specifically can exercise do for you?
If you exercise vigorously at least 30 minutes, 3-4 times a week,
at 50-75 percent of the maximum heart rate by age, you will be
able to substantially improve your health. (Even 30 minutes of
strolling in the mall beats sitting on the couch!)
Exercise increases:
your heart's ability to pump blood
the amount of blood that the heart pumps per beat
the levels of good cholesterol
your survival chances after a heart attack
Exercise decreases:
your blood pressure
the formation of blood clots that cut off circulation
the chance of a stroke
the rate of the heart at rest
the risk of heart disease
Commitment to Personal Injury Clients
Personal Injury lawyer Jeffrey H. Rasansky has one mission: to
fight for the rights of personal injury victims, people just like
you. Jeff has successfully represented victims of: personal injury,
nursing home abuse, nursing home neglect, nursing home negligence,
medical malpractice, car wrecks and product liability.
Jeff Rasansky is licensed to practice before all state courts
in Texas, the United States District Courts in the Northern and
Eastern Districts of Texas and the Fifth United States Circuit
Court of Appeals.
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The Rasansky Law Firm.
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