Feb 13

Angina Chest Pain

Angina Chest Pain – All About This
By Nakul Jain

Angina or Angina pectoris translated from Latin means chest pain. Chest discomfort in angina is often brought on by heavy exercise or tension which increases the oxygen needs of the heart.

What are the causes?

By far the most common cause of angina is arthrosclerosis of the coronary arteries. Other rare causes are damage to the exit valve of the left ventricle and acute anemia or reduction in the oxygen carrying capacity of the blood.

Arthrosclerosis of the coronary arteries is the silting of arteries over a period of time. It starts in the intima or inner lining as small, flat yellow patches or streaks. These patches enlarge gradually, projecting into the arteries where they eventually cause serious interference with or even total obstruction of blood flow. Initially these streaks contain pure cholesterol, with time other substances appear as well.

When the silting up process is fairly advanced, the arteries cannot accommodate the increased blood flow required when you exercise or do any strenuous activity. The temporary shortage of oxygen rich blood causes your heart muscles to go into an uncomfortable or painful cramp. This is the pain of angina.

How does angina feel?

You may experience a tight feeling, oppression or pain in the centre of the chest behind the breastbone. This sometimes spreads into one or both arms, the neck or jaw, through to the back (rarely in other directions) The pain is constant or continuous while it lasts and is never sharp, stabbing or of only a few seconds duration. It may feel to you like indigestion. The pain generally occurs only on exertion – such as walking. You will probably find that the pain occurs every time you walk a certain distance or at a certain
speed. It is relieved by stooping or even by slowing down, and when you start walking again you may be able to walk a good deal further than before. This improved capacity to walk after stopping is very common and is called ‘second’ wind angina. Some things may aggravate angina such as walking in cold, windy weather or after a heavy meal. Emotional upset or tension or excitement might bring pain in effect. Further damage to arteries can cause myocardial infraction or heart attack.

What your doctor would be looking for?

Once angina has been confirmed you will be fully examined before treatment to reveal the condition of the heart muscle and the valves whether there is evidence of trouble in arteries elsewhere in the body and whether important risk factors exist such as high blood pressure and obesity.

An electrocardiogram will reveal the presence of any heart muscle damage and an exercise or TMT will confirm the diagnosis of angina and knowing the severity of arthrosclerosis. Other factors such as high blood pressure, diabetes and reduced function of thyroid gland should be examined thoroughly. An x-ray of coronary arteries will help.

Treatment of Angina

1) The most crucial part of the treatment is risk factor control- regular exercise, return to a normal active life , weight control and stopping smoking often improve symptoms. Lowering cholesterol and high blood pressure also helps.

2) Drugs have to play a part in treatment either to relieve pain , increase exercise capacity or to treat risk factors such as high blood pressure or high cholesterol and arthrosclerosis

3) By pass Surgery:- Coronary artery surgery is aimed at by-passing the obstructions in the coronary arteries by using strips of patients own legs veins or by grafting branches of internal mammary artery. Surgery is not advisable unless all other forms of treatment have been tried as treatment and lifestyle changes are far more effective leaving surgery as the last option.

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