WHAT IS ANGINA?

Angina pectoris is one of the many symptoms of heart disease. It is manifested by an "uncomfortable" achy feeling in the lower half of the sternum, but it can also develop into crushing, intense pain. Often, however, it is not even perceived as pain but it can quickly progress in severity. The pain or uncomfortable sensation can be felt under the sternum (rib cage). It can also be felt down the left arm or in the left shoulder which is typical for cardiac-type pain. An anginal episode can also be an uncomfortable feeling in the jaw, teeth or throat and can even radiate to the back. The pain usually lasts anywhere from 5 to 15 minutes. A patient often thinks they are having a heart attack. Angina pain can also be caused by drug abuse especially with the use of cocaine.

ANGINA WARNING SIGNS AND SYMPTOMS:

During an angina attack, the heart rate can increase and the blood pressure can become elevated. The patient's skin becomes cool, pale and diaphoretic (perspiration). Between angina attacks, signs of heart disease may be absent. Stable angina symptoms for a particular patient remain the same. However, when changes begin to occur such as an increase in intensity, if the angina discomfort suddenly appears when the patient is resting, or if it wakes the patient from sleep, it then becomes unstable angina and the condition is then more serious. An anginal attack is just that: an attack. It comes on at times without warning, but usually with exertion in a person with a heart blockage. It is relieved with rest and nitroglycerin.

CAUSES OF ANGINA PECTORIS:

The cause of angina pectoris is usually plaque buildup in the coronary arteries which reduces or slows blood flow to and from the heart. Previous myocardial infarction (heart attack) is another cause. The flow of blood is obstructed causing spasm and pain. When the heart must work harder than normal and oxygen supply is insufficient, angina pectoris occurs. When a patient exercises and pain begins, and rest relieves the pain, it is a typical sign of angina pectoris. The pain is the result of the blood flow obstruction. Anginal symptoms can also be brought on by stress and anxiety. A damaged heart is sensitive to changes in body dynamics.

PREVENTION OF ANGINA PECTORIS:

If the patient smokes, the patient is encouraged to stop. If the patient has high blood pressure, this should be controlled as well. High blood pressure puts a strain on the heart. A change in diet encouraging more fruits and vegetables and less animal protein is helpful. Elimination of salt in the diet is essential in reducing blood pressure symptoms. Mild-to-moderate exercise is important. Sublingual nitroglycerin can prevent angina during exercise.

TREATMENT AND RELIEF OF ANGINA:

The goal is to reduce ischemia (obstruction). Balloon angioplasty is one way to reduce the obstruction, but it is not always long lasting. Coronary artery bypass surgery (CABG) is very effective in treating blockage, thus reducing or eliminating angina. However, only patients who have no heart enlargement, no history of heart attacks, and a localized area of heart disease can be candidates. In other words, minimal obstruction and minimal risk factors are important for successful CABG surgery.

Patients who have reached the unstable angina stage, getting the anginal symptoms under control is extremely important. Blood pressure must be reduced. Oxygen is usually necessary at this point. Once the patient has been stabilized, some patients will meet the criteria for balloon angioplasty and possible CABG surgery.

In conclusion, coronary artery disease is very complex. Angina is essentially a symptom. Medical therapy is always tried before invasive surgery if at all possible. Any patient with heart disease is considered critical until the heart disease has been brought under control. Diet, exercise, oxygen as needed and medication can and often does control angina. Of course, as a last resort, surgery can certainly be justified if everything else has been tried first without long-lasting effect.

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