Angina
(Angina Pectoris)
In this condition factsheet:
Diagnosing Angina
To diagnose angina, a doctor will evaluate the symptoms and the triggers (e.g., exercise, meals). Certain tests may also be performed. Because angina in most people occurs during exertion, the most common test for angina involves running on a treadmill or performing some other exercise while hooked up to a electrocardiogram (ECG) monitor. This simple device can show changes in the heart's electrical activity, which signals ischemia. This is called an exercise stress test. Some people with angina show normal results on these tests; such people are far less likely to suffer a fatal heart attack than those whose ischemia can be detected.
In some cases, a picture of the heart is taken at rest and with exercise. This can be done with an ultrasound (echocardiogram) or with nuclear imaging in which people are injected with a mildly radioactive dye. (This is safe, except for pregnant women or the rare person who is allergic to the special dye.) The nuclear imaging procedure allows the blood supply through the heart muscle to be seen by a rotating camera in a test called a nuclear stress test.
The insides of the coronary arteries can also be seen directly in a procedure called coronary angiography.
Treating and Preventing Angina
There are 3 complementary approaches to treating angina. One is to reduce angina pain with medications. Another is to treat the narrowed arteries with operations such as coronary artery bypass graft surgery or angioplasty (stenting). The third is to eliminate the risk factors that are causing coronary artery disease, of which angina is a symptom.
Several types of medications are available for managing angina: beta-blockers, nitrates, calcium channel blockers, antianginal, and antiplatelet medications.
- Beta-blockers and some calcium channel blockers reduce the demands put on the heart by decreasing the heart rate and lowering the blood pressure.
- Nitrates, such as nitroglycerin,* help to open the coronary arteries, which then supply more blood to the heart. A tablet or spray of fast-acting nitroglycerin can be placed under the tongue (this is called sublingual) to provide rapid relief of angina pain. Longer-acting nitrates can be taken in tablet form 1 to 3 times a day to help control and prevent angina attacks. Nitroglycerin is also available in patches and ointment that can be applied to the skin for continuous control. With longer-acting nitrates, most physicians advise an 8 to 12-hour period where no nitrates are used or taken, as continuous use causes the nitrates to be less effective at the same dose.
- Antiplatelet medications such as ASA* (acetylsalicylic acid), or clopidogrel are given as "blood thinners" to prevent blood clots from forming and blocking the coronary arteries.
- Antianginal medications like ranolazine do not affect a person's heart rate or blood pressure and can be used to manage angina.
In addition to these medications, cholesterol-lowering medication may also be recommended for people with angina. A family of cholesterol-lowering medications, referred to as "statins," has been shown to best reduce the occurrence of heart attacks in people with angina even if their cholesterol profile is normal. Similarly, a group of blood-pressure-lowering medications, called ACE-inhibitors, have also been shown to reduce the risk of heart attacks in people with angina, even if their blood pressure is normal.
Sometimes, narrowed arteries can be fixed with invasive procedures such as angioplasty (stenting) or bypass surgery. The artery may be opened with angioplasty, a procedure which can directly open the narrowing by inflating a tiny balloon under high pressure. After the balloon is deflated and removed, a metal mesh called a stent is usually left in place to prevent the widened artery from narrowing again. Bypass surgery improves blood flow to the heart by removing blood vessels from elsewhere in the body (usually leg veins or arteries from the inside of the chest) and attaching them to the narrowed coronary arteries.
However, angioplasty and bypass surgery do not get rid of the plaques entirely. If the risk factors which caused the plaques in the first place are not eliminated, the arteries may clog up again.
People with coronary artery disease should quit smoking, lose excess weight, drink alcohol in moderation, maintain a healthy diet with a low salt intake, improve cholesterol levels, and control high blood pressure with lifestyle changes and medications.
Exercise can go a long way in treating angina. Angina can make people want to avoid exercise because it's painful, but it's worth adding exercise to your lifestyle to encourage the growth of new blood vessels that can compensate for existing blockages. Some people whose angina didn't improve with medications and even bypass operations have become pain-free after a sensible exercise program.
People with angina should begin an exercise program only under medical supervision. It's important to start slowly, especially if the person has previously had unstable angina or a heart attack. Along with the benefit of relieving the pain of angina, exercise will also reduce the risk of heart attacks and strokes.
All material copyright MediResource Inc. 1996 – 2024. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/condition/getcondition/Angina
References
