The Cardiovascular System|
(Greek for choking) pectoris is the name for a clinical syndrome
(a set of symptoms and signs) rather than a disease. The term is used to
describe a discomfort due to transient
and moderate myocardial ischaemia. It occurs when the coronary flow is
insufficient to meet the heart’s demands for oxygen. Therefore angina can be
precipitated by any situation that causes an increase in cardiac output, which
is normally accomplished by increased cardiac contractility and rate. Those
exertion e.g., fast walking, climbing stairs
Angina affects about 3% of people between the ages of 25 and 65 years, becoming more common with increasing age.
Clinical features: < BACK TO TOP >
discomfort of angina is not usually perceived as pain; most patients describe
sense of heaviness, tightness or troublesome ache in the middle of the chest
(‘like a band round the chest?, usually induced by exertion and relieved
chest discomfort may be often accompanied by discomfort, weakness or numbness
in the arms, more commonly left, even to the fingers.
may be accompanied breathlessness and palpitations, as well as sweating.
Angina characterised by a progressive increase in anginal symptoms or angina that does not subside or even occurs on rest is classified as unstable angina and is a serious condition since it may progress to myocardial infarction shortly or in the following few months.
Diagnosis: < BACK TO TOP >
(ECG) is normal in most patients at rest between attacks. The most convincing
ECG evidence is the demonstration of reversible ST segment depression and
decreased R-wave height with or without T wave inversion, at the time the
patient is experiencing symptoms.
testing can be done using a treadmill, monitoring ECG all the time; it can
assess the severity of ischaemia by measuring exercise tolerance.
arteriography provides detailed information about the extent and site of
coronary artery stenosis.
SPECT scanning using radioactive thallium or tracers labelled with technetium
may detect areas with reduced perfusion.
is carried out to assess heart muscle contractions and ventricular function,
and it may be done during exercise (stress echocardiography).
Recently introduced intravascular ultrasound using special transducers placed into the affected coronary artery can clearly visualise vascular obstruction or even a plaque that still hasn’t narrowed the blood vessel.
Management < BACK TO TOP >
of the disease and reassurance of the patient is always needed because most
patients are quite concerned about their condition.
are advised to avoid smoking, aim at ideal body weight, take regular exercise
but not beyond the point of pain, avoid severe exertion especially after a
heavy meal or in very cold weather.
treatment is in form of organic nitrates (glyceryl trinitrate administered
transdermally via a “patch? or sublingually immediately before exertion
or when the pain is felt [Anginine, Deponit, Nitradisc, Nitrolingual Spray],
isosorbide [Isordil, Isogen, Sorbidin, Imdur] given regularly by mouth to
prevent attacks), b-adrenoceptor antagonists (e.g., atenolol
[Tenormin, Anselol], metoprolol [Betaloc, Lopresor] in preventing angina),
calcium antagonists (e.g., verapamil [Isoptin, Cordilox, Veracaps], diltiazem
[Cardizem, Dilzem], amlodipine [Norvasc] are also important in prevention).
Percutaneous transluminal coronary angioplasty
(PTCA) is a technique used to dilate the stenosis in the coronary artery
using a special catheter with a balloon which can be inflated. PTCA can
produce excellent results in carefully selected patients who only have one or
two narrowed artery segments which are suitable for balloon dilation
(non-calcified atherosclerosis). Arterial dilation is followed by placement
of a stent (steel mesh or coil) which is left in the artery as a scaffold to
procedure recently introduced is rotational
atherectomy that uses a high speed intravascular drill which pulverises
the plaque into very small particles (suitable for calcified atherosclerosis)
or rotating blades in a steel mesh cylinder (suitable for non-calcified
Coronary artery bypass grafting (CABG) involves major surgery under cardiopulmonary
bypass. Narrowed segments of coronary artery are bypassed using patient’s
venous or arterial grafts. CABG surgery is performed to relieve angina in
patients whose illness has not responded to medications and are not good
candidates for balloon angioplasty or rotational atherectomy. CABG surgery is
ideal for patients with multiple narrowings in multiple coronary artery
branches, such as is often seen in patients with diabetes.
Transmyocardial revascularisation (TVR) is a surgical procedure for patients with severe angina who are unable to benefit from other treatments for some reason (e.g., too ill to undergo PTCA or CABG). A laser is used to open small channels in the wall of the heart (10-40 of them) which initially restore some blood flow and oxygen delivery to the ischaemic area. In time these small channels heal and close but it is thought that the procedure has stimulated development of new blood vessels which is called angiogenesis. The procedure is minimally invasive and is performed through a small incision on the left side of the chest between the ribs.
Prognosis < BACK TO TOP >
Nutrition < BACK TO TOP >
Nutrition that alleviate or prevent Angina Pectoris :-
Herbs < BACK TO TOP >
Herbs that alleviate or prevent Angina Pectoris :-
(source : -)
3 5 June 20096December 2005
10 December 2004 Human Rights DayInternational Day of Disabled Persons
World Environment Day
speaker Mr NgThian Watt the Principal Trainer from
Napoleon Hill Associates MalaysiaDetails