Angina Pectoris

Synonyms :  

Clinical features, Diagnosis, Management, Prognosis, Nutrition, Herbs,

Angina (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 situations are:

       physical exertion e.g., fast walking, climbing stairs

       cold weather

       heavy meals

       intense emotions

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 >

       The 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 by rest.

       This chest discomfort may be often accompanied by discomfort, weakness or numbness in the arms, more commonly left, even to the fingers.

       There 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.

Class I
Ordinary physical activity, such as walking and climbing stairs, does not cause angina. Angina with strenuous or rapid prolonged exertion.

Class II
Slight limitation of ordinary activity. Walking and climbing stairs rapidly, walking uphill, walking or stair climbing after meals, in cold, in wind or when under emotional stress, or only during the few hours after awakening. Walking more than 2 blocks on the level and climbing more than 1 flight of ordinary stairs at normal pace and in normal condition.

Class III
Marked limitation of ordinary physical activity. Walking one to two blocks on the level and climbing more than one flight of stairs in normal condition.

Class IV
Inability to carry on any physical activity without discomfort. Anginal syndrome may be present at rest.

Diagnosis:  < BACK TO TOP >

       Electrocardiography (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.

       Exercise testing can be done using a treadmill, monitoring ECG all the time; it can assess the severity of ischaemia by measuring exercise tolerance.

       Coronary arteriography provides detailed information about the extent and site of coronary artery stenosis.

       Myocardial SPECT scanning using radioactive thallium or tracers labelled with technetium may detect areas with reduced perfusion.

       Echocardiography 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 >

       Explanation of the disease and reassurance of the patient is always needed because most patients are quite concerned about their condition.

       Patients 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.

       Drug 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 prevent restenosis.

       New 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 plaques).

       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 >

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Nutrition < BACK TO TOP >

Nutrition that alleviate or prevent Angina Pectoris :-
C

Herbs < BACK TO TOP >

Herbs that alleviate or prevent Angina Pectoris :-
Ammi visnaga (khella), Astragalus membranaceus (Astragalus), Coleus forskohlii (Coleus), Crataegus oxycantha (Hawthorn),  Panax ginseng (Korean ginseng), Panax notoginseng (Tienchi ginseng), Pueraria lobata (Kudzu), Terminalia arjuna (Arjun tree), Tribulus terrestris (Tribulus terrestris)

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Health topics - Angina