Angina

[Zia_Hayderi]

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Angina (angina pectoris - Latin for squeezing of the chest) is chest discomfort that occurs when there is a decreased blood oxygen supply to an area of the heart muscle. In most cases, the lack of blood supply is due to a narrowing of the coronary arteries as a result of arteriosclerosis.
Angina is usually felt as:

• pressure,
• heaviness,
• tightening,
• squeezing, or
• aching across the chest, particularly behind the breastbone.

This pain often radiates to the neck, jaw, arms, back, or even the teeth.
Patients may also suffer:

• Indigestion
• Heartburn
• Weakness
• sweating,
• Nausea
• cramping, and
• Shortness if breath

Angina usually occurs during exertion, severe emotional stress or after a heavy meal. During these periods, the heart muscle demands more blood oxygen than the narrowed coronary arteries can deliver. Angina typically lasts from 1 to 15 minutes and is relieved by rest or by placing a nitroglycerine tablet under the tongue. Nitroglycerin relaxes the blood vessels and lowers blood pressure. Both rest and nitroglycerin decrease the heart muscles demand for oxygen, thus relieving angina.
Angina is classified in one of two types: 1) stable angina or 2) unstable angina.


Stable angina
Stable angina is the most common type of angina, and what most people mean when they refer to angina. People with stable angina have angina symptoms on a regular basis and the symptoms are somewhat predictable (for example, walking up a flight of steps causes chest pain). For most patients, symptoms occur during exertion and commonly last less than five minutes. They are relieved by rest or medication, such as nitroglycerin under the tongue.
Unstable angina
Unstable angina is less common and more serious. The symptoms are more severe and less predictable than the pattern of stable angina. Moreover, the pains are more frequent, last longer, occur at rest, and are not relieved by nitroglycerin under the tongue (or the patient needs to use more nitroglycerin than usual). Unstable angina is not the same as a heart attack, but it warrants an immediate visit to your healthcare provider or hospital emergency department as further cardiac testing is urgently needed. Unstable angina is often a precursor to a heart attack.
Medications
Nitroglycerin: Resting, nitroglycerine tablets (placed under the tongue), and nitroglycerine spray all relieve angina by reducing the heart muscle's demand for oxygen. Nitroglycerin also relieves spasm of the coronary arteries and can redistribute coronary artery blood flow to areas that need it most. Short-acting nitroglycerin can be repeated at five minute intervals. When 3 doses of nitroglycerin fail to relieve the angina, further medical attention is recommended. Short-acting nitroglycerin can also be used prior to exertion to prevent angina.
Longer-acting nitroglycerin preparations, such as Isordil tablets, Nitro-Dur transdermal systems (patch form), and Nitrol ointment are useful in preventing and reducing the frequency and intensity of episodes in patients with chronic angina. The use of nitroglycerin preparations may cause headaches and lightheadedness due to an excess lowering of blood pressure.
Beta Blockers: beta blockersrelieve angina by inhibiting the effect of adrenaline on the heart. Inhibiting adrenaline decreases the heart rate, lowers the blood pressure, and reduces the pumping force of the heart muscle, all of which reduce the heart muscle's demand for oxygen. Beta blockers include:

• acebutolol(Sectral)
• atenolol(Tenormin)
• bisoprolol(Zebeta)
• metprolol (Lopressor, Lopressor LA, Toprol XL)
• nadolol(Corgard)
• timolol (Blocadren)

Calcium Channel Blockers: calcium channel blockersrelieve angina by lowering blood pressure, and reducing the pumping force of the heart muscle, thereby reducing muscle oxygen demand. Calcium channel blockers also relieve coronary artery spasm. Calcium channel blockers include:

• amlodipine (Norvasc)
• bebridil (Vascor)
• diltiazem (Cardizem)
• feldopine (Plendil)
• isradipine (Dynacirc)
• nicardipine (Cardene)
• nifedipine (Adalat, Procardia)
• nimodipine (Nimotop)
• nisoldipine (Sular)
• verapamil(Calan)