Angina Pectoris
Definition
It is a condition characterized by pain due to myocardial
ischemia due to a reduction in the blood supply to the heart due to any cause.
Classification
1.Stable angina
2. unstable angina
Aetiology
1.Arteriosclerosis of the coronary arteries.
2.Myocardial hypertrophy secondary to hypertension ,which
increases the oxygen demand of the heart.
3.Aortic aneurysm.
4.Severe anemia.
5.Aortic stenosis.
Clinical features
|
Pain |
Features |
|
Site |
·
Rerosternal ·
Sometimes epigastric. ·
Tip of the left shoulder and left arm. |
|
Radiation |
·
Rarely interscapular. ·
Down the left arm up to the fingers. |
|
Nature |
·
Constricting or gripping. ·
Sometimes burning. |
|
Severity |
·
Severe. ·
The
severity is maintained throughout the episode. |
|
Duration |
1to4 minutes. |
|
Precipitating factors |
·
Exercise. ·
Climbing stairs. ·
Walking uphill or against heavy wind. ·
Physical activity after eating. ·
Anger. ·
Fear. ·
May begin even at rest in severe cases. |
|
Relieving factors |
·
Rest. ·
Nitroglycerin tablet placed under the tongue. |
|
|
|
|
|
|
Pain
1.Pain in chest (see the table above).
2.Choking sensationin the chest.
3.Flatulence.
4Frequency of micturition after the pain passes off.
5. Giddiness or drowsiness.
6. Excessive sweating, nausea and vomiting if the pain is
severe.
7.Breathlessness.
Treatment
1.During an attack
·
Glyceryl trinitate 0.6 mg sublingually. It
dissolves and get absorbed by the oral mucous membrane. Its action is seen in 3
to 5 minutes and it lasts for more than half an hour.
·
Amyl nitrate ampoule is broken under a mask and
the patient is asked to inhale it. It causes fast relief.
·
Bed rest.
2.Preventive measures
·
Stop vices like the following.
- Smoking.
-Drinking.
-Use of tobacco in any other
form.
·
Reduction of weight in case of obesity.
·
Dividing food ingested into smaller portions
over the day rather than large meals at fewer times.
·
Adequate rest during the day and at night.
·
Avoiding anxiety, anger,stress.
·
Control of high blood pressure, if any.
·
Keep medicines ready for use.
3.Drug therapy: see the following table.
Drugs
for Treatment of Angina Pectoris
|
Drug |
Features |
|
Isosorbide dinitrate |
·
20mg three to four times a day orally. ·
Its dose is increased gradually so that it
does not cause headache. |
|
Nitroglcerin Ointment |
·
2%ointment is used. It is applied over the
site of the pain. |
|
Propranolol |
·
40mg to 80mg twice a day. |
|
Metoprolol |
·
50mg to 100mg twice a day. |
|
Timolol |
·
10mg to 20 mg twice a day. |
|
|
Surgery is required , if the medical treatment does not work. Coronary arteriography is done before the surgery . In this test cardiac catheterization is done and the tip of the catheter is placed in the coronary arteries. Then radiopaque dye is injected into them and radiograph are obtained. This test tells about any block in the coronary arteries, so that, it can be relieved by surgery, in which the blocked segments of the coronary arteries are replaced by segments of the coronary arteries are replaced by segments of the saphenous vein. Can live after such surgery.
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