Angina pectoris

Angina Pectoris

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Angina Pectoris is ,Ischaemic cardiac Pain of short duration due to lack of sufficient amount of oxygenated blood supply to the cardiac musculáture. (Or, it is a form of ischaemic heart disease; marked by
paroxysmal attacks of substernal pain without evidence of lasting damage to the myocardium).

CAUSES OF ANGINA PECTORIS

Exact cause or aetiology is unknown. Predisposing factors:

Age: middle age.

Sex: male predominate.

  • Habit – Smoking.
  • Food habit – Fatty and hypertensioned personsare more affected.
  • Occluded coronary vessels -(a) syphilitic aortitis;
  • (b) atherosclerosis
  • (c), coronary angitis andembolism.
  • Diminished coronary flow – (a) aortic stenosis; (b) gross aortic incompetence; (c) tight mitral stenosis;(d) severe pulmonary stenosis; (e) high pulmonary
  • Vascular resistance Anoxaemia (a) anaemia; (b) high altitude ncreased work of the heart – (a) hypertension; (b) valvular disease.
  • Precipitating causes -(a) muscular exercise; (b) exposure to cold;(c) heavy meal, etc.
  • Psychogenic factor – mental anxiety.

SYMPTOMS OF ANGINA PECTORIS

  • Angina Is essentially a type of pain thus itself a Symptom.
  • Pain in chest.
  • Location -Mid or upper sternal region; may be felt over the left side of chest.
  • Nature of pain – Classically constricting,_squeczing pressing, or crushing in character, sometime numbing or burning.
  • Duration – usually not more than 2 – 5 minutes. Any cardiac pain of more than 5 min is never due to angina pectoris.
  • Provoking factors usually starts by walking up hill or against the wind, after exertion.weight lifting, emotion, by_ hurrying after meals or heavy meal, by exposure-to cold or by unaccustomed exercise.
  • Pain may_also- be induced by excitement,_anger, fear or apprehension, even during sexualintercourse.
  • Relief – Usually disappears after taking rest for a while or after taking nitroglycerin.

SIGNS

Classical signs are present only during attack.
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(a) Decubitus – propped up. (b) Attitude – Closed
fist kept over the chest. (c) Face – Deathly pale and anxious. (d) Pulse –
Increase. (e) Respiration – Hurried and shallow. (f) Blood Pressure –
may or may not be raised. (g) Shortly after an attack, tender spots may
be present over the praecordium or along the arms. (Cardiac finding-
usually nil. Heart block

Systemic signs – During attack. . Auscultation = Tick-tack rhythm, S4 and S5 may be audible (gallop rhythm), apex beat may
be shified downwards.

COMPLICATIONS

INVESTIGATION

E.C.G. (may or may not show per ischaemic changes ordinarily) STSegment depression flattening of T wave or sometime elevation of`STsegment.

Selective coronary angiography – In many cases it mayshow definite narrowing of coronary artery in more than two segments.

TYPES OF ANGINA PECTORIS

  • Stable angina This is classical angina pectoris shown due to exercise.
  • Unstable angina Same over it is severe; pain occurs in night, duration of pain 15 minutes or more.
  • Variant angina Periodical waking and waning to time fixation.

PROGNOSIS

Prognosis is worse in the patient who has had multiple cardiac infarcts or who has cardiac failure or who has a family history orcoronary disease. Many men have continued to live for many years by restricting their activities & full expectation of life have been achieved.

MANAGEMENT

Patient should be instructed to lead restful life avoiding mental anxieties,worries, smoking and all other provoking factors.

Physical activities should be minimized.

In obese subjects adequate diet chart should be followed so as to reduce the body weight.

SOMETIMES SURGICAL PROCEDURES MAY BE DONE IN EMERGENCY CASES.