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ANGINA PECTORIS

(Greek ankhon ("strangling") and the Latin pectus ("chest"), - "a strangling feeling in the chest".)

DEFINITION:

Angina Pectoris is a condition of severe chest pain due to ischemic heart usually associated with the obstruction or the spasm of the coronary arteries.

Pain may be accompanied by breathlessness, sweating and nausea in some cases. It usually lasts for about 3 to 5 minutes, and is relieved by rest or specific anti-angina medication.

SUBTYPES:
  • Stable Angina:
    It can also be referred to as exertional angina. It is associated with sever narrowing of the coronary artery due to build up of plaque (plaque is excess cholesterol and other debris that has built up inside a coronary artery). With exertion, like walking up a hill or climbing stairs, the heart works harder and needs more oxygen. If it can't get enough oxygen, a person develops symptoms of Angina, the condition improves with rest.

  • Unstable Angina:
    Indicates high risk of Myocardial Infarction, requires emergency treatment. Unstable angina occurs when the narrowing of the coronary artery due to build up of plaque becomes so severe that not enough blood gets through to keep the heart functioning normally, even at rest. In Unstable Angina lack of oxygen to the heart kills the heart tissue thus increasing the chances of Myocardial Infarction.

  • Variant Angina:
    Vasospastic Angina, Prinzmetal's Angina.
    Rare type of Angina caused basically due to spasm of coronary Arteries. Variant Angina may occur during resting or active state, presence or absence of clogged arteries from atherosclerosis. Spasms lead to decreased blood flow to the heart and hence increasing the risk of heart attack.

TREATMENT:

Treatment options include:
  • rest,
  • medications (nitroglycerin, beta blockers, calcium channel blockers),
  • percutaneous transluminal coronary angioplasty (PTCA), or
  • coronary artery bypass graft surgery (CABG).
ANTI-ANGINALS:

Antianginals are used for the treatment Angina viz.:
  • Beta Blockers:
    These agents act by blocking the effect of the sympathetic nervous system on the heart, slowing heart rate, decreasing blood pressure, and thereby, reducing the oxygen demand of the heart. These agents also help in preventing reoccurrence of the angina attack.

    Products: Atenolol, Propranolol

  • Nitro-vasodilators:
    Nitro-vasodilators act by reducing the oxygen demand of the heart muscles. It also relieves the spasm of the coronary arteries and can redistribute coronary artery blood flow to areas that need it the most.

    Products: Nitroglycerine, Isosorbide Mononitrate, Isosorbide di-nitrate

  • Calcium Channel Blockers:
    Calcium channel blockers act 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.

    Products: Verapamil

  • Aspirin combinations:
    Aspirin has a very good antiplatelet and antithrombotic activity. Such combinations are majorly effective in cases of Unstable Angina where the patients suffer from severe coronary artery narrowing and often are at imminent risk of heart attack.

    Products: Isosorbide +Aspirin
CARDIOVASCULAR DISEASES
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