What is Angina Pectoris?

Angina pectorisAngina pectoris means bruising and is a sudden pain in the heart. If you experience such an angina pectoris, you should immediately inform an emergency physician. Only the doctor can determine whether it is also a heart attack.

Angina pectoris is characterized by a painful sensation occurring behind the sternum. This is the main symptom of an arterial calcification (arteriosclerosis) of the coronary arteries. Therefore, angına pectoris is a symptom and not a disease.

There is a stable and an unstable angina pectoris:

Stable angina pectoris

The stable angina pectoris lasts for a few minutes and is triggered by physical or emotional stress. Sometimes even cold or an extensive meal leads to an angina pectoris attack. The pain can radiate into the throat, lower jaw, teeth, shoulder and arms.

Since the angina pectoris attacks are relatively similar, doctors call this a “stable angina pectoris”. If the person experience this, ıt is better to get some rest and take certain medicines like a nitrospray. By doing this measures, the symptoms disappear.

Unstable angina pectoris

Unstable angina pectoris is any new angina or an existing angina that does not decay by rest or effective medication. An unstable angina pectoris can develop even at low load or at rest.

Characteristic is that the angina pectoris attack gets stronger from time to time and lasts longer. The risk of myocardial infarction in patients with unstable angina pectoris is 20 percent. Therefore an emergency physician must be called immediately.

Prinzmetal

The princemetal angina is a rare form of unstable angina pectoris. The pain occurs at rest, for example during sleep. In a princemetal angina, the coronary arteries cramp.


Angina Pectoris Symptoms

SymptomsAngina pectoris symptoms manifest themselves basically through pain and a feeling of tightness, burning, pressure behind the sternum. The pain often radiate into other parts of the body, such as the neck, lower jaw, teeth, arms, or upper abdomen. In addition, pain can occur between the shoulder blades. Affected persons often describe a feeling of heaviness and numbness in the arm, shoulder, elbow or hand, usually affecting the left side.

Symptoms such as sudden dyspnoea, nausea, vomiting, sweating, and a stifling, throbbing sensation in the throat may occur. Those affected often suffer from anxiety and death and suffocation.

In women, other complaints are usually associated with angina pectoris. Symptoms such as fatigue, shortness of breath and stomach discomfort are typical signs. The classic breast pain occurs, however, only in a few women.

Older patients, usually older than 75 years, often show similar angina pectoris symptoms.

Angina pectoris in diabetes has a peculiarity: diabetics with a diabetes-related nerve damage (diabetic polyneuropathy) often do not feel pain, because pain stimuli can not be passed on completely by the damaged nerves. Therefore, the angina pectoris can occur almost painless or with little pain in diabetics.

Stable angina pectoris symptoms

Angina pectoris symptoms are associated with stable angina in connection with physical or emotional stress. The symptoms go away in 15 to 20 minutes or leave approximately after five minutes after when a nitrospray is taken.

Unstable angina pectoris symptoms

An unstable angina can develop from a stable angina. The angina pectoris symptoms increase in severity, duration, frequency and can arise from complete rest.

In addition, medicines need to be taken more frequently to relieve the symptoms. The first-time occurrence of the angina pectoris symptoms also belong to the unstable angina pectoris.

The risk of myocardial infarction is very high in the case of unstable angina. When an unstable angina pectoris passes into a myocardial infarction, medical professionals speak of acute coronary syndrome. Typical angina pectoris symptoms are always a reason to call a doctor immediately.


Angina Pectoris Causes and Risk factors

If the heart muscle is insufficiently supplied with oxygen-rich blood or the heart requires more oxygen through increased cardiac work, an angina pectoris develops. The reason for this is mainly an arterial calcification (arteriosclerosis).

Causes of angina pectoris

Arteriosclerosis is the predominant cause

In arteriosclerosis, the blood vessels are constricted by deposits of fat, blood platelets, connective tissue, and lime. If the heart coronary vessels are affected, the vessels that surround the heart muscle in a net-like manner, the heart receives too little oxygen and nutrients – a coronary heart disease (CHD) with the main symptom angina pectoris.

 Risk factors such as smoking, increased blood pressure, diabetes mellitus and high age favor the removal of fat from the blood in the arterial walls.

Inflammatory processes transform the wall of the blood vessel (atherosclerotic plaque). For many years, the vessels harden and their diameter becomes smaller and smaller. When such a plaque tears in the coronary vessels, blood clots are deposited which can block the artery. A heart attack occurs when the heart muscle area which is supplied by this artery, is not circulated and dies.

Risk factors for angina pectoris

The risk of arterial calcification of the coronary arteries (CHD) is increased by the following factors:

  • Nutrition: High-fat and high-calorie foods lead to overweight and high cholesterol
  • Overweight: This is the result of years of unhealthy diet
  • Lack of exercise: Sufficient exercise reduces blood pressure, improves cholesterol levels and increases the insulin sensitivity of muscle cells
  • Gender: Women have a lower risk of arteriosclerosis before menopause because they are protected by the female sex hormones (from the estrogen)
  • Genetic predisposition: In some families, cardiovascular diseases such as CHD (Coronary heart disease) are common, and the genes seem to play a role. The risk is increased if first-degree relatives are affected by CHD before the age of 55 (women) or before the age of 65 (men)
  • Smoking: Smoking tabocco and among other things promote the formation of unstable plaques in the vessels
  • Increased blood pressure: Hypertension (hypertension) damages the vascular walls directly
  • Increased cholesterol levels: High LDL values and low HDL values promote plaque formation
  • Diabetes mellitus: A poorly adjusted diabetes leads to permanently elevated blood glucose levels, which in turn damage the blood vessels
  • Increased inflammation: An example is an increased CRP value in the blood, it makes the plaque unstable
  • Age: As the age increases, the risk of arterial laryngoscopy increases

Angina Pectoris Examinations and Diagnosis

How to diagnose angina pectorisIn order to ensure an angina pectoris diagnosis, the affected person is first thoroughly questioned about his angina pectoris attack (anamnesis). The doctor inquires as to when the complaints occur, how they express themselves, and whether there is a trigger for them.

It also plays a role whether the symptoms improve when a nitrospray is taken. The physician can better classify whether it is perhaps a coronary heart disease (CHD) or whether another disease causes the chest pain.

For example, pain emanating from the stomach or a pulmonary embolism (occlusion of a pulmonary vessel through a blood clot) may have similar symptoms.

Heart Attack

To rule out a heart attack, it is important to distinguish whether it is a stable angina or an unstable angina. A stable angina can be diagnosed in the hospital and treated immediately. On the other hand, an unstable angina pectoris must be carefully monitored in the hospital as there is a high risk of a heart attack.

The physician will perform a physical examination and listen to the heart for heart valve defects. This also includes a blood pressure measurement in order to determine a hypertension. It damages the vessel wall directly from the inside. Therefore, it is a high risk for arterial calcification.

Rest and long-term ECG

In the electrocardiogram (ECG), the electrical activities of all myocardial fibers are shown as a sum in a heart tension curve. In more than half of the patients with angina pectoris, the ECG is altered. If the physician is suspected of cardiac arrhythmia, a long-term ECG is established.

Cardiac Ultrasound

In heart ultrasound (echocardiography), the physician examines ultrasound to see if the heart is altered. The heart chambers and heart valves as well as their function can be assessed. This method of examination is fast and patient-friendly and is now an indispensable component in the examination of an angina pectoris.

Stress Tests For the Heart

In most cases, an exercise ECG with bicycle ergometry is performed in the clinic or practice. The patient rides on a standing bicycle while the load is gradually raised. At the same time, ECG and blood pressure values ​​are measured.

In the case of a stressed ECG, the aim is to achieve an insufficient circulation of the heart muscle. If an angina pectoris subsequently occurs and the ECG changes, this is referred to as a positive ergometry.

Stress MRI

Another possibility is the stress-magnetic resonance tomography (stress-MRT). Through drugs such as dobutamine and adenosine, the heart beats faster and stronger and is artificially exposed to stress. One provokes an oxygen deficiency at the heart and investigates in the MRT.

Myocardial Scintigraphy

In this study, the patient is injected with a radioactive substance such as thallium via a needle. The radioactive substance accumulates at the heart muscle. In doing so, images are taken with a so-called gamma camera at rest or under physical strain.

This method of examination is used when ECG and echocardiography are not sufficient to provide an accurate angina pectoris diagnosis.


Angina Pectoris Treatment

Treatment of angina pectorisThe angina pectoris treatment should first prevent a heart attack or a life-threatening outcome.

Unstable Angina Pectoris

Call the emergency physician immediately! The unstable angina is an acute emergency because there is a high risk of a heart attack. So if the complaints of a angina occur for the first time or do not get better by rest or nitro preparations, an emergency physician must be called immediately – even if it is perhaps a false alarm. 15 minutes can decide about life and death!

Get rid of tight clothing and store the upper body up. Calm down, open the window for fresh air and wait until the ambulance arrives.

Acute Angina Pectoris Attack

Medicines for the treatment of acute angina pectoris attack are nitro preparations such as, for example, nitroglycerin, which can be used as a spray or capsule.

Nitrates expand the vessels, relieve the heart and consume less oxygen. As the vessels of the whole body are also dilated, the blood pressure drops. In no case should potency agents (phosphodiesterase 5 inhibitors) be used at the same time, since they also lower the blood pressure. The blood pressure can then drop down in a life-threatening manner.

If a vessel section is narrowed so much that almost no blood can flow through, the vessel can be expanded again by an operation such as the bypass operation. In the bypass operation, the narrowed vessel section is bridged by a corporeal or artificial artery to restore the blood supply.

Another possibility of angina pectoris therapy is balloon dilatation. In this case, the narrowed vessel is expanded with a balloon, which is attached to a plastic tube (catheter).


How To Prevent Angina Pectoris

In order to prevent angina pectoris, it is better to change diet behavior and exercise attention. A healthy lifestyle reduces the risk of coronary heart disease (CHD), the most common cause of angina.

  • Smoking narrows the vessels. That is why, you have to stop smoking immediately
  • When overweight is the first priority, the weight is reduced. Pay attention to healthy eating and eat plenty of fruits and vegetables. Do not use animal fats and use vegetable oils in moderation. Even a few kilos less have a positive effect on health and reduce another risk for angina
  • Regular exercise is also important. A half-hour walk or bike ride is better than no movement and can be well integrated into everyday life
  • Consult your doctor or health care professional for regular checks. Diseases such as diabetes, hypertension or increased blood cholesterol levels can damage damage the vessels. These must be treated in time. If the doctor tells you to take medication, you should take it regularly – even if you feel good at the moment
  • Eliminate stress factors and treat yourself to a regular recovery in everyday life
  • Excessive stress can also cause angina pectoris
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