What is Angina Pectoris?
ANGINA PECTORIS is a clinical syndrome resulting from lack of blood supply to heart muscles. During the course of attack of angina pectoris the patient experiences chest pain with heaviness, pressure, suffocation, tightness, choking or squeezing. The typical discomfort is sub-sternal in location.
The attack of angina pectoris occurs during physical or emotional stress and is relieved by rest. The syndrome of angina pectoris may occur due to fright, shock, hurrying, anger, excellent, violence, sexual activities, walking against the wind, ascending staircases, walking uphills, walking on ramps as well as by having heavy meals and during exercise. Angina may also occur during or after eating, exposure to cold temperature or to wind.
The main cause of occurrence of angina is only when the workload on the heart is increased and furthermore the most common cause of angina is due to accumulation of atheroman (fatty deposits ‘cholesterol’) inside the blood vessels wall, which causes obstruction in the normal flow of the blood to the heart. Due to deposit of atheroma, the passage becomes narrow in the blood vessels wall and once the normal coronary artery becomes totally blocked, the heart attack takes place. Thus, the angina is a symptoms of coronary artery disease and in other word it is a sign of future heart attack (due to impairing the pumping ability of the heart).
The pain is normally experienced in the chest, behind the sternum, neck, jaw, throat, back, left shoulder, abdomen, left wrist and in the left arm with numbness or heaviness as well as with peculiar sensation of anxiety and fear of death. The pain is knife-like and cutting (stabbing pain) may accompany the feeling of cold, sweating and breathlessness. Angina is always of a short duration, say 1-2 minutes. However, if the chest pain persists ten minutes or more and is not relieved by rest, there is a possibility of heart attack. Therefore, all chest pain should be considered seriously and the medical assistance and care is required immediately.
Angina Pectoris is more common in men than woman (The heart’s size and work load are usually smaller in women) aged 35-60 years, who normally take rich diet and do not exercise.
Etiology of angina symptoms
Atherosclerosis of the coronary arteries is the most common cause of angina pectoris. It accounts for almost all cases of angina pectoris seen in general practice.
Coronary artery spasm is another relatively common cause of angina, but about 75 percent of patients with coronary artery spasm have also associated atherosclerotic obstruction of the coronary arteries.
Cause of Angina symptoms other than Atherosclerosis
- Severe aortic stenosis
- Hypertrophic cardimyopathy
- Severe pulmonary hypertension
- Syphilis (Coronary osteal stenosis)
- Aortic regurgitation
- Kawasaki’s disease
- Severe anemia
- Emboli to coronary arteries (e.g. infective endocarditis).
- Chest pain lasting 3 to 5 minutes— not all patients get substernal pain; it may be described as pressure, heaviness, squeezing, or tightness. Use the patient’s words.
- Can occur at rest or after exertion, excitement, or exposure to cold-due to increased oxygen demands or vasospasm.
- Usually relived by rest — a chance to re-establish oxygen needs.
- Pain may radiate to other parts of the body such as the jaw, back, or armsâ€”angina pain is not always felt in the chest.
- Sweating (diaphoresis) —increased work of body to meet basic physiologic needs; anxiety.
- Tachycardia — heart pumping faster trying to meet oxygen needs as anxiety increases.
- Difficulty breathing, shortness of breath (dyspnea)â€”increased heart rate increase respiratory rate and increases oxygenation.
- Anxietyâ€”not getting enough oxygen to heart muscle, the patient becomes nervous.
Clinical Diagnosis of angina
Clinical diagnosis of angina pectoris depends on the history of chest discomfort. Differentiation from other causes of chest pain is by careful analysis of site, duration, aggravating factor, relieving factor, radiation and other aspects of the chest discomfort.
Physical examination is usually normal Diagnosis depends on history and ECG changes.
It is important to look for any aggravating factors.
Aggravating Factors of Angina
- Aortic stenosis
- Hypertrophic Cardimyopathy
Difference Diagnosis of angina symptoms
Conditions which Cause Chest Pain Very Similar to Angina Pectoris
- Oesophageal spasm
- Gastrop-oesophageal reflux
- Musculoskeletal pain
- Anxiety and hyperventilation
- Pericardial pain
- Pulmonary embolism
- Aortic dissection
ECG is the single most important investigation and should be done in all patients with suspected angina. ECG at rest may be normal in about 25 to 50% of patients.
Stress Testing (TMT)
This is most commonly used test for making the diagnosis and determining the prognosis of angina. ECG is recorded before, during, and after exercise. It is abnormal in about 80% of patients.
Echocardiography can detect abnormalities of ventricular wall motion due to ischemia or myocardial infarction. Stress (exercise) echocardiography is more sensitive than exercise ECG in the diagnosis of IHD.
Echocardiography should be done to asses left ventricular function in patients with angina.
Stress Thallium -201 Myocardial imaging
This is superior to exercise ECG for the diagnosis of angina pectoris, but this test is not widely available.
Homeopathic treatment of angina symptoms – Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to treat angina symptoms but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several medicines are available for angina symptoms treatment that can be selected on the basis of cause, sensation, modalities of the complaints. For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. There are some specific homeopathic remedies which are quite helpful in the treatment of angina symptoms:
Glonine, Cactus, Amyl Nitrate, Crataegus, Lachesis, Naja, Aconite, Spigelia, Arsenic Album, Mag Phos, Cimicifuga and many other remedies..
- Ahmad Sayeed: Angina pectoris & lts Cure; 2002 ; 3-4.
- Mary digiulio, James Keogh, Donna Jackson- Medical-Surgical Nursing Demystified; 2008; 7-8
- Rajendern-Clinical Diagnosis Cardiovascular System; 2004; 193