QUESTION: What is Angina? And what is the cure?RESPONSE: Angina refers to the pain arising from lack of adequate blood supply tothe heart muscle.
Typically, it is a crushing pain behind the breastbonein the center of the chest, brought on by exertion and relieved by rest. It may at times radiate to or arise in the left arm, neck, jaw, left chest,or back. It is frequently accompanied by sweating, palpitations of theheart, and generally lasts a matter of minutes. Similar pain syndromes maybe caused by other diseases, including esophagitis, gall bladder disease,ulcers, and others. Diagnosis of angina begins with the recognition of the consistentsymptoms. Often an exercise test with radioactive thallium is performed ifthe diagnosis is in question, and sometimes even a cardiac catheterizationis done if the outcome is felt necessary to make management decisions.
This is a complex area which requires careful judgment by physician andpatient. Angina is a manifestation of coronary artery disease, the same diseaseleading to heart attacks. Coronary artery diseas refers to those syndromescaused by blockage to the flow of blood in those arteries supplying theheart muscle itself, i. e.
, the coronary arteries. Like any other organ, theheart requires a steady flow of oxygen and nutrients to provide energy forrmovement, and to maintain the delicate balance of chemicals which allowfor the careful electrical rhythm control of the heart beat. Unlike someother organs, the heart can survive only a matter of minutes without thesenutrients, and the rest of the body can survive only minutes without theheart–thus the critical nature of these syndromes. Causes of blockage range from congenital tissue strands within or overthe arteries to spasms of the muscular coat of the arteries themselves. Byfar the most common cause, however, is the deposition of plaques ofcholesterol, platelets and other substances within the arterial walls.
Sometimes the buildup is very gradual, but in other cases the buildup issuddenly increased as a chunk of matter breaks off and suddenly blocks thealready narrowed opening. Certain factors seem to favor the buildup of these plaques. A strongfamily history of heart attacks is a definite risk factor, reflecting somemetabolic derangement in either cholesterol handling or some other factor. Being male, for reasons probably related to the protective effects of somefemale hormones, is also a relative risk. Cigarette smoking and high bloodpressure are definite risks, both reversible in most cases. Risk alsoincreases with age.
Elevated blood cholesterol levels (both total and lowdensity types) are risks, whereas the high density cholesterol level is arisk only if it is reduced. Possible, but less well-defined factorsinclude certain intense and hostile or time-pressured personality types(so-called type A), inactive lifestyle, and high cholesterol diets. Medications are increasingly effective for symptom control, as well asprevention of complications. The oldest and most common agents are thenitrates, derivatives of nitroglycerine.
They include nitroglycerine,isosorbide, and similar agents. Newer forms include long acting oralagents, plus skin patches which release a small amount through the skininto the bloodstream over a full day. They act by reducing the burden ofblood returning to the heart from the veins and also by dilating thecoronary arteries themselves. Nitrates are highly effective for relief andprevention of angina, and sometimes for limiting the size of a heartattack. Used both for treatment of symptoms as well as prevention ofanticipated symptoms, nitrates are considered by many to be the mainstay ofmedical therapy for angina. The second group of drugs are called “beta blockers” for their abilityto block the activity of the beta receptors of the nervous system.
Thesereceptors cause actions such as blood pressure elevation, rapid heart rate,and forceful heart contractions. When these actions are reduced, the heartneeds less blood, and thus angina may be reduced. The newest group of drugs for angina is called the calcium channelblockers. Calcium channels refer to the areas of the membranes of heartand other cells where calcium flows in and out, reacting with otherchemicals to modulate the force and rate of contractions. In the heart,they can reduce the force and rate of contractions and electricalexcitability, thereby having a calming effect on the heart.
Although theirfinal place in heart disease remains to be seen, they promise to play anincreasingly important role. When medications are unsuccessful, or if there is concern about animpending or potential heart attack, coronary bypass surgery is highlysuccessful in reducing symptoms. Whether or not it prolongs survival isquestionable for most patients. Angina which is new or somehow different from previous episodes in anyway is termed unstable angina,is a medical emergency, and requiresurgent attention.
Research is active, and careful medical follow-up isimportant. mergency, and requires urgent attention. Research is active, andcareful medical follow-up is important.
