Angina

When blood supply to the heart and its muscles is slowed down due to a partial blockage of blood flow  (due to fatty deposits  and/or small blood clots in heart arteries) and as a result the muscles of the heart does not pump the blood to meet the demands of the body.

• Stable angina refers to symptoms only upon exertion or effort.
• Unstable angina occurs at rest.

Two types of angina:

Stable Angina

The blood flow to their heart muscle is adequate (this does not mean it is ‘ok’, but means the heart is just about receiving enough blood) and meets the demands of the body.

(Symptoms tend to develop over time and predictable)

• One has symptoms when doing:
  • Physical activity
  • Emotional activity
  • Cold weather exposure
  • Eating a meal
  • Straining in toilet
• Symptoms last a few minutes  and may have no ‘chest pain’ and symptoms are relieved by Glycerin trinitrate medicine and can be a warning sign of heart attack and stroke.

Unstable Angina

The blood flow to the heart and its muscles is very low, leading to damage to the heart muscles (due to the muscles not receiving enough oxygen) and as result may not be able to the pump the blood to the rest of the body efficiently and meet the body’s demands.

• Symptoms develop rapidly, can occur with or without having stable angina and can occur unpredictability (even at rest).
• The pain can be more intense than stable angina and easily provoked.
• Symptoms can last 5 min – 30 minutes and treatment by glycerine trinitrate may not help
• Increased risk of heart attack and stroke.

Variant Angina

• Patients with variant angina typically report a pattern of chest pain at rest that lasts 5-15 minutes and is most often present from midnight until early morning.
• Short-acting nitrates are effective in decreasing pain.
• Exertion does not trigger the pain, and it is not relieved with rest as in patients with stable angina.
• Patients with variant angina are typically younger and do not typically have classic cardiovascular risk factors.

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Further points:

• Chest discomfort rather than frank pain.
• The former is usually described as pressure, heaviness, squeezing, burning, or a choking sensation.
• Typically, angina is precipitated by exertion, eating, exposure to cold, or emotional stress.
• Chest pain lasting only a few seconds is not usually angina pectoris.
• The intensity of angina does not change with respiration, cough, or change in position.
• Anginal pain may be primarily localised in the epigastrium (stomach), back, neck, jaw, or shoulders.
• Typical locations for radiation of pain are the arms, shoulders, and neck.

• The intensity of pain on a 1-10 scale does not correlate with diagnosis or prognosis.
• Older patients and female patients are more likely to have atypical signs and symptoms.
• A large area of myocardial jeopardy (risk of arteries blocked around the heart and those which supply blod to the heart) may manifest as signs of transient myocardial (heart) dysfunction and typically signifies a higher risk situation.
• Such signs include:
  • Systolic blood pressure < 100 mm Hg or overt hypotension (low blood pressure)
  • Elevated jugular venous pressure (blood vessel on ones neck)
  • Dyskinetic apex beat (Medical Doctor can tell with a stethescope)
  • Reverse splitting of the second heart sound (Medical Doctor can tell with a stethescope)
  • Presence of a third or fourth heart sound (Medical Doctor can tell with a stethescope)
  • New or worsening apical systolic murmur due to papillary muscle dysfunction (Medical Doctor can tell with a stethescope)
  • Rales or crackles (Medical Doctor can tell with a stethescope)

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