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Angina

Overview

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Angina is a type of chest pain or discomfort that occurs when the heart muscle doesn't get enough oxygen-rich blood. It’s often a symptom of coronary artery disease (CAD) and can be a warning sign of a potential heart attack.

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Symptoms
  • Chest Pain or Discomfort: Often described as pressure, squeezing, or a feeling of fullness in the chest.
  • Radiating Pain: Pain may spread to the shoulders, neck, arms, back, teeth, or jaw.
  • Shortness of Breath: This may occur with or without chest discomfort.
  • Nausea or Fatigue: Some people may also experience sweating or dizziness.

Types of Angina

  • Stable Angina: Predictable and occurs during physical exertion or stress; usually relieved by rest or medication.
  • Unstable Angina: Unpredictable and can occur at rest; may signal a heart attack.
  • Variant Angina (Prinzmetal's Angina): Caused by spasms in the coronary arteries, often occurring at rest.
Complications
  • Attack: Prolonged angina can lead to a heart attack.
  • Arrhythmias: Irregular heartbeats can occur as the heart muscle struggles for oxygen.
  • Failure: Over time, ongoing angina can weaken the heart muscle.
Causes
  • Artery Disease (CAD): The most common cause, where arteries become narrowed by plaque.
  • Spasms in Coronary Arteries: Can restrict blood flow temporarily.
  • Other Factors: High blood pressure, high cholesterol, diabetes, and lifestyle choices (like smoking and a sedentary lifestyle).
Prevention
  • Healthy Diet: Focus on fruits, vegetables, whole grains, and lean proteins.
  • Regular Exercise: Aim for at least 150 minutes of moderate aerobic activity each week.
  • Avoid Smoking: Quitting smoking dramatically reduces heart disease risk.
  • Maintain a Healthy Weight: Helps manage blood pressure and cholesterol levels.
  • Regular Check-ups: Monitoring blood pressure, cholesterol, and diabetes can help catch issues early.
Risk Factors
  • Age: Risk increases with age.
  • Family History: A family history of heart disease increases risk.
  • Smoking: Significantly raises the risk of developing heart disease.
  • High Blood Pressure and Cholesterol: These contribute to arterial damage.
  • Diabetes: Increases the risk of CAD.
  • Obesity: Linked to heart disease and other risk factors.
  • Sedentary Lifestyle: Lack of physical activity contributes to heart disease.
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How is it treated?

Lifestyle Changes: Diet, exercise, and smoking cessation.

Medications

  • Nitrates: To relieve angina symptoms.
  • Beta-Blockers: To reduce heart workload.
  • Calcium Channel Blockers: To relax coronary arteries.
  • Antiplatelet Agents: To prevent blood clots.

Medical Procedures

  • Angioplasty and Stenting: To open narrowed arteries.
  • Coronary Artery Bypass Grafting (CABG): For severe cases.

Conclusion

  • Angina is a significant health concern that requires attention. Early intervention, lifestyle changes, and appropriate medical treatment can help manage symptoms and reduce the risk of serious complications. If you experience symptoms of angina, consult a healthcare professional for evaluation and treatment options.
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How is it Diagnosed?

Angina, characterized by chest pain due to reduced blood flow to the heart muscle, is primarily diagnosed through clinical history, physical examination, and diagnostic testing.

The history includes details about the chest pain—its nature (tightness, pressure), location (often behind the breastbone), duration, triggers (exertion, stress), and relief with rest or nitroglycerin. Associated symptoms like shortness of breath, nausea, or sweating are also considered.

A physical examination may be normal in stable angina but helps rule out other causes of chest pain.

    Initial diagnostic tests include:

  • Electrocardiogram (ECG): Identifies ST changes, arrhythmias, or signs of prior myocardial infarction.
  • Cardiac biomarkers (troponin levels): Used mainly to differentiate angina from myocardial infarction in acute cases.
  • Chest X-ray: Helps assess cardiac silhouette and rule out pulmonary causes.
  • Echocardiogram: Assesses heart function and regional wall motion abnormalities.
  • Stress testing (exercise treadmill test or pharmacological): Evaluates for inducible ischemia.
  • Coronary angiography is the gold standard for diagnosing coronary artery disease. It visualizes blockages in the coronary arteries and is used when non-invasive tests are inconclusive or in high-risk patients.
  • Other tests may include CT coronary angiography or myocardial perfusion imaging, depending on availability and clinical suspicion.
  • A comprehensive approach combining clinical features with investigative findings ensures accurate diagnosis and appropriate management of angina.

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