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Angina Pectoris

(A failing Heart and Your Sexual Health)
Angina pectoris which is often referred to as angina, are terms derived from two Latin words "angere" meaning "to strangle" and "pectus" meaning "chest". Therefore, the terms angina pectoris means " a strangling sensation or feeling in the chest".

In present day,  angina pectoris means a suffocating pain or discomfort which is felt in the chest. It is typically described as a squeezing pressure, heaviness, tightness, pain or fullness in the chest. Angina pectoris is caused by the narrowing and hardening of the blood vessels going to the heart, thereby reducing the blood  flow and consequently causing insufficient supply of oxygen to the heart muscles and the heart itself (which results to a short or a temporary lack of oxygen-reach blood to the heart).

This decrease in blood flow can happen for a number of reasons, but the most common reason is coronary heart disease (CHD). For those with certain prevailing conditions, it often occurs with exertion. Angina pectoris can be a recurring problem, and/ or an acute health concern. In some instance, it is a major cause of sudden death. Angina is relatively common, but in some instances it can be hard to distinguish it from other types of chest pain such as indigestion pain.

The pain of angina is as old as man himself. William Harvey, a pioneer of modern medicine referred to it as "an oppression in the breast". This pain usually begins near the heart and stomach, but it may spread or travel: to the neck, jaw, back, arms, shoulders, and abdomen. Most commonly, an attack is triggered by smoking, eating, exertion, anxiety, or exposure to cold. These triggering factors are known to increase the heart's need for oxygen.

            Classification of Angina

There are basically two main types of angina:
  • Stable, and
  • Unstable angina.

Stable angina

This type of angina is also known as "effort" angina. It is the most common type of angina and occurs typically with exertion. It has a clear predictable pattern of chest pain. It's cause is. primarily as a result of myocardial ischaemia. In most cases, it appears to be triggered by physical activities, or emotional stress.

              Characteristics of Stable Angina

The characteristics of stable angina are;
  • It develops when your heart is over worked, as in physical exertion,
  • Pain lasting between 5 -15 minutes,
  • Pain that is relieved by angina medication or by adequate rest,
  • Pains that may feel like gas or indigestion,
  • Intermittent claudication, etc. 
Stable angina is not life-threatening as it is, but is a more serious sign that you have a higher risk of experiencing a more serious conditions such as heart attack or stroke. It could also be triggered by cold weather, heavy meal, anxiety, etc.

Unstable Angina 

In this type of angina, the angina pains typically starts suddenly even during resting and may last for more than 15 minutes. Unstable angina is unpredictable since its occurrence is erratic and seems to get worse with time. It may or might eventually lead to heart attack. This type of angina is also called "crescendo" angina.

Unstable angina develops without any obvious trigger. It's occurrence is sudden, it can start when you are at rest, or sleeping. It may be a serious indication of an impending heart attack.


Characteristics of Unstable Angina

Some of the characteristics specific to unstable angina are;
  • Last for over 15 minutes and it's even more severe,
  • Comes as a surprise,
  • Occur while at rest, or even sleeping,
  • It may get worse over time,
  • Might signal or be a signal to a heart attack,
  • It occurs with a crescendo pattern (basically more severe, prolonged and frequent than ever),
  • May not go away with rest or even with certain medications,
  • Starts without a trigger, etc. 
Unstable angina could be life threatening, for it starts with atherosclerosis, progresses through inflammation to yield an active unstable angina. This atherosclerosis which is cause basically by the deposition of atheroma (fats) on the inner lining of the arteries leads to myocardial ischaemia, which if not treated or reverse almost immediately leads to mycardial infarction and/ or tissue necrosis.

Variant Angina 

This is also known as "prinzmetal's" angina. It is a rare form of angina that usually happens at night while resting or sleeping. The coronary arteries of the heart suddenly tightens or constricts as a result of muscular spasm, it sure can cause a lot of pain.

           Characteristics of Variant Angina

Some of the characteristics that are specific to angina are;
  • Causes a lot of pain,
  • Usually occur at night while resting or sleeping,
  • It's often severe,
  • Normally relieved by  taking angina medications, etc.
In variant angina, the sudden and temporary constrictions or narrowing of the coronary arteries reduces the flow of blood to the heart, hence the angina crisis. This, like all other angina could be triggered by a number of factors such as anixiety, emotional stress, allergies, etc.

Microvascular angina

This type of angina is also known as "cardiac syndrome x" angina, and is consistent with chest pain. This type of angina is also triggered by myocardial ischaemia as a result of exertion, anxiety, etc.

However, in Microvascular angina there are no noticeable narrowing, constriction or hardening of the coronary arteries, which makes it somehow difficult to identify the cause.

 Characteristics of Microvascular Angina

Some of the characteristics that are specific to Microvascular angina are;
  • It causes lots of pain and discomfort,
  • May be the most severe,
  • It's duration may be longer than all the other types of angina,
  • Crisis is followed by shortens of breath,
  • May show symptoms of sleep problems (insomnia), fatigue and lethargy,
  • It is triggered by exertion, anixiety, stress, etc.

Causes of Angina Pectoris

Angina which is a squeezing, suffocating or strangulating chest pain or discomfort of the chest is caused primarily by myocardial ischaemia. The coronary arteries suddenly becomes thickens and narrowed or constricts, as a result it reduces the flow of blood to the heart muscles and to the heart at large. This deprivation of oxygen cause or leads to the angina pain. The nature and patterns of the angina pain is very important, as any changes in them might indicate subtle progression from previous stable angina to a more severe and unstable angina, with increased risk of developing heart attack or stroke.

But troubled or narrowed arteries are not the only cause of angina pectoris. Sometimes, it strikes even when these important blood vessels are in good shape. Research shows that, the problem sometimes proves to be too much thyroid hormones in the blood, severe anaemia, syphilis, or a disease of the heart itself, instead of its arteries.

Risk factors are any thing or conditions that increases a persons prospect of developing a disease. Or  risk factors are anything that increases a person’s chances of developing or getting a disease. It is important to note that having a risk factor does not necessarily mean that he/ she will develop the disease. This is because risk factors does not cause the disease, rather they help or promote the possibilities of getting or contracting it. Sometimes, people who do not have risk factors still develop it. Generally, the more risk factors a person have, the higher the tendency for him/ her to develop or contract the disease or condition. There are a number of angina specific risk factors, which are;
  • Tobacco use or cigarettes smoking,
  • High blood pressure,
  • Diabetes,
  • High blood cholesterol level,
  • Age,
  • Medications (such as vasoconstrictors),
  • Gender,
  • Sedentery lifestyle,
  • Obesity,
  • Stress,
  • History of heart disease,
  • Genetics/ Family history, etc. 
There are a number of signs and symptoms of angina, some of the most common once are;
  • Chest pain or discomfort,
  • Breathlessness,
  • Nausea,
  • Vomiting,
  • Dizziness,
  • Restlessness,
  • Fatigue and/ or tiredness,
  • Sweating,
  • Pain in the jaw, arms, shoulder, upper abdomen, etc.
  • Apprehensiveness,
  • Light headedness (sometimes blackout may occur),
  • Burning or Choking sensation, etc.

Treatment 

Angina attacks can be both painful and frightening, but there is a bright side. More importantly, for some of us, angina is a signal that warms us of underlying trouble before a more worse fate: stroke or heart attack. The angina treatments and management methods are;

Change of lifestyle

Changing of lifestyle is one of the most important step to effective treatment and management of angina. Below are some routine that should be followed,
  1. Needless to say, take care to get enough rest, avoid stress as much as possible,
  2. Quit smoking and the use of tobacco,
  3. Keep warm,
  4. Carefully start regular exercise,
  5. Control your obesity,
  6. Control your diabetes,
  7. Control your high blood pressure,
  8. Control your blood cholesterol levels,
  9. Quit alcohol,
  10. Talk to your doctor about your options, etc.
A healthy and a balanced diet keep you physically fit, thus changing your diet helps in the management of angina, so;
  1. Eat healthy and balanced diets,
  2. Avoid large meals,
  3. As much as possible, avoid diets containing large amount of striated fats,
  4. Eat healthy diets of whole grains, fruits and vegetables,
  5. Eat more of beans and oat bran as much as possible,
  6. Eat plenty of banana, Apple and pineapple as much as possible,
  7. Eat plenty of broccoli as much as possible, etc.

  Medications

Angina is often treated with medications, some medications for angina are;
  1. Nitroglycerine, a potent vasodilator which is an effective pain relieve for angina,
  2. Glyceryl trinitrate spray, a droplets sprayed into the mouth get absorbed quickly into blood stream and provides immediate relief,
  3. Aspirin, a drug that reduces the ability of your blood to clot, thereby relieving and controlling angina,
  4. Statrins, drugs that are used to reduce your blood cholesterol levels,
  5. Beta blockers, drugs used to relax and dilates your blood vessels, thereby reducing blood pressure,
  6. Talk to your doctor about your options, etc.

  Surgery 

Where the above stated treatment methods or angina management plans like lifestyle changes, dieting and/ or medications are not giving expected results, the last option is surgery such as;
  1. Angioplasty and stent placement, or
  2. Coronary artery bypass.

See a doctor

If you have and/ or experiencing some of the symptoms and risk factors stated above, if your chest pain is becoming frequent with exertion and lasts for few seconds to about 5 minutes and seems not to go away even when you have rested or sometimes relief you only with adequate rest. Dear, it could be...
 "THIS" 
Call Your Doctor...! 
Make an appointment with your doctor and get evaluated for proper treatment. If the chest pain is sudden and persistent, please call your local emergency service.

References

  1. Papadakis M. A, ed., et al. Current Medical Diagnosis & Treatment 2014. 53rd ed. New York, N.Y.: The McGraw-Hill Companies; 2014. http://accessmedicine.mhmedical.com/book.aspx?bookId=330. Accessed Nov. 18, 20.
  2. Mayo clinic online; http://www.mayoclinic.org/diseases-conditions/angina/basics/risk-factors/con-20031194?p=1
  3. Stock E. O, et al. Cardiovascular disease in women. Current Problems in Cardiology. 2012;37:450.
  4. Thomas, Michel. "Treatment of Myocardial Ischemia". In Brunton, Laurence L.; Lazo, John S.; Parker, Keith L. Goodman & Gilman's The Pharmacological Basis of Therapeutic (11th ed.). p. 823. ISBN 0071422803.
  5. First Global Health Care Channel; http://www.medibiztv.com/articles/angina-pectoris-symptoms.
  6. Shinozaki, Norihiko; Yuasa, Toyoshi; Takata, Shigeo (2008). "Cigarette Smoking Augments Sympathetic Nerve Activity in Patients with Coronary Heart Disease". International Heart Journal. 49 (3): 261–72.
  7. Kusumoto, Fred M. "Chapter 10: Cardiovascular Disorders: Heart Disease". In McPhee, SJ; Hammer, GD. Pathophysiology of Disease: An Introduction to Clinical Medicine (6th ed.). p. 276. ISBN 978-0-07-162167-0.
  8. Guyton and Hall. "Textbook of Medical Physiology" 11th edition. Philadelphia; Elsevier, 2006.
  9. Patricia H. and Judith Benn H., (1989), The Healing Foods; The Ultimate Authority on the Curative Power of Nutrition. New York, Dell Publishing. ISBN 0-440-21440-8.
  10. Wikipedia: https://en.wikipedia.org/wiki/Angina, Retrieved 22nd September, 2017.


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