What is Angina Pectoris?
Angina, or put more correctly angina pectoris is a medical condition caused by a temporary lack of oxygen in the heart (myocardial) tissue with an accumulation of carbon dioxide and lactic acid (both waste products). Angina occurs during a period of increased oxygen demand when the heart is working hard.
Angina occurs due to Atherosclerosis. Atherosclerosis is a disease in which plaques that are made up of fat, cholesterol, calcium and other substances, build up in the coronary artery walls. Over time, the plaques harden, narrow the opening of the arteries and restrict the blood flow. When these fatty plaques rupture (break open), they form a thrombus (blood clot) that can further limit, or even block the flow of oxygen-rich blood to the heart and other parts of the body.
Angina can be brought on by physical activity or emotional distress. It often comes on when walking or after eating. Sometimes attacks of angina happen while the person is resting or it may even wake them from their sleep.
Angina is usually described as an uncomfortable feeling or pain in the chest, which usually feels like a heaviness or tightness in the centre of the chest which may spread to the arms, neck, jaw, back or stomach. The pain may be described as a dull persistent ache.
Symptoms usually fade within about 10 to 15 minutes. For some people the tightness is severe; for others it is not much more than mild discomfort
There are 2 main types of angina – stable and unstable.
Unstable angina is an emergency condition requiring urgent treatment as this can indicate a heart attack (Myocardial Infarction) is about to occur.
Stable Angina follows a recurrent pattern and is caused by exertion or emotion. It gives pain of similar intensity, duration and location and most attacks are relieved by rest within 2-3 minutes. The patient may be prescribed a spray to help with synptoms (GTN).
More serious condition, indicating an increasing obstruction of the coronary arteries. It is unpredictable and changes in frequency, intensity and duration of pain. It can occur at rest and even wake the patient from sleep. GTN is not always effective.
Unstable angina can often precede a heart attack (myocardial infarction)
Clinical features of Angina
- Pain behind the breastbone and spreading across the chest
- Pain referred to the throat, jaw and teeth also to the armpits and down into the arm
- Frequently described as a heaviness in the arms or chest
- Pale and sweaty skin
- Usually relieved by rest and GTN
- The most significant clinical feature is the relationship to exertion, stress etc.