Angina pectoris, also known as Angina, a symptoms of Ischemic
heart disease, is defined as a condition of chest pain caused by poor
blood flow through the blood vessels due to obstruction or spasm of the
coronary arteries resulting of lack of blood that lead to
lack of oxygen supply and waste removal.
Types of Angina pectoris
1. Stable angina res
Stable angina is the chest pain occurred after physical activity or stress and may last up to 10 minutes
. the symptoms may improve or go away when stop or slow down the exercise.
2. Unstable angina
Unstable angina is a type of angina with chest pain occurs even at rest, with Crescendo
angina and/or new-onset
angina(1)
Symptoms
Beside chest pain or discomfort, patients with angina may also experience heaviness,
tightness, squeezing, burning, or choking sensation of the chest and
pain in the back, neck area, jaw, or shoulders. These are results of the
pain perceived at a location other than the chest depending to the
spinal level that receives visceral sensation.
Causes and risk factors
A. Causes
A.1. Stable angina
Physical exertion is the most common cause of stable angina as a result of severely
narrowed arteries of that interfere with the blood flow to the heart.
A.2. Unstable angina
Unstable angina is a condition of blood clots
causes of partially or totally block of an artery as a result of
rupture of an artery. If severe case, large blood clot can increase the
risk of cardiovascular diseases,
Blood clots may form, partially dissolve, and later form again. Angina can occur each time a clot blocks an artery.
B. Risk factors
1. Cigarette smoking
Men who are smokers are at higher risk to develop angina. According to
the study of Framingham Heart Study, posted by Harvard University,
indicated that those less than 60 years of age at
angina
onset who were nonsmokers or quitters during follow-up had a definite
prognostic advantage over similarly aged continuing smokers. These
results could not be explained by differences in coronary risk factors
prior to symptom onset or by changes in factors other than
smoking during follow-up. The findings suggest that stopping the
cigarette smoking habit can improve both short-term and long-term prognosis in the younger patient and
angina pectoris(2).
2. Obesity
in the study to evaluate the effects of moderate
weight loss, in overweight patients with
angina,
on plasma coagulation, fibrinolytic indicies and pain frequency, at the
University of Glasgow, researchers found that after the 12-week dietary
intervention period, mean
body weight fell by 3.5 (s.d. 2.6) kg or 4.3% (P=0.0001), range -11.7 to +1.7 kg. Mean
angina
frequency fell by 1.8 (s.d. 3.6) from 3.2 to 1.4 episodes/week
(P=0.009) and plasma cholesterol by 0.4 (s.d. 0.7) from 6.3 to 5.9
mmol/l (P=0.0001). HDL cholesterol and triglyceride were unchanged. Of
the coagulation and fibrinolytic factors, factor VII activity and RCA
were significantly reduced by 5 (s.d. 20), IU/dl (P=0.04) and 1.3 (s.d.
1.3) arbitrary units (P=0.014), respectively(3).
3. Diabetes
In the study of nineteen diabetic and 25 nondiabetic patients with exertional
angina
were exercised on a treadmill to measure anginal perceptual threshold,
researchers at the Newham General Hospital found that the diabetic group
had a longer anginal perceptual threshold (138 +/- 64
seconds vs 34 +/- 51 seconds, p less than 0.001), which correlated
positively with the somatic pain threshold (r = 0.5, p = 0.03); patients
with more prolonged anginal perceptual thresholds tended to have higher
somatic pain thresholds. In the diabetic group anginal perceptual (r =
-0.3, p = NS) and somatic pain (r = -0.4, p = 0.05) thresholds tended to
increase as the ratio of peak to minimal heart rate during the Valsalva
maneuver fell below 1.21, but these variables were unrelated in the
nondiabetic group(4).
4. High cholesterol
According to the study of The Heart Center of Chonnam National University Hospita of 34 stable
angina pectoris (SAP) patients showed that these patients had unstable plaques (UPs) (61.6±9.2 years, 24 males, 12.8%).
The percentage of plaque area in the minimum luminal area in high low
density lipoprotein-
cholesterol (LDL-C)/high density lipoprotein-
cholesterol
(HDL-C) ratio patients was significantly higher than in low LDL-C/HDL-C
ratio patients (72.7±9.5% vs. 69.9±9.3%, p=0.035). An LDL-C/HDL-C ratio
>2.0 was an independent predictor for UPs in SAP patients (odds
ratio 5.252, 95% confidence interval 1.132-24.372, p=0.034)(5).
5. High blood pressure
Hypertension is associated to increased risk of Angina pectoris. In the study ofManagement of patients with
hypertension and
angina pectoris, reserachers showed that
in managing the patient with
hypertension and
angina pectoris, it is important to determine whether the
angina occurs in the setting of hypertensive hypertrophic disease alone or coexists with coronary arterial stenoses(6).
6. Sedentary lifestyle and Unhealthy diet
Lifestyle with no or irregular physical activity is
associated with increased risk of Angina pectoris. Diet high in
saturated and trans fat with less fruits and vegetables enhances the
building up of blood cholesterol of that increase the risk of angina.
7. Family history of early heart disease
If you have a family history of early heart disease, you are at higher
risk to develop angina pectoris as family history of premature coronary
artery disease increase the risk of
an imbalance between myocardial oxygen supply and demand that may result of angina.
8. Coronary artery disease
Coronary artery disease can cause decreased blood flow to the coronary
arteries from the heart as a result of narrowing of the small blood
vessels that supply blood and oxygen to the
heart.
9. Other heart diseases
Increased blood flow for patients with preexisting ischemic heart
disease may reduced the risk of angina pertoris, according to the study
of Efficacy of early invasive strategy of diagnostics and treatment of
unstable
angina at the background of
preexisting ischemic heart disease, indicated that detection of
indications for myocardial revascularization in patients with unstable
angina
including those at medium and low risk confirms necessity of
application of early invasive strategy as conventional strategy ensuring
timeliness of pathogenetic treatment. Absence of indications to
myocardial revascularization in a limited group of patients gives an
opportunity to clarify
diagnosis, prescribe drug therapy and prevent unjustified hospitalizations(7)
10. Previous heart attack
Heart attack victims may experience a diversity of symptoms, including
chest pain, heaviness, tightness, squeezing, burning, or choking
sensation of the chest and pain in the back, neck area, jaw, or
shoulders.
11. Age and lower socioeconomic status
According to the study of Dr. Sekhri N, and the research team at the
Barts and the London NHS Trust, here is evidence of underutilisation of
chest pain
clinics by older people and those from lower socioeconomic status. More
robust and patient focused administrative pathways need to be developed
to detect inequity, correction of which has the potential to
substantially reduce coronary mortality(8).
12. Etc.
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Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/7785791
(2) http://www.ncbi.nlm.nih.gov/pubmed/7058782
(3) http://www.ncbi.nlm.nih.gov/pubmed/12373626
(4) http://www.ncbi.nlm.nih.gov/pubmed/2035379
(5) http://www.ncbi.nlm.nih.gov/pubmed/22563337
(6) http://www.ncbi.nlm.nih.gov/pubmed/6148886
(7) http://www.ncbi.nlm.nih.gov/pubmed/22839708
(8) http://www.ncbi.nlm.nih.gov/pubmed/22700834
