Angina Pectoris

Dr. Hassan Chamsi Pasha Dr. Fawaz Akhras

Coronary heart disease, the biggest killer in affluent countries, is also one of the most preventable causes of death, since dietary habits and smoking are major causes. Coronary heart disease affects the heart's own blood vessels, the "Coronary Arteries".

What are the Coronary Arteries?

The coronary arteries are the vessels which supply blood to the heart muscle itself. This supply is carried in the right and left coronary arteries, which are the first vessels to leave the aorta ( the body's main artery) as it emerges from the heart. Almost as soon as it branches off the aorta, the left coronary artery splits into two big branches so there are in effect, three coronary arteries: the right and the two branches of the left. They go on to completely encircle and penetrate the heart supplying blood to every part of it.

What is Angina?

Angina occurs when some part of the heart requires more oxygen than it can get from the blood reaching it through the coronary arteries. Narrowing of the coronary blood vessels prevent sufficient blood and oxygen getting to the heart muscle. This relative lack of blood produces the typical central chest pain of angina which spreads to the arms (usually the left arm) shoulders or neck. It is usually brought on by exertion or excitement and relieved with rest. It is often described as a sensation of pressure on the chest. Typically the pain develops at the same stage in daily activities, for example, at the same point on a flight of stairs. A prolonged and usually more severe attack of angina may be due to heart attack, therefore medical advice should be sought promptly

What are the causes of Angina?

The commonest cause is hardening and narrowing of the coronary arteries "atherosclerosis" which reduces their capacity to carry sudden increase in flow when the person is exercising or is under stress. Other causes of angina include:

1. Coronary artery spasm, in which sudden narrowing of the blood vessels occurs and lasts only for a short time but returns to normal with no permanent obstruction.

2. Aortic stenosis (narrowing of the aortic valve).

3. Abnormal heart rhythm.

Rare causes of angina include severe anemia and thyrotoxicosis.

How is the diagnosis of angina made?

Your doctor will ask for few tests including E.C.G. and exercise test. The E.C.G. performed at rest may be entirely normal, but may show evidence of previous damage.

He may also ask for blood tests to look for underlying cause such as anemia, thyrotoxicosis or hypercholesterolemia (high cholesterol in the blood). Coronary angiography (visualizing the coronary arteries by a special x-ray examination) may also be performed (for more details see the chapter on Cardiac Catheterization).

How is angina treated?

Attacks of angina can be treated with nitroglycerin tablets (G.T.N.) put under the tongue and allowed to dissolve. The pain usually settles within few minutes. If you have angina you are advised to carry these tablets in your pocket. Your doctor may prescribe "nitrate" tablets similar in action to the tablets you put under your tongue but have a longer duration of action. These tablets increase the flow of blood through the heart muscle and improve blood flow around the body. However, these tablets may cause headaches because they dilate the vessels of the brain as well. Other drugs which can be prescribed include beta blockers, calcium channel blockers and aspirin. If hypertension is also discovered during examination, drugs may be given to control high blood pressure. If your blood cholesterol is found high you will be advised to adhere to a low fat, low cholesterol diet. Drugs which reduce your cholesterol may have to be used later.

Do I need to change my lifestyle?

The answer is yes. If you are a smoker you should give up smoking immediately because nicotine and carbon monoxide contribute to further progression of coronary artery disease and make your symptoms worse. If you are overweight you should loose weight. You need to have a more healthy diet and undertake regular exercise.

I still have angina attacks despite taking my medication, doctor?

You have to realize that drug therapy can control the symptoms of angina but it does not cure the disorder. If you still get angina attacks despite drug treatment and if there is angiographic evidence of advanced narrowing of coronary arteries, coronary angioplasty (dilating the narrowing in the coronary artery with a balloon) or coronary artery bypass surgery may be performed to restore a good blood flow to the heart muscle. Fortunately modern treatment has made a considerable impact on angina in terms of preventing symptoms and improving survival.

What is unstable angina?

If your angina attacks become more severe, more frequent or more prolonged or occurring at rest with decreasing response to GTN tablets then you have what is called "unstable angina".

You need to seek a medical advice immediately with a view of admission into hospital to have further assessment and intensive treatment.

From the Book : “ Patient Guidelines to Heart Disease : Questions and Answers “

By Dr. Hassan Chamsi Pasha & Dr. Fawaz Akhras

Dar Almanara – Jeddah in 1999

Tel : 6603652