Angina pectoris

Angina pectoris is a heart disease that occurs due to lack of sufficient blood supply to the heart muscle and manifests as chest pain. It must be differentiated from the one that also causes pain in the chest but in which there is necrosis (death) of the heart muscle. Currently both diseases are part of what is known as acute coronary syndrome.

Symptoms of angina pectoris

The key symptom in angina pectoris is the appearance of pain of varying intensity in the center of the chest and / or in the left arm, which can also spread to the neck and jaw. These episodes generally last only a few minutes, and the pain is described as "a weight or tightness." Other symptoms may appear such as nausea and malaise, pain in the pit of the stomach, feeling short of breath, sweating, dizziness and palpitations.

In the event that these symptoms appear for the first time, urgent medical attention must be sought.

In patients with a known diagnosis of angina pectoris, if the pain lasts over time and does not subside with rest and the usual medication, it must be suspected that they are suffering from a myocardial infarction.

Types of angina pectoris

exist two types of angina They are classified based on their behavior.

• In stable angina symptoms appear predictablyIt usually occurs with activity or stress, lasts less than five minutes, and is relieved by rest or medication. It's the most frequent form.
• In unstable angina symptoms are unpredictableIt can appear with rest, usually causes more pain, lasts longer and is not relieved by rest and medication in many cases. This type is usually more serious since it can precede a heart attack.

Causes

The heart is nourished by a series of arteries called coronary arteries which supply the heart muscle and allow it to exert its function as a heart pump, contracting and relaxing. When there is a increased oxygen demands of the heart and the coronary arteries cannot provide sufficient flow, there is a decrease in blood supply, which is known as ischemia and which gives rise to the symptoms of angina (chest pain).

The most common cause of angina pectoris is. It is a slowly evolving disease in which there is a progressive narrowing of the artery walls due to an accumulation of lipids (fats) and inflammatory cells (lymphocytes) forming plaques. Angina usually occurs when the heart has a greater need for oxygen-rich blood and due to the narrowing of the arteries, no more blood flow can get through.

Other causes They include: injuries, trauma or inflammation of the arteries, infections, drug use (cocaine) and drugs.

Both in angina pectoris and in a heart attack, the mechanism is the same (ischemia or inadequate feeding of the heart muscle), but differ in the duration of the phenomenon. Myocardial infarction is the total and permanent cessation of blood supply to an area, which causes necrosis in that area (equivalent to a field that does not receive water, dries out) and is caused by a sudden and complete coronary obstruction . Angina pectoris, on the other hand, is a temporary phenomenon, that is, the decrease in blood flow to the diseased area, due to the inability of the narrowed arteries to give the heart enough food when it needs more (effort, etc.) occurs only for a time (a few minutes) and then recovers

Diagnosis

The diagnosis is based mainly on the symptoms presented by the patient and in a series of tests that allow to confirm it.

• Conducting a electrocardiogram it is essential in all patients presenting with symptoms suggestive of angina pectoris or myocardial infarction.
• A chest x-ray to see if there is fluid in the lungs due to failure of the heart.
• One of the most widely used and useful tests is the Patient walks on a treadmill or pedals on a bicycle while taking an electrocardiogram to detect if blood flow to the heart decreases during exercise.
• In those patients who present some physical limitation and cannot perform the stress test, the drug stress tests (dobutamine) or radioisotopes in which the heart is stimulated and it is measured if there are areas with poor blood flow.
• Coronary arteriography (or coronary angiography) is the most accurate diagnostic test as it allows viewing of the coronary arteries and locating the obstruction. It is indicated in patients with severe angina and when the above tests are not sufficient for diagnosis. A catheter is inserted through the arm or groin into the heart, through which a contrast medium is injected. Using an X-ray machine, the map of the arterial circulation can be seen.

Treatment of angina pectoris

Pharmacological treatment will depend on the symptoms, however, there are a series of measures beyond medication. Sometimes it is necessary to resort to surgical treatment in some patients.

Non-pharmacological measures

In any patient with angina, it is essential to treatment of risk factors cardiovascular:

• Abandonment of tobacco.
• Control of diabetes and, if necessary with drugs.
• Follow one healthy diet low in cholesterol and fats. If necessary, drugs to lower cholesterol will be indicated.
• Achieve an ideal body weight if it exists overweight.
• Establish a program of physical exercise appropriate to the patient's capacity.
• Avoid the stress.

Pharmacotherapy

Medical treatment of angina pectoris It includes the use of drugs to increase coronary blood supply and facilitate cardiac work, such as beta-blockers, nitroglycerin or calcium antagonists; a treatment to prevent and reduce the formation of blood clots: antiaggregants (acetylsalicylic acid and clopidogrel) and general measures to relieve symptoms during the acute episode: morphine for pain, oxygen and tranquilizers.

Coronary revascularization

Some patients are candidates for coronary artery bypass grafting that consists of restore blood flow through the blocked artery. It can be done by angioplasty or surgery (bypass).

• Coronary angioplasty. A catheter is inserted into the area of ​​the coronary artery that is narrowed and dilated with a small balloon. To keep the artery open, a small metal device called a stent is placed inside it. It cannot always be done. It is indicated in those patients with severe angina that does not improve with medical treatment or at high risk of suffering a myocardial infarction.
• Bypass surgery treatment. A surgery is performed on the coronary arteries that allows to implant a piece of vein of oneself (generally the saphenous vein of the calf) and implant it in the coronary arteries bypassing the obstructed area. It is carried out in patients in whom angioplasty is not possible.

Prevention

The precautionary measures They include avoiding well-known risk factors: quitting tobacco, eating a healthy diet, losing weight if overweight, and controlling blood pressure, cholesterol, and diabetes.