ANGINA PECTORIS

Angina is chest pain or discomfort caused when your heart

muscle doesn't get enough oxygen-rich blood. It may feel
like pressure or squeezing in your chest. The discomfort
also can occur in your shoulders, arms, neck, jaw, or back.
Angina pain may even feel like indigestion.
But, angina is not a disease. It is a symptom of an
underlying
heart
problem,
usually
coronary heart disease (CHD).There are many types of
angina,
includingmicrovascular
angina,
Prinzmetal's
angina,stable angina, unstable angina and variant angina

Types of Angina - Knowing the types of angina and how

they differ is important.
Stable Angina / Angina Pectoris
Unstable Angina
Variant (Prinzmetal) Angina
Microvascular Angina

Risk for Angina

If youre at risk for heart disease or coronary MVD, youre also at risk for angina. The major
risk factors for heart disease and coronary MVD include:
Unhealthy cholesterol levels
High blood pressure
Smoking
Diabetes
Overweight or obesity
Metabolic syndrome
Inactivity
Unhealthy diet
Older age (The risk increases for men after 45 years of age and for women after 55 years
of age.)
Family history of early heart disease

STABLE AP
Symptoms of Stable Angina
The pain or discomfort:
Occurs when the heart must work harder, usually during physical exertion
Doesn't come as a surprise, and episodes of pain tend to be alike
Usually lasts a short time (5 minutes or less)
Is relieved by rest or medicine
May feel like gas or indigestion
May feel like chest pain that spreads to the arms, back, or other areas
Possible triggers of stable angina include:
Emotional stressExposure to very hot or cold temperatures
Heavy meals
Smoking

STABLE AP
Treatment ofAngina Pectoris
People with angina pectoris or sometimes referred to as
stable angina have episodes of chest pain.The
discomfort that are usually predictable and manageable.
You might experience it while running or if youre dealing
with stress.
Normally this type of chest discomfort is relieved with
rest, nitroglycerin or both. Nitroglycerin relaxes the
coronary arteries and other blood vessels, reducing the
amount of blood that returns to the heart and easing the
heart's workload. By relaxing the coronary arteries, it

UNSTABLE AP
unstable angina or sometimes referred to as
acute coronary syndrome causes unexpected chest pain,
and usually occurs while resting. The most common
cause is reduced blood flow to the heart muscle because
the coronary arteries are narrowed by fatty buildups (
atherosclerosis) which can rupture causing injury to the
coronary blood vessel resulting in blood clotting which
blocks the flow of blood to the heart muscle.

UNSTABLE AP
Causes of Unstable Angina:
Blood clots that block an artery partially or totally are what causes unstable angina.
Blood clots may form, partially dissolve, and later form again and angina can occur
each time a clot blocks blood flow in an artery. Learn more about
excessive blood clotting.
Symptoms of Unstable Angina
The pain or discomfort:
Often occurs while you may be resting, sleeping, or with little physical exertion
Comes as a surprise
May last longer than stable angina
Rest or medicine usually do not help relieve it
May get worse over time
Can lead to a heart attack

Treatment for Unstable Angina

First, your healthcare provider will need to find the blocked part or parts of the
coronary arteries by performing a cardiac catheterization. In this procedure, a
catheter is guided through an artery in the arm or leg and into the coronary arteries,
then injected with a liquid dye through the catheter. High-speed X-ray movies
record the course of the dye as it flows through the arteries, and doctors can
identify blockages by tracing the flow. An evaluation of how well your heart is
working also can be done during cardiac catheterization.
Next, based on the extent of the coronary artery blockage(s) your doctor will discuss
with you the following treatment options:
Percutaneous coronary intervention (PCI) may be required to open a blocked
coronary artery. Briefly, this procedure involves undergoing cardiac catheterization
followed by using a catheter with a small inflatable balloon at the tip. The balloon
is inflated, squeezing open the fatty plaque deposit located on the inner lining of
the coronary artery. Then the balloon is deflated and the catheter is withdrawn.
This procedure is often followed by insertion of a stent to then keep the coronary
artery vessel propped open to allow for improved blood flow to the heart muscle.
Coronary artery bypass graft surgerymay be indicated depending on the
extent of coronary artery blockages and medical history. In this procedure, a blood
vessel is used to route blood around the blocked part of the artery, forming a kind
of detour.

Angioplasty (also called

percutaneous coronary intervention
or PCI) opens blocked arteries and
restores normal blood flow to your
heart muscle. It is done through a
small puncture in a leg or arm
artery and opens a clogged heart
artery by inflating a tiny balloon in
it. It is often combined with
implantation of a stent to help prop
the artery open and decrease the
chance of another blockage.

Coronary Artery Bypass

Graft Surgery (CABG) treats
blocked heart arteries by
creating new passages for
blood to flow to your heart
muscle. It works by taking
arteries or veins from other
parts of your body - called
grafts - and using them to
reroute the blood around the
clogged artery

PRINZMETAL ANGINA
Unlike typical angina which is often triggered by
exertion or emotional stress - Prinzmetals angina
almost always occurs when a person is at rest, usually
between midnight and early morning. These attacks can
be very painful.
Prinzmetalangina may also be referred to as:
Variant angina
Prinzmetal's variant angina
Angina inversa

Causes of Variant (Prinzmetal) Angina:

The pain from variant angina is caused by a spasm in the coronary arteries (which supply
blood to the heart muscle).
The coronary arteries can spasm as a result of:
Exposure to cold weather
Stress
Medicines that tighten or narrow blood vessels
Smoking
Cocaine use
Symptoms of Variant (Prinzmetal) Angina:
The pain or discomfort: Usually occurs while resting and during the night or early
morning hours
Are usually severe
Can be relieved by taking medication
Treatment of Variant Angina| Prinzmetal's Angina
Medicines can help control the spasms. Drugs such as calcium antagonists and nitrates
are the mainstays of treatment.

MICROVASCULAR ANGINA
This type of angina, or chest pain,may be a symptom of coronary microvascular disease (MVD).
Coronary MVD is heart disease that affects the hearts smallest coronary artery blood vessels.
Causes of microvascular angina:
Spasms within the walls of these very small arterial blood vessels causes reduced blood flow to the
heart muscle leading to a type of chest pain referred to as microvascular angina.
Symptoms of microvascular angina:
Angina that occurs in coronary MVD may differ from the typical angina that occurs in heart disease in
that the chest pain usually lasts longer than 10 minutes, and it can last longer than 30 minutes. If you
have been diagnosed with MVD, follow the directions from your healthcare provider regarding how to
treat your symptoms and when to seek emergency assistance.
The pain or discomfort:
May be more severe and last longer than other types of angina pain
May occur with shortness of breath, sleep problems, fatigue, and lack of energy
Often is first noticed during routine daily activities and times of mental stress