Angina Pain and Related Cardiovascular Problems

What is Angina Pain?  A condition often referred to as “angina pectoris” --refers to thoracic pain originating from a lack of oxygen to the heart muscle (ischemia)  Described by a feeling of discomfort or heavy pressure localized in the chest region

How it differs from a Heart Attack…  Angina pain is a short pain resulting from the muscle temporarily receiving insufficient amounts of oxygen vs. vs.  Myocardium infarction results in cardiac arrest and permanent damage to the heart muscle, results from a complete cut off of oxygen

Types of Angina 1.) Angina of Effort- A medical condition that often results from atherosclerosis - arteries can supply sufficient oxygen to resting heart but fail to do so during periods of exercise or stress resulting in a painful sensation - arteries can supply sufficient oxygen to resting heart but fail to do so during periods of exercise or stress resulting in a painful sensation 2.) Variant Angina- An uncommon condition that exists independently of atherosclerosis -arteries cannot supply enough oxygen to the resting heart; the condition does not result from excessive work by myocardium -arteries cannot supply enough oxygen to the resting heart; the condition does not result from excessive work by myocardium *can also occur as a result of eating (postprandial) and while sleeping (nocturnal)

Symptoms of Angina  Pain/heaviness under the sternum  Can be experienced elsewhere (back, arms, neck, shoulders, or jaw regions)  Breathlessness and Fatigue  Increased risk of heart attack

Causes of Angina  Excessive exercise and stress when coupled with atherosclerosis (effort)  Insufficient coronary arterial muscle spasms (variant)  The difference between demand and supply of blood/oxygen to myocardium ---5% of angina cases actually result from a predisposed heart demanding an abnormal amount of oxygen to function ---5% of angina cases actually result from a predisposed heart demanding an abnormal amount of oxygen to function *more common in the adult population as risk for coronary heart disease increases

Detection Methods  Physicians  Electrocardiogram –non-invasive (85% accurate)  Stress Tests  Angiograms –invasive (used in other 15% of cases)

Electrocardiogram  Electrocardiogram*- useful to confirm Angina pain and other abnormal features -must be coupled with some sort of stress test (before, during, and after)  Echocardiogam- associates symptoms and ECG levels during a 24 hour period (used with nocturnal angina) (used with nocturnal angina)

Angiogram  a virtual x-ray of coronary arteries  Image is derived by the placement of a catheter in a major coronary artery  Dye is injected to “see” the blood flow to the heart  *Most accurate and effective way to determine presence and severity of angina

Risk Factors  Cigarette Smoking (results in atheroma)  High cholesterol intake (results in atheroma)  Extreme temperatures  Emotional Stress  Alcohol Abuse  Heredity …ethnic predispositions/diabetes  Personality Type

Treatments  Often can be alleviated within minutes by relaxation/resting  Intake of prescribed angina medications often consisting of nitroglycerin (reduces ischemia)  Reduce risk factors through conventional treatments  Surgical procedures increase blood flow to the heart

Conventional Treatments  Exercise/yoga and even massage therapy have been said to alleviate painful effects  Behavioral counseling-reduce cholesterol, smoking, drinking, and obesity (i.e.- diet)  Nitroglycerin meds.- increases diameter of blood vessels (taken orally or transdermally)  Beta blockers- decrease demand and workload of myocardium

Surgical Treatments  Coronary Bypass Surgery- blood vessel from leg often grafted on the blocked artery, increasing blood flow  Balloon angioplasty- catheter with small balloon placed into coronary artery to expand blood vessel  Angioplasty and bypass surgery often followed by behavioral counseling to reduce risk factors like obesity

Final Thought *We must take preventative efforts to help reduce the presence of Coronary Artery Disease, as it is the underlying cause of angina pain *

Road Map  Coronary Heart Disease – What is it?  Risk Factors – Unavoidable – Treatable or changeable  Myocardial Infarctions – What is it? – Symptoms – Treatment options

What is Heart Disease?  Called Coronary Heart Disease or Coronary Artery Disease  Diagnosed when arteries that supply blood to heart muscle becomes hardened and narrowed – Caused by plaque on inner walls and called atherosclerosis – Eventually Heart suffers from lack of oxygen and causes  Angina  Heart Attack (Myocardial infarction)

Clogged arteries

Who can develop Heart Disease?  Unavoidable Risk Factors – Age – Sex – Heredity  Treatable Risk Factors – Smoking – High Blood Pressure – High Blood Cholesterol – Physical Activity – Obesity – Diabetes

Unavoidable Risk Factors  Increasing Age – Fact of life, everyone gets older. 83 % of people who die from Heart Disease is over 65  Being male – Have a greater risk and die younger  Heredity -- Children with parents suffering from Heart Disease; African Americans greater risk of High Blood Pressure and Heart Disease

Risk Factors that can be changed or treated  Smoking – Smokers have increased risk 2-4 times greater than non-smokers  High Blood Cholesterol – The greater amount of cholesterol greater increase risk of heart disease  High Blood Pressure – Greater the pressure, the harder the heart must work, causing heart to thicken and stiffer

Treatable Risk Factors (cont)  Physical Inactivity – inactive lifestyle increases risk of heart disease; regular moderate-to- vigorous physical activity helps prevent heart and blood vessel disease  Obesity and overweight – people with excess body fat are more likely to develop heart disease and strokes  Diabetes mellitus – Even when glucose levels are under control, there is still an increased risk, but risk is greater if left untreated

Predicting who will develop heart disease  Subjects: 2489 men and 2856 women 30 to 74 yrs. Old – Baseline reading – 12 years later  Subjects 383 men and 227 women developed heart disease  Those with heart disease were associated with high blood pressure, total cholesterol, LDL and HDL, sex,  Used prediction equation to predict likelihood of developing disease – Age, diabetes, smoking, blood pressure, total cholesterol, and LDL

Results And Discussion  28 % of male and 29 % female cases attributed to blood pressure levels that exceeded normal high130/85  27 % of male and 34 % female cases attributed to high total cholesterol (greater than 200 mg/dL)  Study confirmed the medical guidelines for blood pressure, total Cholesterol, and LDL as accurate for predicting risk of middle-aged white population

Myocardial Infarctions  Also known as an MI or heart attack  Happens when the blood supply to the heart is blocked long enough to cause death of heart tissues  If enough permanent damage occurs, the patient may die

Myocardial Infarction

Symptoms of MI  Angina  Pain or discomfort in upper arms, left shoulder, back, neck, jaw or stomach  Difficulty Breathing  Sweating or “cold sweat”  Fullness, indigestion, or heartburn  Feeling Lightheaded  Extreme weakness  Rapid, irregular heart rate

Treatment Options  Before getting to the hospital – Quick response time is critical – Call 911 if observe symptoms and do CPR if necessary – Can take asprin, heprin, antiplatelet drugs, therombic therapy  At the hospital – Angioplasty – Bypass surgery