angina pectoris


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angina

 [an-ji´nah, an´jĭ-nah]
spasmodic, choking, or suffocative pain; now used almost exclusively to denote angina pectoris. adj., adj an´ginal.
agranulocytic angina agranulocytosis.
crescendo angina old term for unstable angina.
angina cru´ris intermittent claudication.
herpes angina (angina herpe´tica) herpangina.
intestinal angina generalized cramping abdominal pain occurring shortly after a meal and persisting for one to three hours, due to ischemia of the smooth muscle of the bowel.
Ludwig's angina see ludwig's angina.
angina pec´toris acute pain in the chest resulting from myocardial ischemia (decreased blood supply to the heart muscle); the condition has also been called cardiac pain of effort and emotion because the pain is brought on by physical activity or emotional stress that places an added burden on the heart and increases the need for blood being supplied to the myocardium. Some patients can predict the kinds of events that will precipitate an attack while others are unaware of any relationship between onset of an attack and any particular situation in their lives.

Angina pectoris occurs more frequently in men than in women, and in older persons than in younger persons. It is not a disease entity but a symptom of an underlying disease process involving the arteries that supply blood to the heart muscle. About 90 per cent of all cases can be attributed to coronary atherosclerosis. Studies have shown that at least one of the three major coronary arteries usually is stenosed before angina develops. In most cases, all of the major coronary arteries are involved.

Angina pectoris also can result from stenosis of the aorta, pulmonary stenosis and ventricular hypertrophy, or connective tissue disorders such as systemic lupus erythematosus and periarteritis nodosa that affect the smaller coronary arteries.
Symptoms. The chief symptom is chest pain, usually unmistakably distinguished by the patient as different from other types of pain such as that caused by indigestion. It is generally described as a feeling of tightness, strangling, heaviness, or suffocation and is usually concentrated on the left side, beginning just under the sternum; it sometimes radiates to the neck, throat, and lower jaw and down the left arm, and occasionally to the stomach, back, or across to the right side of the chest. The pain seldom lasts more than 15 minutes and is usually relieved by rest and relaxation or by administration of nitrates. If it is not relieved in 10 to 15 minutes, the physician should be notified and the patient taken to a cardiac care unit. The decreased blood supply to the heart makes it especially vulnerable to arrhythmias and myocardial infarction, which are the cause of death in about one third of all cases.

Coronary arteriography and ventriculography are valuable in determining the prognosis for angina pectoris. The mortality rate for patients having a narrowing of all three main coronary arteries is higher than for those who have only one vessel involved. Severity of pain is not a good prognostic indicator; some patients with severe discomfort live for many years, while others with mild symptoms die suddenly. An enlarged heart, a third heart sound, ECG abnormalities at rest, and hypertension are all indicative of a poor prognosis.
Treatment and Patient Care. Relief from pain by rest and prevention of attacks by avoiding situations which precipitate them are the first steps in the care of the patient with angina. In most cases patients are eager to learn about the disease process causing the pain and want to know how they can participate in control of their attacks. However, compliance with the prescribed regimen usually requires a change in life style and the breaking of some lifelong habits. The known risk factors for coronary heart disease are explained to the patient, and a regimen designed to avoid further damage to the arteries is prescribed.

Organic nitrates may be administered orally or sublingually for relief from anginal pain. They act by dilating the arteries and may be used to treat acute attacks, for long-term prophylaxis and management, or for prophylaxis in situations likely to provoke an attack. Commonly used nitrates are erythrityl tetranitrate, isosorbide dinitrate, and nitroglycerin.

Beta-adrenergic blocking agents, such as propranolol, are used to treat patients who do not respond to weight control and treatment with vasodilators and whose angina significantly limits their activities. These agents decrease the heart rate, blood pressure, and myocardial oxygen consumption and increase the patient's exercise tolerance.

The calcium channel blocking agents (nifedipine, verapamil, diltiazem, and others) are drugs that are particularly beneficial in relieving pain in patients whose angina is the result of coronary artery spasm or constriction. They act by selectively inhibiting the transport of calcium across the cell membrane of myocardial cells and also by reducing myocardial oxygen utilization. Patients most likely to obtain dramatic relief from drugs of this kind are those who experience chest pain while resting or sleeping, upon exposure to cold, or during emotional stress.

Surgical procedures involving arterial bypass and angioplasty have become fairly common as a form of treatment of certain types of ischemic heart disease and resulting angina pectoris. The surgical procedures attempt to bypass the diseased portion of the coronary artery by suturing a vein graft or the internal mammary artery from the aorta to one or more coronary arteries beyond the area of obstruction. In most instances the graft is obtained from the patient's saphenous vein. Angioplasty reestablishes patency of the vessels; in most cases, it is now accompanied by insertion of a stent to help prevent restenosis.

An attitude of calmness and efficiency is most important when caring for a person suffering from an attack of angina pectoris. The pain produces emotional reactions and the strongest of these is fear. Most of these patients know that their pain is resulting from an insufficient supply of oxygen to the heart and they frequently have a feeling of impending death. It usually helps to raise the patient to a sitting position so that breathing is less difficult. The prompt administration of nitroglycerin or the specific drug ordered by the physician should shorten the attack and relieve pain. Above all, the calm presence of someone who knows how to care for them can do much to reassure patients and help them relax, thus lessening the severity of the attack.
preinfarction angina angina that lasts longer than 15 minutes; it is a symptom of worsening cardiac ischemia.
Prinzmetal's angina a variant of angina pectoris in which the attacks occur during rest, exercise capacity is well preserved, and attacks are associated electrocardiographically with elevation of the ST segment. It is cyclic in nature and is believed to be caused by coronary artery spasm.
stable angina chest pain of cardiac origin that has not changed in character, frequency, intensity, or duration for 60 days.
unstable angina chest pain of cardiac origin that is variable, usually increasing in frequency and intensity and with irregular timing.
variant angina Prinzmetal's angina.
Vincent's angina see vincent's angina.

an·gi·na pec·'to·ris

severe constricting pain or sensation of pressure in the chest, often radiating from the precordium to a shoulder (usually left) and down the arm, resulting from ischemia of the heart muscle usually caused by coronary disease.

angina pectoris

(pĕk′tər-ĭs)
n.
Severe paroxysmal pain in the chest associated with an insufficient supply of blood to the heart.

an·gi·na pec·to·ris

(anji-nă pek-tōris)
Paroxysmal severe constricting pain or pressure in the chest due to myocardial ischemia; typically radiates from the precordium to one or both shoulders, neck, or jaw; often precipitated by exertion, exposure to cold, or emotional excitement.
Synonym(s): stenocardia.
Enlarge picture
ANGINA PECTORIS

angina pectoris

An oppressive pain or pressure in the chest caused by inadequate blood flow and oxygenation to heart muscle. It is usually due to atherosclerosis of the coronary arteries and in Western cultures is one of the most common emergent complaints bringing adult patients to medical attention. It typically occurs after (or during) events that increase the heart's need for oxygen, e.g., increased physical activity, a large meal, exposure to cold weather, or increased psychological stress. See: illustration; table

Symptoms

Patients typically describe a pain or pressure located behind the sternum and having a tight, burning, squeezing, or binding sensation that may radiate into the neck, jaw, shoulders, or arms and be associated with difficulty in breathing, nausea, vomiting, sweating, anxiety, or fear. The pain is not usually described as sharp or stabbing and is usually not aggravated by deep breathing, coughing, swallowing, or twisting or turning the muscles of the trunk, shoulders, or arms. Women, diabetics, and the elderly may present with atypical symptoms, such as shortness of breath without pain.

Treatment

In health care settings, oxygen, nitroglycerin, and aspirin are provided, and the patient is placed at rest. Morphine sulfate is given for pain that does not resolve after about 15 min of treatment with that regimen. Beta-blocking drugs (such as propranolol or metoprolol) are used to slow the heart rate and decrease blood pressure. They are the mainstay for chronic treatment of coronary insufficiency and are indispensable for treating unstable angina or acute myocardial infarction. At home, patients should rest and use short-acting nitroglycerin. Patients with chronic or recurring angina pectoris may get symptomatic relief from long-acting nitrates or calcium channel blockers. Patients with refractory angina may be treated with combinations of all of these drugs in addition to ranolazine, a sodium channel blocker.

Patient care

The pattern of pain, including OPQRST (onset, provocation, quality, region, radiation, referral, severity, and time), is monitored and documented. Cardiopulmonary status is evaluated for evidence of tachypnea, dyspnea, diaphoresis, pulmonary crackles, bradycardia or tachycardia, altered pulse strength, the appearance of a third or fourth heart sound or mid- to late-systolic murmurs over the apex on auscultation, pallor, hypotension or hypertension, gastrointestinal distress, or nausea and vomiting. The 12-lead electrocardiogram is monitored for ST-segment elevation or depression, T-wave inversion, and cardiac arrhythmias. A health care provider should remain with the patient and provide emotional support throughout the episode. Desired treatment results include reducing myocardial oxygen demand and increasing myocardial oxygen supply. The patient is taught the use of the prescribed form of nitroglycerin for anginal attacks and the importance of seeking medical attention if prescribed dosing does not provide relief. Based on his needs, the patient should be encouraged and assisted to stop smoking, maintain ideal body weight, lower cholesterol by eating a low-fat diet, keep blood glucose under control (if the patient is diabetic), limit salt intake, and exercise (walking, gardening, or swimming regularly for 45 min to an hour every day). The patient is also taught about prescribed beta-adrenergic or calcium channel blockers and any other needed interventions should they become necessary.

Four major forms of angina are identified: 1. stable: predictable frequency and duration of pain that is relieved by nitrates and rest; 2. unstable: pain that is more easily induced and increases in frequency and duration; 3. variant: pain that occurs from unpredictable coronary artery spasm; and 4. microvascular: impairment of vasodilator reserve that causes angina-like chest pain even though the patient’s coronary arteries are normal. Severe and prolonged anginal pain is suggestive of a myocardial infarction.

SOURCE: Campeau, L: Grading of Angina Pectoris [letter]. Circulation 54(3), 522. Copyright 1976, American Heart Association.
ClassDescription
IOrdinary physical activity, such as walking or climbing stairs, does not cause angina. Angina occurs with strenuous, rapid, or prolonged exertion at work or recreation.
IISlight limitation of ordinary activity. Angina occurs on walking or climbing stairs rapidly, walking uphill, walking or stair climbing after meals, in cold, or in wind, under emotional stress, only during the few hours after awakening, or walking more than two level blocks and climbing more than one flight of stairs at a normal pace and in normal conditions.
IIIMarked limitation of ordinary physical activity. Angina occurs on walking one to two level blocks and climbing one flight of stairs in normal conditions at a normal pace.
IVInability to carry on any physical activity without discomfort—angina symptoms may be present at rest.
See also: angina

angina pectoris

The symptom of oppression, pain or tightness in the centre of the chest which occurs when the CORONARY arteries are unable to provide an adequate blood supply to meet the immediate demands of the heart muscle. Angina is almost always related to exercise or emotion and is relieved by rest. It is worse in cold conditions and after a meal. The symptom is often described as of a tight band round the chest. The pain may radiate down the arms, especially the left, or up into the neck or jaw. There may be associated breathlessness. Rapidly worsening angina, induced by ever-lessening amounts of exertion, is called unstable angina and requires urgent attention. Angina can be controlled with nitrates, especially nitroglycerine which is best taken in a tablet held under the tongue. The term derives from the Latin angere , to strangle and pectus , the breast. See also CORONARY SYNDROME.

Angina pectoris

A feeling of tightness, heaviness, or pain in the chest, caused by a lack of oxygen in the muscular wall of the heart.

Heberden,

William, Sr., English physician, 1710-1801.
Heberden angina - severe constricting pain in the chest. Synonym(s): angina pectoris; Rougnon-Heberden disease
Heberden anomaly
Heberden asthma
Heberden disease - small-joint rheumatism, with distal interphalangeal joint nodules and angina.
Heberden nodes - small exostoses found on the terminal phalanges of the fingers in osteoarthritis. Synonym(s): Heberden nodosities; Rosenbach disease (1); tuberculum arthriticum
Heberden nodosities - Synonym(s): Heberden nodes
Heberden rheumatism
Rougnon-Heberden disease - Synonym(s): Heberden angina

an·gi·na pec·to·ris

(anji-nă pek-tōris)
Severe constricting chest pain or pressure, often radiating from precordium to shoulder (usually left) and down the arm, resulting from ischemia of the heart muscle.

Patient discussion about angina pectoris

Q. I still have chest pain after 5 angioplasties/stents. Does anybody else still have that much angina?

A. my uncle had the same problem. went through several catheterization at several different cardiologist (some are well known), but couldn't get this annoying pain off his chest. the weird part was that it didn't even reacted to effort. but eventually (i don't remember the stent amount) one of the cardiologist solved the problem. so don't give up and continue searching the cause!

More discussions about angina pectoris
References in periodicals archive ?
(1987) Nitrate therapy in stable angina pectoris. N.
In a meta-analysis of 24 studies regarding the concomitant use of CDDP and aspirin for the treatment of angina pectoris of CHD, a total of 2275 patients were included.
(1) WCM treatment of coronary heart disease and angina pectoris includes nitrates, aspirin, and amlodipine; (2) WCM treatment for stroke includes nimodipine, flunarizine, and aspirin; (3) angina pectoris routine treatment includes nitrous esters, aspirin, amlodipine, and isosorbide dinitrate; (4) the treatment dose of YD capsule was referenced according to drug directions; the courses ranged from 2 to 12 weeks.
However, the evidence is weak for pain in refractory angina pectoris and in painful ischemic lower limb; therefore, in appropriately selected patients, NS is a useful and reversible treatment to treat severe chronic pain associated to diseases described here, when an initial conservative treatment has shown to be ineffective.
The Mg values in patients with angina pectoris were lower on the 3rd day and higher on the 1st day and on the 12th day.
Key clinical point: Rates of acute Ml and all-cause mortality in patients with stable angina pectoris but no obstructive CAD are significantly lower than in the general population.
Patients were assigned to 2 groups according to symptoms and diagnostic standards of the American Heart Association, namely 60 cases to the stable angina pectoris (SAP) group and 60 cases to the unstable angina pectoris (UAP) group.
El estudio Electrical stimulation versus coronary artery bypass surgery in severe angina pectoris evaluo si la EME podia utilizarse como alternativa a la cirugia de puentes coronarios en pacientes seleccionados con alto riesgo quirurgico.
Cardioselective beta-blockers are indicated in the treatment of hypertension and angina pectoris. These drugs lower blood pressure primarily by blocking beta-1 receptors and decreasing cardiac output.
Wenger, "Management options in chronic stable angina pectoris: focus on ranolazine," Clinical Medicine Insights, vol.
The recurrence of the angina pectoris on effort was revealed in 26 patients from group A, at the reevaluation performed 3 months after the start of the study.
In China, ginseng based medicines and nitrates are commonly used in treating ischemic heart disease angina pectoris. Ischemic heart disease (IHD) is defined as myocardial impairment due to an imbalance between coronary blood flow and myocardial requirements.