Angina

The term angina describes chest pain caused by too little oxygen to the heartmuscle. An angina episode is not the same as a heart attack, because the pain is temporary and it seldom causes permanent damage to heart muscle.

Angina is divided into two categories: angina of effort and variant angina. Angina of effort is caused by the narrowing of the arteries (atherosclerosis).The narrowed arteries don't allow enough blood through to the heart muscle during periods of exercise, stress, or excitement. Due to atherosclerosis, people with angina of effort have an increased risk of heart attack.

Variant angina is uncommon and occurs independently of atherosclerosis. Variant angina is not related to excessive work by the heart muscle. Research indicates that it is caused by heart artery muscle spasm that is too brief or tooweak to cause an actual heart attack.

Angina causes a pressing pain or sensation of heaviness, usually in the chestunder the breast bone. Sometimes the pain is felt in the shoulder, arm, neck, or jaw. Angina episodes occur when the heart's need for oxygen increases beyond what is available. Emotional stress, extreme temperatures, heavy meals,cigarette smoking, and alcohol can cause or contribute to an episode of angina.

Physicians can usually diagnose angina based on symptoms and what causes them. However, other diagnostic testing is used to confirm the diagnosis. This testing can also reveal any underlying heart disease.

An electrocardiogram is a test that records electrical impulses from the heart. The resulting graph shows if the heart muscle isn't functioning properly.Electrocardiograms are also useful in investigating other possible heart abnormalities.

Because angina often occurs during stress, the heart may need to be tested during exercise. The stress test is an electrocardiogram done before, during, and after exercise. Blood pressure is also measured and any angina symptoms are noted.

A more complex stress test, called an angiogram, may be used to picture the blood flow in the heart muscle during the most intense time of exercise and after rest. In this procedure, a long, thin, flexible tube (catheter) is placedin an artery located in the forearm or groin. This catheter is threaded through the artery into a heart artery. A dye is injected through the catheter sox rays can clearly detect the heart and arteries. Many brief x rays are madeto create a movie of blood flowing through the coronary arteries.

Angina is first treated by controlling factors that put a person at risk. Risk factors include cigarette smoking, high blood pressure, high cholesterol levels, and obesity. Angina is often controlled by medication, usually nitroglycerin. This drug relieves angina pain by increasing the diameter of the bloodvessels carrying blood to the heart muscle. Nitroglycerin is taken wheneverdiscomfort occurs or is expected. It may be taken by mouth by placing the tablet under the tongue or through the skin with a medicated patch. In addition,beta blockers or calcium channel blockers may be prescribed.

If these treatments don't work, physicians may recommend surgery or angioplasty. Coronary artery bypass surgery is an operation in which a blood vessel (often a long vein taken from the leg) is grafted onto the blocked artery to bypass the blocked portion. This newly formed pathway allows blood to flow to the heart muscle.

Another procedure to improve blood flow is balloon angioplasty. In this procedure, the physician inserts a catheter with a tiny balloon at the end into aforearm or groin artery. The catheter is then threaded into the coronary arteries and the balloon is inflated to open narrowed sections of the blood vessel.

Long-term treatment for angina usually involves treating atherosclerosis. This treatment requires diet and lifestyle changes such as regular exercise, reducing dietary sugar and saturated fats, and increasing dietary fiber. Medications to decrease blood pressure or cholesterol may be prescribed.

The prognosis for a patient with angina depends on its origin, type, severity, and the person's general health. Someone with angina has the best outsome if he or she gets prompt medical attention and learns what causes the attacks,what they feel like, how long episodes usually last, and whether medicationrelieves the attacks. If symptom patterns change significantly, or if symptoms resemble those of a heart attack, immediate medical help is vital.

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