CHEST PAIN/ ANGINA PAIN

Chest pain or angina pain is when the heart does not receive its proper nutrients and oxygen supply.

when the heart does not receive proper oxygen, the condition is called ischemia. If oxygen deprivation occurs for 30 minutes the heart muscles undergo necrosis which means the death of cardiac tissues and the condition is called myocardial ischemia.

Ischemic Heart Disease = Inadequate oxygen = Myocardial Ischemia

Angina pain is often described as squeezing pressure, chest tightness, and heaviness in the chest. Although it is very common and very hard to distinguish from another type of chest pain, It should be checked by a health care provider, that goes away with treatment.

4 Types of Ischemic heart disease:

• Myocardial Infarction

( HEART ATTACK WHEN MUSCLES OF THE HEART DOES NOT RECEIVE PROPER OXYGEN)

• Sudden Chronic death

(CHRONIC MEANS A DISEASE FOR A LONG TIME PERIOD AND SUDDEN CHRONIC DEATH MEANS  SUDDENLY HEART STOPS BEATING )

• Angina Pectoris

(CHEST PAIN) pectoris is the name of muscle in the chest .

• Chronic Ischemic heart disease

( HEART IS SUFFERING FOR A LONG TERM DISEASE IN WHICH IT DOESNOT GET ENOUGH OXYGEN).

Causes:

• Coronary atherosclerosis.

(blockage of coronary artery due to lipid deposition and causes the plaque formation reduces blood flow to heart).

• Coronary emboli.

(blockage of a coronary artery due to any plaque formation, if the plaques get raptured it will block the whole artery)

• Myocardial vessel inflammation.

(damage of vessels to the heart )

• Vessel spasm (narrowing of the artery due to constant constriction of vessels ).

The coronary artery is the heart’s main artery that supplies a major part of the blood to the heart. All of the above causes a decrease or block of the blood supply to the heart as a result heart does not get enough oxygen and nutrient result in heart muscles can not survive and cause ischemia.

Common in:

• Man middle age.
• Post menopausal women.

(A woman of age above 40 does not receive her menstrual cycle).

Pathogenesis of IHD:

2 steps:

• Coronary artery occlusion:

Narrowing ( stenosis ) of the lumen (diameter) of the coronary artery is mostly due to atherosclerosis ( lipid accumulation inside the cell )

75% artery Narrowing = Angina.

Complete blockage of the lumen of the artery.

100% complete blockage  = Infarction.

• Acute plaque changes:

• Thrombus( blood clot) develops on atheroma. (atheroma is the damage to the wall of arteries due to fat deposition.)
• Haemorrhage on atheroma (constantly bleeding from that clot).
• Vaso spasm.

Angina Pectoris:

Irregular interval, behind or below the sternum in heart region chest pain remaining for (15 sec to 15 mints).

Angina Pectoris should be suspected in patients with a tight chest, or heavy chest pain that is on the left side radiating to an arm, neck, jaw or back.

Association increases stress relief by some rest and medicine.

Double product = stress increase = workloads increase = systolic bp increase (contraction of heart) = heart rate increase.

Types of angina:

Stable angina

Moat common type of angina usually occurs while doing some activity and exerting stress and relief by medications. It lasts for a short time period of 5 minutes.

Cause:

fixed coronary artery blockage due to fats deposition narrowing without plaque change (75% Narrowing).
Pain is relieved by rest and vasodilators (substances that dilate the vessels) like angered and nitro-glycerine.(medicine name)

It has a stable pattern.

Prinzmetal / vaso spastic angina:

Episodic chest pain in rest.

Cause: it is caused by narrowing of the coronary artery with or without blockage and blocking the blood supply of the heart.

Respond to vasodilators such as nitroglycerin.

Unstable/ Atypical angina:

It is a type of pain that is not even relieved by rest, gets worst and occurs with less physical effort

It is a form of the acute coronary syndrome (a range of conditions associated with suddenly reduced blood flow to the heart).

Increase in frequency, duration, and intensity over a very small amount of stress.

Last longer than 20 minutes.

Treatment

Divided into two groups.

• Vasodilators
• Cardiac depressants.

VASODILATORS:

It increases the blood flow towards the heart by increasing the diameter of the artery.

CARDIAC DEPRESSANTS:

It decreases the workload of the heart as a result heart contract less and demands less oxygen.

Symptoms of angina pain:

Angina pain or chest pain discomfort may feel like:

• Burning
• Fullness
• Squeezing
• Pressure
• Fatigue
• Nausea
• Shortness of breath
• Sweating

and also felt in the left arm, neck, jaw shoulder, and back.

When to call a doctor:

When you see the condition getting worse and not relieved by medication and the pain getting longer from 20 minutes, immediately call a doctor.

RISK FACTORS:

INCREASE AGE:  Most common in people 60s or above but now the young ones are also getting infected with a sedentary lifestyle.

diseases than risk chance increases.

TOBACCO USERS:  Smoking chewing tobacco or exposure to tobacco can cause damage to your arteries.

HIGH CHOLESTEROL Too much use of bad cholesterol LDL (low-density protein) triglycerides can cause the arrowng of an artery by fat deposition and block the blood supply and muscle undergo ischemic condition.

DIABETES: Diabetes increases the risk of heart diseases like hypertension or heart attack.

HYPERTENSION: Increase in bp as a result of hardening of arteries.

OTHER HEALTH CONDITIONS: Kidney failure, stroke ,or any metabolic disease increase risk of angina

LACK OF EXERCISE: sedentary life style contributes to high ccholesterollevel and heart diseases.

OBESITY: Increase in body weight increase the risk of heart disease the heart has to work hard to supply blood to the body.

EMOTIONAL STRESS: Too much stress cause an increase in bp, and chances of blood vessel damage increase.

DRUG MISUSE: Cocaine and other drugs can cause blood vessel spasms and angina.

PREVENTION:

Prevention of angina 1st includes lifestyle changes that are:

• Not smoking
• Eating healthy food
• avoid smoking and alcohol
• Exercise daily
• Maintain body weight
• Less stress
• Getting recommended vaccine to prevent heart disease
• Managing other conditions that increase the risk of heart diseases