Angina: Diagnosis and Treatment Options

Angina: Diagnosis and Treatment Options

Angina refers to the pain arising from lack of adequate blood supply to

the heart muscle. Typically, it is a crushing pain behind the breastbone

in the center of the chest, brought on by exertion and relieved by rest. It

may at times radiate to or arise in the left arm, neck, jaw, left chest, or

back. It is frequently accompanied by sweating, palpitations of the heart,

and generally lasts a matter of minutes. Similar pain syndromes may be

caused by other diseases, including esophagitis, gall bladder disease,

ulcers, and others.

Diagnosis of angina begins with the recognition of the consistent

symptoms. Often an exercise test with radioactive thallium is performed if

the diagnosis is in question, and sometimes even a cardiac catheterization

is done if the outcome is felt necessary to make management decisions. This

is a complex area which requires careful judgment by physician and patient.

Angina is a manifestation of coronary artery disease, the same disease

leading to heart attacks. Coronary artery diseas refers to those syndromes

caused by blockage to the flow of blood in those arteries supplying the

heart muscle itself, i.e., the coronary arteries. Like any other organ, the

heart requires a steady flow of oxygen and nutrients to provide energy for

rmovement, and to maintain the delicate balance of chemicals which allow

for the careful electrical rhythm control of the heart beat. Unlike some

other organs, the heart can survive only a matter of minutes without these

nutrients, and the rest of the body can survive only minutes without the

heart--thus the critical nature of these syndromes.

Causes of blockage range from congenital tissue strands within or over

the arteries to spasms of the muscular coat of the arteries themselves. By

far the most common cause, however, is the deposition of plaques of

cholesterol, platelets and other substances within the arterial walls.

Sometimes the buildup is very gradual, but in other cases the buildup is

suddenly increased as a chunk of matter breaks off and suddenly blocks the

already narrowed opening.

Certain factors seem to favor the buildup of these plaques. A strong

family history of heart attacks is a definite risk factor, reflecting some

metabolic derangement in either cholesterol handling or some other factor.

Being male, for reasons probably related to the protective effects of some

female hormones, is also a relative risk. Cigarette smoking and high blood

pressure are definite risks, both reversible in most cases.