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Encyclopedia > Angina pectoris
Angina
Classification & external resources
ICD-10 I20.
ICD-9 413

Angina pectoris is chest pain due to ischemia (a lack of blood and hence oxygen supply) of the heart muscle, generally due to obstruction or spasm of the coronary arteries (the heart's blood vessels). Coronary artery disease, the main cause of angina, is due to atherosclerosis of the cardiac arteries. The term derives from the Greek ankhon ("strangling") and the Latin pectus ("chest"), and can therefore be translated as "a strangling feeling in the chest". The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... Necrotic tonsils Tonsillitis is an inflammation of the tonsils in the mouth and will often, but not necessarily, cause a sore throat and fever. ... Ludwigs angina, otherwise known as angina ludovici, is a serious, potentially life-threatening infection of the tissues of the floor of the mouth, usually occurring in adults with concomitant dental infections. ... In medicine, chest pain is a symptom of a number of conditions and is generally considered a medical emergency, unless the patient is a known angina pectoris sufferer and the symptoms are familiar (appearing at exertion and resolving at rest, known as stable angina). When the chest pain is not... In medicine, ischemia (Greek ισχαιμία, isch- is restriction, hema or haema is blood) is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. ... General Name, Symbol, Number oxygen, O, 8 Chemical series nonmetals, chalcogens Group, Period, Block 16, 2, p Appearance colorless (gas) very pale blue (liquid) Standard atomic weight 15. ... Myocardium is the muscular tissue of the heart. ... The coronary circulation consists of the blood vessels that supply blood to, and remove blood from, the heart muscle itself. ... This article or section does not adequately cite its references or sources. ... Latin is an ancient Indo-European language originally spoken in Latium, the region immediately surrounding Rome. ...


It is common to equate severity of angina with risk of fatal cardiac events. There is a weak relationship between severity of pain and degree of oxygen deprivation in the heart muscle (i.e. there can be severe pain with little or no risk of a heart attack, and a heart attack can occur without pain)


Worsening ("crescendo") angina attacks, sudden-onset angina at rest, and angina lasting more than 15 minutes are symptoms of unstable angina (usually grouped with similar conditions as the acute coronary syndrome). As these may herald myocardial infarction (a heart attack), they require urgent medical attention and are generally treated as a presumed heart attack. There are different forms of heart disease: Coronary heart disease Ischaemic heart disease Cardiovascular disease The study of heart disease is Cardiology This is a disambiguation page — a navigational aid which lists pages that might otherwise share the same title. ... Acute myocardial infarction (AMI or MI), commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ...

Contents

Symptoms

Most patients with angina complain of chest discomfort rather than actual pain: the discomfort is usually described as a pressure, heaviness, tightness, squeezing, burning, or choking sensation. Apart from chest discomfort, anginal pains may also be experienced in the epigastrium (upper central abdomen), back, neck, jaw, or shoulders. Typical locations for radiation of pain are arms (often inner left arm), shoulders, and neck into the jaw. Angina is typically precipitated by exertion or emotional stress. It is exacerbated by having a full stomach and by cold temperatures. Pain may be accompanied by breathlessness, sweating and nausea in some cases. It usually lasts for about 1 to 5 minutes, and is relieved by rest or specific anti-angina medication. Chest pain lasting only a few seconds is normally not angina. Radiation of pains denotes the characteristic of some types of pains to spread out to distant parts than the origin of the pain. ...


Myocardial ischemia comes about when the myocardia (the heart muscles) fail to take in sufficient blood and oxygen to function correctly. This inadequate perfusion of blood and the resulting reduced delivery of oxygen and nutrients, is directly correlated to blocked or narrowed blood vessels. In medicine, ischemia (Greek ισχαιμία, isch- is restriction, hema or haema is blood) is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. ... In physiology, perfusion is the process of nutritive delivery of arterial blood to a capillary bed in the biological tissue. ...


Some experience "autonomic symptoms" (related to increased activity of the autonomic nervous system) such as nausea, vomiting and pallor. This article or section is in need of attention from an expert on the subject. ... For the Beck song, see Nausea (song). ... Vomiting (also throwing up or emesis) is the forceful expulsion of the contents of ones stomach through the mouth and sometimes the nose. ... Pallor is an abnormal loss of skin or mucous membrane color. ...


Major risk factors for angina include cigarette smoking, diabetes, high cholesterol, high blood pressure and family history of premature heart disease. The cigarette is the most common method of smoking tobacco. ... For the disease characterized by excretion of large amounts of very dilute urine, see diabetes insipidus. ... Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood [1]. It is not a disease but a metabolic derangement that can be secondary to many diseases and can contribute to many forms of disease, most notably cardiovascular disease. ... This article or section does not cite its references or sources. ... In medicine, a family history consists of information about disorders that a patients direct blood relatives have suffered from. ...


A variant form of angina (Prinzmetal's angina) occurs in patients with normal coronary arteries or insignificant atherosclerosis. It is thought to be caused by spasms of the artery. It occurs more in younger women. Prinzmetals angina, also known as variant angina or angina inversa, is a syndrome typically consisting of angina (cardiac chest pain) at rest that occurs in cycles. ...


Diagnosis

In patients with the occasional angina who are not having chest pain, an electrocardiogram (ECG) is typically normal, unless there have been other cardiac problems in the past. During pain, depression or elevation of the ST segment may be observed. To elicit these changes, an exercise ECG test ("treadmill test") may be performed, during which the patient exercises to their maximum ability before fatigue, breathless or, importantly, pain supervenes; if characteristic ECG changes are documented (typically more than 1 mm of flat or downsloping ST depression), the test is considered diagnostic for angina. The exercise test is also useful in looking for other markers of myocardial ischaemia: blood pressure response (or lack thereof, particularly a drop in systolic pressure), dysrhythmia and chronotropic response. Other alternatives to a standard exercise test include a thallium scintigram (in patients that cannot exercise enough for the purposes of the treadmill tests, e.g., due to asthma or arthritis or in whom the ECG is too abnormal at rest) or Stress Echocardiography. “QRS” redirects here. ... “QRS” redirects here. ... A cardiac stress test is a medical test performed to evaluate relative arterial blood flow increases to the left ventricular heart muscle during exercise, as compared to resting blood flow rates (i. ... A cardiac stress test is a medical test performed to evaluate relative arterial blood flow increases to the left ventricular heart muscle during exercise, as compared to resting blood flow rates (i. ... Arthritis (from Greek arthro-, joint + -itis, inflammation; plural: arthritides) is a group of conditions where there is damage caused to the joints of the body. ... An echocardiogram. ...


In patients in whom such noninvasive testing is diagnostic, a coronary angiogram is typically performed to identify the nature of the coronary lesion, and whether this would be a candidate for angioplasty, coronary artery bypass graft (CABG), treatment only with medication, or other treatments. In patients who are in hospital with unstable angina (or the newer term of "high risk acute coronary syndromes"), those with resting ischaemic ECG changes or those with raised cardiac enzymes such as troponin may undergo coronary angiography directly. Coronary angiogram A coronary catheterization is a minimally invasive procedure to access the coronary circulation and blood filled chambers of the heart using a catheter. ... This article or section does not adequately cite its references or sources. ... Early in a coronary artery bypass surgery during vein harvesting from the legs (left of image) and the establishment of bypass (placement of the aortic cannula) (bottom of image). ...


Pathophysiology

Increase in heart rate results in increased oxygen demand by the heart. The heart has a limited ability to increase its oxygen intake during episodes of increased demand. Therefore, an increase in oxygen demand by the heart (eg, during exercise) has to be met by a proportional increase in blood flow to the heart.


Myocardial ischemia can result from:

  1. a reduction of blood flow to the heart caused by the stenosis or spasm of the heart's arteries
  2. resistance of the blood vessels
  3. reduced oxygen-carrying capacity of the blood.

Atherosclerosis is the most common cause of stenosis (narrowing of the blood vessels) of the heart's arteries and, hence, angina pectoris. Some people with chest pain have normal or minimal narrowing of heart arteries; in these patients, vasospasm is a more likely cause for the pain, sometimes in the context of Prinzmetal's angina and syndrome X. A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure. ... Vasospasm refers to a condition in which blood vessels spasm, leading to constriction. ... Prinzmetals angina, also known as variant angina or angina inversa, is a syndrome typically consisting of angina (cardiac chest pain) at rest that occurs in cycles. ... (Cardiac) syndrome X is angina(Chest Pain) with signs associated with decreased blood flow to heart tissue but with normal Coronary arteries. ...


Myocardial ischemia also can be the result of factors affecting blood composition, such as reduced oxygen-carrying capacity of blood, as seen with severe anemia (low number of red blood cells), or long-term smoking. Human blood smear: a - erythrocytes; b - neutrophil; c - eosinophil; d - lymphocyte. ... Anemia (AmE) or anaemia (BrE), from the Greek () meaning without blood, refers to a deficiency of red blood cells (RBCs) and/or hemoglobin. ... The cigarette is the most common method of smoking tobacco. ...


Epidemiology

Roughly 6.3 million Americans are estimated to experience angina. Angina is more often the presenting symptom of coronary artery disease in women than in men. The prevalence of angina rises with an increase in age. Similar figures apply in the remainder of the Western world. All forms of coronary heart disease are much less-common in the Third World, as its risk factors are much more-common in Western and Westernized countries; it could therefore be termed a disease of affluence. The increase of smoking, obesity and other risk factors has already led to an increase in angina and related diseases in countries such as China. For the Jamaican reggae band, see Third World (band). ... Diseases of affluence are those diseases which are thought to be a result of increasing wealth in a society. ... The cigarette is the most common method of smoking tobacco. ...


Treatment

The main goals of treatment in angina pectoris are relief of symptoms, slowing progression of the disease, and reduction of future events, especially heart attacks and of course death. An aspirin (75 mg to 100 mg) per day has been shown to be beneficial for all patients with stable angina that have no problems with its use. Beta blockers have a large body of evidence in morbidity and mortality benefits (fewer symptoms and disability and live longer) and short-acting nitroglycerin medications are used for symptomatic relief of angina. Calcium channel blockers (such as nifedipine and amlodipine), Isosorbide mononitrate and nicorandil are vasodilators commonly used in chronic stable angina. A new therapeutic class, called If inhibitor, has recently been made available: ivabradine provides pure heart rate reduction,.[1] leading to major anti-ischemic and antianginal efficacy. ACE inhibitors are also vasodilators with both symptomatic and prognostic benefit and lastly, statins are the most frequently used lipid/cholesterol modifiers which probably also stabilise existing atheromatous plaque. Acute myocardial infarction (AMI or MI), commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ... Aspirin or acetylsalicylic acid (acetosal) is a drug in the family of salicylates, often used as an analgesic (against minor pains and aches), antipyretic (against fever), and anti-inflammatory. ... Beta blockers or beta-adrenergic blocking agents are a class of drugs used to treat a variety of cardiovascular conditions and some other diseases. ... Nitroglycerin (NG), also known as nitroglycerine, trinitroglycerin, and glyceryl trinitrate, is a chemical compound. ... Calcium channel blockers are a class of drugs with effects on many excitable cells of the body, like the muscle of the heart, smooth muscles of the vessels or neuron cells. ... Nifedipine (brand name Adalat and Procardia) is a dihydropyridine calcium channel blocker. ... Amlodipine (as besylate or malleate) is a long-acting calcium channel blocker used as an anti-hypertensive and in the treatment of angina. ... Isosorbide mononitrate is a drug used principally in the treatment of angina pectoris and acts by dilating the blood vessels so as to reduce the blood pressure. ... Nicorandil is a drug used to treat coronary heart disease. ... Ivabradine (marketed as Procoralan® by Servier Laboratories, also known as S16257) is a new medication registered for use in stable angina pectoris. ... Captopril, the first ACE inhibitor ACE inhibitors, or inhibitors of Angiotensin-Converting Enzyme, are a group of pharmaceuticals that are used primarily in treatment of hypertension and congestive heart failure, in most cases as the drugs of first choice. ... Lovastatin, the first statin to be marketed The statins form a class of hypolipidemic agents. ...


Surprising perhaps is that exercise is also a very good long term treatment for angina[2] (but only particular regimes - gentle and sustained exercise rather than dangerous intense short bursts), probably working by complex mechanisms such improving blood pressure and promoting coronary artery collateralisation.


Identifying and treating risk factors for further coronary heart disease is a priority in patients with angina. This means testing for elevated cholesterol and other fats in the blood, diabetes and hypertension (high blood pressure), encouraging stopping smoking and weight optimisation. Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood [1]. It is not a disease but a metabolic derangement that can be secondary to many diseases and can contribute to many forms of disease, most notably cardiovascular disease. ... For the disease characterized by excretion of large amounts of very dilute urine, see diabetes insipidus. ... This article or section does not cite its references or sources. ... A No Smoking sign Smoking cessation (commonly known as quitting, or kicking the habit) is the effort to stop smoking tobacco products. ... Weight loss, in the context of medicine or health, is a reduction of the total body weight, which can mean loss of fluid, muscle, bone mass, or fat. ...


Even though known victims may wear a necklace or bracelet identifying the medical condition, EMS (ambulance) is still required.


Ranolazine (Ranexa) is a new class of anti anginal drug that was approved by the Food and Drug Administration (FDA) Ranolazine, sold under the trade name Ranexaâ„¢ by Cardiovascular Therapeutics, is an anti-anginal medication. ...


Recently, University of Cincinnati medical researchers in cardiology have tried to use a non-invasive, non-surgical collecting tool to gather harvested erythropoietic bone marrow-based adult stem cells and coax them into regrowing new coronary blood vessels to supply the cardiac muscle's cells (cardiac myocytes) with oxygenated blood, with some success- leading to larger Phase 2 trials.


References

  1. ^ Sulfi S, Timmis AD. Ivabradine - the first selective sinus node I(f) channel inhibitor in the treatment of stable angina. Int J Clin Pract 2006;60:222-8. PMID 16451297. Full text
  2. ^ PA, Ades; ML Waldmann, ET Poehlman, P Gray, ED Horton, ES Horton and MM LeWinter (1993 - 08). "Exercise conditioning in older coronary patients. Submaximal lactate response and endurance capacity". circulation 88: 572-577. Retrieved on 2007-02-08. 

2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the Anno Domini era. ... February 8 is the 39th day of the year in the Gregorian calendar. ...

External links

  • British Heart Foundation - Angina
  • Angina Pectoris Online Resource for nurses and those in similar professions.

  Results from FactBites:
 
Angina Pectoris (543 words)
Angina Pectoris is a term for chest pain caused by an inadequate supply of blood and oxygen to the heart.
Angina may be more difficult to identify in some elderly patients when they have symptoms such as abdominal pain after eating (due to increased blood demand for digestion) or have back or shoulder pain (which may be thought to be due to arthritis).
Stable angina is characterized by predictable patterns of symptoms and periods of discomfort that occur during exercise or periods of stress.
  More results at FactBites »

 
 

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