Angina Pectoris (Stable Angina)

Angina pectoris or angina is a type of chest pain caused by reduced blood flow to the heart. Angina is a symptom of coronary artery disease.

Types

There are different types of Angina. The type depends on the cause and whether rest or medication relieve symptoms.

Stable Angina.

Stable angina is the most common form of angina. It usually happens during activity (exertion) and goes away with rest or angina medication. For example, pain that comes on when you're walking uphill or in the cold weather may be angina.

Stable angina pain is predictable and usually similar to previous episodes of chest pain. The chest pain typically lasts a short time, perhaps five minutes or less.

Unstable Angina (a medical emergency).

Unstable angina is unpredictable and occurs at rest. Or the angina pain is worsening and occurs with less physical effort. It's typically severe and lasts longer than stable angina, maybe 20 minutes or longer. The pain doesn't go away with rest or the usual angina medications. If the blood flow doesn't improve, the heart is starved of oxygen and a heart attack occurs. Unstable angina is dangerous and requires emergency treatment.

Variant Angina (Prinzmetal angina).

Variant angina, also called Prinzmetal angina, isn't due to coronary artery disease. It's caused by a spasm in the heart's arteries that temporarily reduces blood flow. Severe chest pain is the main symptom of variant angina. It most often occurs in cycles, typically at rest and overnight. The pain may be relieved by angina medication.

Refractory Angina.

Angina episodes are frequent despite a combination of medications and lifestyle changes.

Clinical features

• Chest pain (tightness or heaviness) with exertion that is relieved with rest or nitroglycerin.
• Pain of stable angina usually lasts less than 10 to 15 minutes.
• It may radiate to one or both arms, jaws or teeth.
• Associated symptoms include dyspnea, nausea, sweatiness faintness.

Investigations

• Hemoglobin (to look for anemia)
• ECG ( to look for LVH , prior infarction or ischemic changes ),
• Echocardiography ( when there is suspicion of aortic stenosis or hypertrophic cardiomyopathy ),
• ETT (to document workload at onset and record any associated ECG abnormality), Trop - I and Myocardial nuclear scan, CT coronary angiography

Essentials Of Diagnosis

• Precordial chest pain usually precipitated by stress or exertion and relieved rapidly by rest of nitrates
• ECG or scintigraphic evidence of ischemia during pain or stress testing
• Angiographic demonstration of significant obstruction of major coronary vessels.

Management

• Tab- Glyceral Trinitrate (Angised) 0.5mg 1 tab S / L x SOS, can be repeated after 5-10 minutes, if pain not relieved. If pain is not relived or improving after 5 minutes, the patient should consult Emergency department
• Tab- Isosorbide Mononitrate (Monis) 10-40mg 1 tab PO x BD continuous
• Tab -Atenolol (Cardiolite) 25 / 50mg 1 tab PO x OD ' OR ' Tab - Metoprolol (Merol) 25 / 50mg 1 tab PO X OD
• If B - blocker cannot be tolerated or is contraindicated, consider long-acting calcium channel blocker, give Tab- Amlodipine (Sofvasc / Norvasc) 5-10mg 1 tab PO x OD ' OR ' Tab – Diltiazem (Herbesser) 30-60mg PO x TDs ' OR ' Tab - Verapamil (Calan) 40-120mg PO x TDs
• Tab - Aspirin (Loprin / Ascard) 75mg 1 tab PO x OD Tab- Rosuvastatin (Rast/Crescor) 10mg or any other statin 1 tab PO x OD at night
• Tab- Rimipril (Ramipace) 1.25-5mg 1 tab PO X OD