STENOCARDIA
Angina pectoris (stenocardia) or 'stable angina' is a clinical condition characterized by bouts of chest pain on the left side. This is as a consequence of lack of oxygen (anoxia) to the heart muscle (myocardis). Such bouts usually disappear after resting, or the usage or coronary dilators. Stenocardia is the medical term for chest pain or discomfort due to coronary heart disease.
The main factor for the development of this disease is atherosclerosis of the coronary blood vessels (hardening of the arteries).
CAUSES
Blood supply to the heart muscle is done by coronary arteries. When they become narrow, blood flow to the heart muscle becomes insufficient. Usually, the cause of this narrowing is hardening of the arteries (atherosclerosis). In rare cases the cause may be heart disease e.g. damaged heart valves.
SYMPTOMS
- Stenocardia manifests itself by seizures that usually occur during physical activities. They appear less frequently in connection with anxiety, can also be caused by output from a warm room into the cold air, Smoking, alcohol, rich food.
- Steno cardiac pressure is manifested by pain, which occurs as it compresses the heart. Sometimes it is perceived as heaviness, squeezing, tightness or compression in the chest cavity. Most patients with stenocardia describe the pain as a brick on the chest”.
- The pain is located behind the breastbone. Attacks may be accompanied by difficulty in breathing, dizziness and fear, sometimes nausea or vomiting.
- After the stress attack ceases, it resolves on its own within 2 to 5 minutes. The fastest effect of taking nitroglycerin tablets under the tongue.
THE DIFFERENT TYPES OF STENOCARDIA
- Stable Angina / Angina Pectoris: Angina pectoris is the medical term for chest pain or discomfort due to coronary heart disease. This happens when the heart muscle doesnot get much blood as it needs usually as a result of one or more of the heart's arteries being narrowed or blocked.
- Symptoms: This type occurs predictably, when you exert yourself physically or feel considerable stress. It doesnot change in frequency and it doesnot worsen over time. The condition usually causes uncomfortable pressure, fullness, squeezing or pain in the center of the chest. The discomfort may also be felt in the neck, jaw, shoulder, back or arm.
Note: there are many types of chest discomfort e.g., heartburn, lung infection or inflammation which arenot in any way related to angina.
- Unstable Angina: Unstable angina is chest pain that occurs while at rest or with exertion or stress.
- Symptoms: Unlike the stable type, the pain worsens in frequency and severity. Unstable angina means that the blockages in the arteries supplying your heart with blood and oxygen have reached critical levels. An attack of unstable angina must be treated as an emergency and immediate medical treatment must be sought.
If left untreated, unstable angina can easily lead to a heart attack, heart failure, or arrhythmias (irregular heart rhythms), which are all life-threatening conditions.
- Variant (Prinzmetal) Angina: is caused by spasms(a sudden, temporary narrowing or tightening of a small part of a vessel) in a coronary artery that supplies the heart muscle with blood, oxygen, and nutrients. This spasm results in a temporary situation where the heart does not get enough blood. It is the blockage of blood flow that causes the chest pain associated with angina.
- Symptoms: Unlike other forms, variant angina occurs during periods of rest. Usually overnight or early morning hours. Such spasms can occur in people who do not have significant coronary artery disease (CAD). However, some people with variant angina have severe CAD disease in at least one blood vessel. Fortunately, coronary artery spasm does not typically trigger a heart attack. However, if a spasm is severe and occurs for a long period, a heart attack can occur.
Such spasm may be triggered by emotional stress, exposure to cold, cocaine use, or heavy smoking.
- Micro vascular Angina - This type of angina, or chest pain, may be a symptom of coronary micro vascular disease (MVD) which is a heart disease in which spasms within the walls of these very small arterial blood vessels causes a reduced flow of blood to the heart muscle leading to chest pain.
- Symptoms: Angina that occurs in coronary MVD may differ from the typical angina that occurs in heart disease in that the chest pain usually lasts longer than 10 minutes, and it can last longer than 30 minutes. If you have been diagnosed with MVD, follow the directions from your healthcare provider regarding how to treat your symptoms and when to seek emergency assistance.
- The pain or discomfort, may be more severe and may last longer than other types of angina pain.
- The pain may also occur with shortness of breath, sleep problems, fatigue, and lack of energy. Often is first noticed during routine daily activities and times of mental stress
TREATMENT
- The use of therapeutic agents will depend on the frequency and severity of attacks. Nitroglycerin tablets are usually prescribed to patients (nitroglycerin dilates blood vessels, and the pain passes in a few minutes). Patients with recurrent stenocardia, would be required to take extra medication, the effect of which is longer.
- If stenocardia is not reduced with medical treatment, then the artery bypass surgery is done to impose bypass graft lesions of the coronary arteries.
- Smokers should first of all quit smoking, limit consumption of fatty foods – these are the first and the second contributors to the hardening of blood vessels. Smoking will narrow more blood vessels.
- You should move regularly, however at a moderate pace, because too much exercise could also be dangerous. If the condition is frequent, one can take nitroglycerin for prevention before a planned physical activity.
The goals of treatment are to reduce the frequency and severity of angina symptoms and improve general heart health.
PREVENTION/SELF-MANAGEMENT
Since angina can be triggered by factors like physical exertion, anxiety or emotional stress, cold weather, or even eating a heavy meal, certain behavioral changes may help to alleviate the symptoms:
- Rest as soon as you feel symptoms coming on
- Reduce and manage stress
- Avoid eating large meals.
- Pace yourself and take regular breaks
- Keep warm
Risk factors
- Smoking,
- High blood pressure,
- Cholesterol levels,
- Diabetes,
- Excess weight,
- Low levels of physical activity.
Therefore, the following lifestyle changes can help to minimize angina symptoms and improve your heart’s health:
- Quit smoking and avoid second-hand smoke
- Control high blood pressure or high blood cholesterol levels
- Exercise moderately and regularly, especially heart disease-appropriate exercise
- Maintain a healthy weight
- Follow a heart disease-appropriate diet
- Manage diabetes,
- Avoid drinking alcohol or do so in moderation
MEDICATIONS
If lifestyle changes do not help, prescription medications may be necessary. The most commonly used medications for controlling angina symptoms are nitrates. They work by widening blood vessels, which allows for more blood to reach the heart muscles. Nitrates come as short and long-acting:
Short-acting nitrates
- Glyceryl trinitrate spray: Droplets sprayed on or under the tongue are absorbed quickly from the mouth into the blood stream and provides very quick almost immediate relief
- Glyceryl trinitrate tablets: Usually placed under the tongue and left to dissolve or chewed, the tablets are absorbed into the blood stream from the lining of the mouth.
Long-acting nitrates
- Nitrate skin patches: These provide a slow release of nitrate which is absorbed through the skin. It provides the longest duration of effect of all the nitrate medications
- Nitrate tablets or capsules: They provide nitrates that is absorbed through the stomach rather than the mouth. They have a longer lasting effect than nitrate spray or tablets.
- Beta-blockers: These help the heart to pump more efficiently, and
- Calcium antagonists: They widen the arteries and allow more blood to flow to the heart.
Surgical procedures
- Coronary artery bypass surgery: in which blood vessels taken from elsewhere in the body are used to bypass the blocked coronary arteries or
- Coronary angioplasty: The opening up the coronary arteries with a special balloon. This may be required for severe angina..
WHEN TO SEE A DOCTOR
At the onset of stenocardia symptoms, one should see a doctor.
-If the presence of the disease attacks more frequent or stronger, you should also seek medical advice.
-If the duration of the attack for more than 15 minutes, you should immediately call an ambulance: during such an attack, the likelihood of myocardial infarction is greatly increased.