Overview
The main symptoms of angina include a pain radiating around the central
area of the chest, spreading to the arms, neck or jaw, often triggered
during exertion. Undoubtedly, many people attribute this to indigestion,
rather a vague term, which also causes upper abdominal pain. However,
it is very important not to delay in seeking urgent medical advice from
a doctor. Angina may also be brought on, in some cases, by overeating
and may be noticed if the sufferers tries to 'walk off' the meal on
a cold winter's day.
The investigations of this pain is levelled at the heart. The physical
examination involves measuring blood pressure and checking various pulse
points. A full examination may take place which often merits further
investigations.
These may include:
Electrocardiogram
This will indicate whether or not you have sustained damage to the heart
muscle. If positive this will require further in patient investigation.
Blood Tests
Particularly for cholesterol estimation and other fats.
Thallium scan
This test is not often done, but is useful in people who cannot
exercise. This indicates which part of the muscle is not receiving an
adequate supply of blood.
Coronary Angiography
A tube or catheter is inserted into an artery (forearm or groin), a
local anaesthetic, having been injected into the area. A dye is injected
and any narrowing in the heart arterial network is noted.
TREATMENT
If angina is diagnosed treatment will be commenced with the intention
of increasing blood supply to the heart. Drugs used are nitrates taken
in tablet or spray form. Tablets are placed under the tongue and allowed
to dissolve. They may occasionally cause transient headaches, but with
prolonged use this tends to disappear. They deteriorate quickly and
a new supply would be obtained every two months or so.
Beta Blockers
The next line of attack are Beta Blockers and these are also supplied
iin tablet form. They produce slowing of the heart rate, thereby resting
the heart. If you have some other problem, for example diabetes, these
will usually be prescribed.
Calcium Channel Blockers
These are used in patients who have other problems, such
as asthma.
Potassium Channel Activators
Thses are similar to nitrates and are used as their effect is not decreased
over time, unlike nitrates.
If it is found that that your artery or arteries are narrowed and that
medication has been unsuccessful, more radical treatment may be necessary.
Such techniques include:
Coronary Angioplasty
This involves inserting a small inflatable balloon into the artery.
The intention is, that when fatty tissue within the artery is encountered
the balloon is inflated thus, squashing the material. Occasionally a
'stent' or frame is inserted to keep the arterial walls apart.
Coronary Bypass Surgery
This may have to follow if the above methods have not been successful.
The idea is to keep the coronary circulation doing its job, by grafting
a blood vessel between the aorta (the largest artery in the body leading
from the heart) and a point in the artery affected beyond the blocked
area. Grafts come from leg veins, or indeed, other arteries can actually
be used.
Patients may be given choice between these two procedures. If you do
not wish a general anaesthetic, then if your doctor is in agreement,
you could opt for angioplasty. Following which you could be back to
work in a week or so. However, your chances of having the procedure
repeated is about 50:50.. A bypass on the other hand carries a repeat
rate of 5-10%.
Angina is aggravated by smoking, obesity, often due to poor eating
habits and high blood pressure. If you have any of these risk factors
and need to change your lifestyle you would be well advised to start
do something about it, starting now.
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