| The word angina
is derived from the latin, angina pectoris, which literally
means a choking pain in the chest. It describes the sensation
of chest discomfort which occurs when the heart muscle
is not getting an adequate supply of oxygen-rich blood.
By far the commonest cause of angina is narrowing of the
coronary arteries, the small arteries which lie on the
surface of the heart and supply the contracting muscle
(the myocardium) with blood. The coronary arteries become
narrowed because of thickening of their walls with a substance
called atheroma.
Angina is often described as a tightness in the centre
of the chest, but can also manifest as a heaviness or
pressure and can radiate to the left arm, throat and
jaw. Stable angina occurs on exertion or with stress/anxiety
and is due to the workload of the heart muscle increasing
and demanding more oxygen, which it is unable to obtain
through the narrowed coronary arteries. Thus patients
may complain of chest tightness on exertion eg. walking
too briskly, or up a steep hill. This can be worse in
cold weather or after a large meal. Unstable angina
describes angina pain which occurs at rest or on minimal
exertion. This is a more serious situation and may indicate
that one of the coronary arteries is critically narrowed.
The treatment of angina consists of:
1) Revascularisation This is the technical
term for re-supplying the heart muscle with blood. The
narrowings in the coronary arteries can be opened up
from within the vessel with a tiny balloon (angioplasty),
usually in conjunction with a sophisticated metal device
called a stent. This is placed within the artery to
hold it open and most coronary narrowings can now be
treated in this way. When angioplasty/stenting is not
technically possible, the narrowings can be bypassed
with a coronary artery bypass operation.
2) Medical therapy Aspirin reduces
the chance of blood clots forming in the coronary arteries.
Drugs such as beta-blockers are effective treatments
for angina and work by decreasing the workload of the
heart. Nitrates (which can be sprayed under the tongue)
temporarily increase blood flow to the heart muscle.
However, anti-anginal drug treatments should only be
used after revascularisation has been considered.
3) Modification of vascular risk factors
Everything should be done to slow down/prevent progression
of coronary atheroma, which is a progressive disease
process. This includes giving up smoking, dietary change
and statin therapy to lower cholesterol, strict control
of blood pressure, regular exercise and weight loss
if needed.
Click here for more information on Respiratory/Chest consultants at London Bridge Hospital |
