Wockhardt Guide on Angina

What is angina?
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Angina is chest pain or discomfort that occurs when your heart muscle does not get enough blood. Angina may feel like pressure or a squeezing pain in your chest. The pain may also occur in your shoulders, arms, neck, jaw, or back. It may also feel like indigestion.

Angina is a symptom of coronary artery disease (CAD),the most common type of heart disease. CAD occurs when plaque builds up in the coronary arteries. This buildup of plaque is called atherosclerosis. As plaque builds up, the coronary arteries become narrow and stiff. Blood flow to the heart is reduced. This decreases the oxygen supply to the heart muscle.

What are the types of angina?
 

There are three types of angina.It is important to know the differences among them.

  • Stable angina: This is the most common type. It occurs during physical effort or emotional stress. The pain usually goes away in a few minutes after you rest or take your angina medicine. It is not a heart attack but makes it more likely that you will have a heart attack in the future.
  • Unstable angina: This is a very dangerous condition that requires emergency treatment.It is a sign that a heart attack could occur soon. It can occur without physical exertion and is not relieved by rest or medicine.
  • Variant angina: This is a rare type of angina.It usually occurs at rest. The pain can be severe and usually occurs between midnight and early morning.It is relieved by medicine.

Not all chest pain is angina. Chest pain or discomfort can be caused by a heart attack,lung problems(such as an infection or a blood clot),heartburn, or a panic attack.However, all chest pain should be checked by a doctor.

What are the signs and symptoms of angina?
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Pain and discomfort are the main symptoms of angina. These symptoms.

  • Are often described as pressure, squeezing, burning, or tightness in the chest.
  • Usually starts in the chest behind the breastbone.
  • May also occur in the arms, shoulders, neck, jaw, throat, or back.
  • May feel like indigestion.

Some people say that angina discomfort is hard to describe or that they can’t tell exactly where the pain is coming from. Symptoms such as nausea, fatigue, shortness of breath, sweating, light-headedness, or weakness may also occur.

What is the difference between heart attack and angina?
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A heart attack happens when a narrowed coronary artery becomes blocked by a blood clot. The chest pain that comes with a heart attack is sometimes more severe than angina. It also lasts longer and does not usually go away with rest. You may sweat and feel sick.Severe indigestion symptoms that do not get better after taking medication may be a heart attack.

A nitrate tablet or spray, which is usually very effective in relieving angina, will not help in a heart attack.

How is angina diagnosed?
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To find out if you have angina, your doctor will:

  • Ask about your symptoms.
  • Ask about your risk factors and your family history of coronary artery disease (CAD) or other heart disease.
  • Do a physical exam.

Sometimes, your doctor can diagnose angina by noting your symptoms and how they occur. Your doctor may order one or more tests to help make a diagnosis of angina.

These tests are usually carried out in hospital as a day care (which means that you do not have to stay overnight).

Electrocardiogram (ECG) Your doctor is likely to send you for an electrocardiogram (ECG), which records the rhythm and electrical activity of your heart.The test is painless and usually takes about 5 minutes.

Small patches, set in sticky plaster, are put on your arms, legs and chest and are connected to a recording machine. The machine then takes a reading. If you have had a heart attack in the past or having chest pain at the time of recording ECG may be abnormal. However, you could have a normal ECG reading and still have coronary atherosclerosis.

Exercise electro cardiography (TMT) Angina often occurs with physical activity. This means that, if the ECG is done while you are resting, it may show a normal reading. For this reason you may be asked to do an ‘exercise ECG’ or a ‘Tread mill test’. This is an ECG carried out while you are pedaling an exercise bicycle or walking on a treadmill. For patients of stable angina TMT is often more useful than simple ECG.

 

Nuclear heart scan

This test shows blood flow to the heart and any damage to the heart muscle. A radioactive dye (technetium or thallium) is injected into your bloodstream. A special camera can see the dye and find areas where blood flow is reduced. Nuclear heart scans are often taken while you are at rest and again after exercise.If you cannot exercise, a medicine is given to increase the workload of the heart. The before-and-after exercise scans are compared.

CTA(computed tomography angiography) It is non-invasive test using a advanced CT scanner (64-slice CT ) to detect presence of coronary artery disease. The advantage of CTA is that is done as an out patient procedure and can be per formed in a very short time. In fact, the actual imaging takes place during a single breath hold i.e less than 15 seconds).Compared to coronary angiography which involves placing catheters in to the arteries, CTA contrast is injected into a vein in the forearm using a small plastic needle-making the procedure very comfortable.

This type of exam has been used to screen large numbers of individuals for arterial disease, identifying aneurysms and detecting thrombosis (clots) in veins. CTA can also detect narrowing or obstruction of arteries in the pelvis and in the carotid arteries, which bring blood from the heart to the brain.

 

Coronary angiography

A thin flexible tube (catheter) is passed through an artery in the groin (upper leg)or arm to reach the coronary arteries. Radio opaque dye is injected into the coronary artery through thin catheter and picturised using x-rays.The coronary arteries and blocks, if any can be visualized by this test.

How is angina treated?
 

Most patients who are diagnosed with angina will have drug treatment at first, but some will need coronary angioplasty or coronary bypass surgery.

Drug treatment

Drugs can help in various ways. They can-

  • Reduce the chance of blood clots development
  • Increase the blood supply to your heart.
  • Reduce the work your heart has to do,
  • Help keep your blood cholesterol levels down.

Remember: never run out of your tablets!

 

If your coronary arteries are narrowed and if drugs do not relieve your symptoms, or if your angina is life threatening, you may be advised to have

  • Coronary angioplasty, or
  • Coronary artery bypass surgery
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Coronary angioplasty

If your coronary Angiography has shown a narrowing in an artery, you may be recommended to have a coronary angioplasty with stenting. This is a treatment, which improves the blood supply to the heart muscle.

A catheter (a fine, hollow tube) with a small inflatable balloon at its tip is passed into an ar ter y in either your groin or your arm. The operator then uses X-ray screening to direct the catheter to a coronary artery until its tip reaches the narrowed or blocked section.

The balloon is then gently inflated so that it squashes the fatty tissue responsible for the narrowing. As a result, this widens the artery.

The catheter contains a 'stent' that is a short tube of stainless-steel mesh. As the ball oon is inflated, the stent expands so that it holds open the nar rowed blood vessel. The balloon is then let down and removed, leaving the stent in place.

Coronary angioplasty with sten ting will usually involve an overnight stay in hospital.

In the past, angioplasty was done without using stents, but stenting is now routine, unless the artery is too small to accept one.

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Drug-eluting stent

With the earl'1 ergeneration stents knowas Bare Metal Stents (BMS).there was a problem of recurrence of coronary blocks- known as restonosis.The metal stents coated with a special drug called drug-eluting stents (DES or coated stents) have been introduced.

These stents release the drug in the area of the block slowly and prevent recurrence of the block. DES is considered state –of- the art in the field of interventional cardiology for treating coronary blocks without surgery.

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Coronary bypass surgery

This is major surgery and you would need to stay in hospital for about a week. It has proved to be very effective in reducing the symptoms of angina and improving the outlook for patients with severe narrowing of the main coronary arteries. The aim of the operation is to bypass narrowed sections of coronary arteries by grafting a blood vessel between the aorta (the main artery leaving the heart) and a point in the coronary artery beyond the narrowed or blocked area. For purpose of grafting,internal mammary artery (artery that runs down the inside of the chest wall),radial artery(artyery of the forearm) or section of vein removed from the leg are used. Arterial grafts especially the internal mammary grafts have a very high longevity and are preferred for most patients whenever possible.

Before the decision is taken to operate, you will need to have a coronary Angiography to find out exactly which arteries are narrowed and where

How can angina be prevented?
 

You can prevent or lower your risk for heart disease and angina by making lifestyle changes and getting treatment for related conditions.

Make lifestyle changes

You can prevent or lower your risk for angina and heart disease by making healthy lifestyle choices:

  • Eat a healthy diet to prevent or reduce high blood pressure, high blood cholesterol, and obesity.
  • Quit smoking, if you smoke.Smoking is a major cause of coronary heart disease, especially among younger patients. Pipe and cigar smoking also increase the risk.

Within five years of stopping smoking, the risk of having a heart attack falls to about half that of a smoker.Your Doctor can also give you advice,includingin formation on nicotine replacement products such as chewing gum,skin patches,and tablets.

  • Be physically active, as directed by your doctor
  • Lose weight, if you are overweight.

Treat related conditions

In addition to make lifestyle changes follow your Doctor’s advice to reduce• High blood cholesterol- take medications to lower your cholesterol as directed.

  • High blood pressure- keep your blood pressure under control. Take blood pressure medications as directed.
  • Diabetes (high blood sugar)- keep your blood sugar levels under control and take medicines as directed.
  • Overweight or obesity-talk to your doctor about how to lose weight safely.
 

Within five years of stopping smoking, the risk of having a heart attack falls to about half that of a smoker.Your Doctor can also give you advice,includingin formation on nicotine replacement products such as chewing gum,skin patches,and tablets.

  • Be physically active, as directed by your doctor
  • Lose weight, if you are overweight.

Treat related conditions

In addition to make lifestyle changes follow your Doctor’s advice to reduce• High blood cholesterol- take medications to lower your cholesterol as directed.

  • High blood pressure- keep your blood pressure under control. Take blood pressure medications as directed.
  • Diabetes (high blood sugar)- keep your blood sugar levels under control and take medicines as directed.
  • Overweight or obesity-talk to your doctor about how to lose weight safely.
Everyday life with angina
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After treatment, most people with angina can get back to a normal or near normal life. However, if you have a very demanding job, you may need to rearrange your commitments.

For example,
Can you plan your work better? Do you do unnecessary and stressful things? If your job involves heavy manual work, you may need to ask your doctor if it is likely to bring on angina.

Sex

Many people who have angina continue to enjoy sex. In general, if you can briskly climb up and down two flights of stairs without getting any angina symptoms, then sex will not usually bring on your angina. To reduce the chance of having angina symptoms during sex, wait at least two hours after a meal or a hot bath, and make sure the room is comfortably warm. Symptoms may also be less likely if you have sex after a good night sleep. Consult your cardiologist before taking Viagra or sexual stimulants.

Driving

If you drive a car and you have angina that is well controlled, you will not usually be restricted. Inform vehicle insurance company about it. If you do not, your insurance may not be valid. Stop driving if you ever have an attack of angina. Once your symptoms are controlled, you can start driving again.

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Holidays and travel

  • Holidays are important and recommended.Organize your journey carefully and allow plenty of time.
  • Take enough tablets for your trip and carry some in your hand luggage.
  • Avoid rushing and carrying heavy pieces of luggage.
  • Air travel should not be a problem.However, if you cannot walk at least 100 yards briskly on the flat without angina or undue breathlessness, you should talk to your doctor before deciding to fly.

Take a rest in the airport lounge so that you are less likely to get angina as you walk to the departure gate. If you think your angina may be brought on by the hect'1c activity of an air port, ask the air line or your travel agent for a medical form to ask the air line for extra help such as early boarding or a wheel chair.

You should avoid hol'1days at high altitudes, especially if your angina is brought on easily, or if you suffer from breathl ess ness.

At Wockhardt, we care for your well being. We strongly recommend practicing prevention and securing health. In a world where lifestyle evolves by the day, it is essential to stay in the pink of health.Wishing you and your family good health and happiness always.

The information in the booklet is not intended as a substitute for medical advice but is to be used as an aid in understanding ailment. Always consult your doctor about your medical condition.

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