Angina Pain and Related Cardiovascular Problems

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Angina Pain and Related Cardiovascular Problems

• Ric and Jennifer

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What is Angina Pain?

• A condition often referred to as
• angina pectoris --refers to thoracic pain
  originating from a lack of oxygen to the heart
  muscle (ischemia)
• Described by a feeling of discomfort or heavy
  pressure localized in the chest region

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How it differs from a Heart Attack

• Angina pain is a short pain resulting from the
  muscle temporarily receiving insufficient amounts
  of oxygen
• vs.
• Myocardium infarction results in cardiac arrest
  and permanent damage to the heart muscle, results
  from a complete cut off of oxygen

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Types of Angina

• 1.) Angina of Effort- A medical condition that
  often results from atherosclerosis
• -arteries can supply sufficient oxygen to
  resting heart but fail to do so during periods of
  exercise or stress resulting in a painful
  sensation
• 2.) Variant Angina- An uncommon condition that
  exists independently of atherosclerosis
• -arteries cannot supply enough oxygen to the
  resting heart the condition does not result from
  excessive work by myocardium
• can also occur as a result of eating
  (postprandial) and while sleeping (nocturnal)

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Symptoms of Angina

• Pain/heaviness under the sternum
• Can be experienced elsewhere (back, arms, neck,
  shoulders, or jaw regions)
• Breathlessness and Fatigue
• Increased risk of heart attack

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Causes of Angina

• Excessive exercise and stress when coupled with
  atherosclerosis (effort)
• Insufficient coronary arterial muscle spasms
  (variant)
• The difference between demand and supply of
  blood/oxygen to myocardium
• ---5 of angina cases actually result from a
  predisposed heart demanding an abnormal amount of
  oxygen to function
• more common in the adult population as risk for
  coronary heart disease increases

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Detection Methods

• Physicians
• Electrocardiogram non-invasive (85 accurate)
• Stress Tests
• Angiograms invasive (used in other 15 of cases)

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Electrocardiogram

• Electrocardiogram- useful to confirm Angina pain
  and other abnormal features
• -must be coupled with some sort of stress test
  (before, during, and after)
• Echocardiogam- associates symptoms and ECG levels
  during a 24 hour period
• (used with nocturnal angina)

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Angiogram

• a virtual x-ray of coronary arteries
• Image is derived by the placement of a catheter
  in a major coronary artery
• Dye is injected to see the blood flow to the
  heart
• Most accurate and effective way to determine
  presence and severity of angina

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Risk Factors

• Cigarette Smoking (results in atheroma)
• High cholesterol intake (results in atheroma)
• Extreme temperatures
• Emotional Stress
• Alcohol Abuse
• Heredity ethnic predispositions/diabetes
• Personality Type

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Treatments

• Often can be alleviated within minutes by
  relaxation/resting
• Intake of prescribed angina medications often
  consisting of nitroglycerin (reduces ischemia)
• Reduce risk factors through conventional
  treatments
• Surgical procedures increase blood flow to the
  heart

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Conventional Treatments

• Exercise/yoga and even massage therapy have been
  said to alleviate painful effects
• Behavioral counseling-reduce cholesterol,
  smoking, drinking, and obesity (i.e.- diet)
• Nitroglycerin meds.- increases diameter of blood
  vessels (taken orally or transdermally)
• Beta blockers- decrease demand and workload of
  myocardium

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Surgical Treatments

• Coronary Bypass Surgery- blood vessel from leg
  often grafted on the blocked artery, increasing
  blood flow
• Balloon angioplasty- catheter with small balloon
  placed into coronary artery to expand blood
  vessel
• Angioplasty and bypass surgery often followed by
  behavioral counseling to reduce risk factors like
  obesity

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Final Thought

• We must take preventative efforts to help reduce
  the presence of Coronary Artery Disease, as it is
  the underlying cause of angina pain

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Road Map

• Coronary Heart Disease
• What is it?
• Risk Factors
• Unavoidable
• Treatable or changeable
• Myocardial Infarctions
• What is it?
• Symptoms
• Treatment options

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What is Heart Disease?

• Called Coronary Heart Disease or Coronary Artery
  Disease
• Diagnosed when arteries that supply blood to
  heart muscle becomes hardened and narrowed
• Caused by plaque on inner walls and called
  atherosclerosis
• Eventually Heart suffers from lack of oxygen and
  causes
• Angina
• Heart Attack (Myocardial infarction)

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Clogged arteries
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Who can develop Heart Disease?

• Unavoidable Risk Factors
• Age
• Sex
• Heredity
• Treatable Risk Factors
• Smoking
• High Blood Pressure
• High Blood Cholesterol
• Physical Activity
• Obesity
• Diabetes

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Unavoidable Risk Factors

• Increasing Age Fact of life, everyone gets
  older. 83 of people who die from Heart Disease
  is over 65
• Being male Have a greater risk and die younger
• Heredity -- Children with parents suffering
  from Heart Disease African Americans greater
  risk of High Blood Pressure and Heart Disease

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Risk Factors that can be changed or treated

• Smoking Smokers have increased risk 2-4 times
  greater than non-smokers
• High Blood Cholesterol The greater amount of
  cholesterol greater increase risk of heart
  disease
• High Blood Pressure Greater the pressure, the
  harder the heart must work, causing heart to
  thicken and stiffer

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Treatable Risk Factors (cont)

• Physical Inactivity inactive lifestyle
  increases risk of heart disease regular
  moderate-to-vigorous physical activity helps
  prevent heart and blood vessel disease
• Obesity and overweight people with excess body
  fat are more likely to develop heart disease and
  strokes
• Diabetes mellitus Even when glucose levels are
  under control, there is still an increased risk,
  but risk is greater if left untreated

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Predicting who will develop heart disease

• Subjects 2489 men and 2856 women 30 to 74 yrs.
  Old
• Baseline reading
• 12 years later
• Subjects 383 men and 227 women developed heart
  disease
• Those with heart disease were associated with
  high blood pressure, total cholesterol, LDL and
  HDL, sex,
• Used prediction equation to predict likelihood of
  developing disease
• Age, diabetes, smoking, blood pressure, total
  cholesterol, and LDL

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Results And Discussion

• 28 of male and 29 female cases attributed to
  blood pressure levels that exceeded normal
  high130/85
• 27 of male and 34 female cases attributed to
  high total cholesterol (greater than 200 mg/dL)
• Study confirmed the medical guidelines for blood
  pressure, total Cholesterol, and LDL as accurate
  for predicting risk of middle-aged white
  population

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Myocardial Infarctions

• Also known as an MI or heart attack
• Happens when the blood supply to the heart is
  blocked long enough to cause death of heart
  tissues
• If enough permanent damage occurs, the patient
  may die

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Myocardial Infarction
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Symptoms of MI

• Angina
• Pain or discomfort in upper arms, left shoulder,
  back, neck, jaw or stomach
• Difficulty Breathing
• Sweating or cold sweat
• Fullness, indigestion, or heartburn
• Feeling Lightheaded
• Extreme weakness
• Rapid, irregular heart rate

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Treatment Options

• Before getting to the hospital
• Quick response time is critical
• Call 911 if observe symptoms and do CPR if
  necessary
• Can take asprin, heprin, antiplatelet drugs,
  therombic therapy
• At the hospital
• Angioplasty
• Bypass surgery

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References

• Larson, J.P. (2006) Angina. Encyclopedia of
  Medicine.
• Satyamurthy, I. Sharma, V. (2004). What is
  Angina? DoctorNDTV, Aug. 13.
• Peter W. F., Wilson MD, Ralph B. ,DAgostino
  PhD, Levy MD, Belanger BS, Sibershatz PhD, Kannel
  MD. (1998). Prediction of Coronary Heart Disease
  Using Risk Factor Categories. Circulation 97,
  1837-1847. Retrieved November 6, 2006 from
  http//circ.ahajournals.org/cgi/reprint/97/18/1837
  .pdf.
• http//en.wikipedia.org/wiki/Myocardial_infarction
  
• http//www.clevelandclinic.org/heartcenter/pub/gui
  de/disease/cad/mi_symptoms.htm