Angina – A Health Awareness Campaign for Nigerians

Introduction

Chest pain is a very common complaint in most out-patient clinics around Nigeria. There are many possible causes of chest pain, some requiring urgent medical attention, others not so. Amongst those that require urgent attention is Angina.

What is Angina?

Angina, short for Angina Pectoris, is derived from the Latin word "angina" meaning "infection of the throat", the Greek word "ankhone" meaning "strangling" and the Latin word "pectus" meaning "chest". It can hence be described as a strangling chest pain. Wikipedia defines Angina as a chest pain due to a lack of blood, hence a lack of oxygen supply to the heart muscle, generally due to obstruction or spasm of the blood vessels of the heart.

Causes of Angina

The main, or more common, cause of Angina is Coronary Artery Disease which is due to a build up of cholesterol in the wall of the coronary arteries (arteries that supply oxygenated blood to the heart muscle). This deposition of cholesterol causes a narrowing of the arteries over time, a process called arteriosclerosis, hence resulting in partial obstruction to the flow of oxygenated blood to the heart muscle. Inadequate oxygen supply to the heart is what causes the chest pain. A less common cause is spasm (involuntary contraction) of the muscle of the coronary arterial wall. The walls of arteries contain muscle fibres and any sudden contraction of these muscle fibres can result in a narrowing of the artery which in turn reduces the supply of oxygenated blood to the heart, hence causing Angina. Angina caused by such spasm is known as variant or Prinzmetal angina and typically occurs at rest, mostly in the early mornings. Factors that can predispose one to Angina include: age, cigarette smoking, high blood pressure, diabetes, elevated blood cholesterol levels, obesity, physical inactivity, hereditary and kidney disease. Factors that can exacerbate or provoke Angina include: some medications, smoking and other medical conditions, including heart conditions.

Types of Angina

There are several types of angina but for the purpose of this article I’ll briefly discuss only two: the Stable and Unstable Angina. Stable Angina is the more common type and is usually precipitated by physical exertion or emotional stress but subsides with termination of the precipitating event, hence it’s also known as "effort angina". Unstable Angina, on the other hand, typically occurs at rest or on very minimal exertion, gradually becoming worse and is very unpredictable, possibly culminating in heart attack. It is, hence, also known as "crescendo angina".

Symptoms of Angina

Words commonly used by patients to describe anginal chest pain are heaviness, pressure, strangling, squeezing, tightening, choking and sometimes burning or aching behind the sternum or breast bone. Apart from the chest, the pain of angina could also be felt in the upper central abdomen, mimicking peptic ulcer disease, the back, neck, jaw or the shoulders. Other symptoms include breathlessness, weakness, sweating, nausea and vomiting. These symptoms are usually triggered by physical exertion, like climbing up a flight of stairs, or by emotional stress. It can be exacerbated by having a full stomach or in cold conditions. The pain of angina usually lasts 3 – 5mins before it is relieved by rest or medication. Chest pain lasting only a few seconds is probably not angina.

Diagnosis of Angina

Angina is suspected if a person presents with chest pain or discomfort described as heaviness, tightening or choking, located behind the breast bone or to the left side of the chest, precipitated by exertion or emotional stress and relieved by rest. Angina could also present in an atypical pattern as described above. Typically, an ECG (electrocardiogram) done when there is no pain is usually normal, but an exercise or stress ECG done when the patient is exercising, like walking or jogging on a thread-mill, is usually diagnostic. A stress echocardiography could also be diagnostic. There are other investigations that could be done, but they are beyond the scope of this article.

Treatment of Angina

Possible treatment options include: 1. Rest 2. Nitroglycerin pill under the tongue – this is the main stay of treatment and it works by dilating the coronary arteries and increasing the supply of oxygenated blood to the heart muscle. 3. Beta blockers like propranolol, acebutolol, etc – these work by reducing the workload of the heart, reducing its oxygen demand. 4. Calcium channel blockers like nifedipine, amlodipine, etc – also reduce the workload of the heart. 5. Exercise – gentle and sustained exercise rather than 6. Treatment of co-existing medical conditions like diabetes, hypertension, obesity, elevated cholesterol levels, etc

Dr Ranami Obhuo
http://naijadoctors.blogspot.com

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