Semey State Medical University Department Russian and

Semey State Medical University. Department : Russian and Foreign Languages. IWS “ Angina Pectoris”. Execute: Kenzhaeva J. GMF, 215 gr. Checked up: Tyneyeva Z. A. 2012

Plan. 1. Introduction. l 2. Pathophysiology. l 3. Types of angina. l 4. Signs and Symptoms. l 5. Treatment. l 6. Eduction. l

Introduction. l Angina is a term for chest pain caused by an inadequate supply of blood and oxygen to the heart. More than 7 million people in the United States are thought to have angina. It is often associated with the narrowed arteries found in coronary artery disease (CAD). This narrowing is caused by the buildup of plaques in the arteries, due to a process called atherosclerosis.

Pathophysiology. l Angina results when there is an imbalance between the heart's oxygen demand supply. This imbalance can result from an increase in demand (e. g. during exercise) without a proportional increase in supply (e. g. due to obstruction or atherosclerosis of the coronary arteries).

Types of angina. l l There are three main types of angina: Stable angina is characterized by predictable patterns of symptoms and periods of discomfort that occur during exercise or periods of stress. This pain is usually relieved with rest and/or treatment with nitroglycerin or another appropriate medication. Many people with this type of angina can live a relatively normal life for many years, but some will progress over time, or relatively rapidly, to unstable angina.

l Unstable angina, one of the acute coronary syndromes that includes heart attack, is characterized by a change in the pattern of angina episodes, occurring more frequently, at rest, and/or not responding to treatment. It is usually a sign that the person's condition is worsening. The pain someone experiences with unstable angina may be more severe and prolonged than that of stable angina. People with unstable angina are at increased risk of a heart attack, severe cardiacarrhythmia, and cardiac arrest. This is an acute emergency and should be evaluated and treated immediately. The first episode of angina that a person ever experiences is also called unstable angina.

l Variant angina (Prinzmetal's angina) almost always occurs during periods of rest, usually at night. The cause is a spasm of a coronary artery. Many people who have this type also have severe atherosclerosis in at least one major blood vessel on the heart. It can also occur, although much less often, in people with heart valve disease or uncontrolled high blood pressure (hypertension), and may be seen with the use of cocaine and methamphetamines.

Signs and Symptoms. l Symptoms of angina appear and then may or may not disappear when the person is at rest. A person may have chest pain, discomfort and/or pressure, or experience referred pain – pain that is felt in the left shoulder, arm, back, or jaw. Angina may be more difficult to identify in some elderly people when they have symptoms such as abdominal pain after eating (due to increased blood demand for digestion)

Treatment. l The most specific medicine to treat angina is nitroglycerin. It is a potent vasodilator that makes more oxygen available to the heart muscle. Betablockers and calcium channel blockers act to decrease the heart's workload, and thus its requirement for oxygen. Nitroglycerin should not be given if certain inhibitors such as Sildenafil (Viagra), Tadalafil (Cialis), or Vardenafil (Levitra) have been taken by the casualty within the previous 12 hours as the combination of the two could cause a serious drop in blood pressure. Treatments are balloon angioplasty, in which the balloon is inserted at the end of a catheter and inflated to widen the arterial lumen. Stents to maintain the arterial widening are often used at the same time. Coronary bypass surgery involves bypassing constricted arteries with venous grafts. This is much more invasive thanangioplasty.

l The main goals of treatment in angina pectoris are relief of symptoms, slowing progression of the disease, and reduction of future events, especially heart attacks and, of course, death. Beta blockers (e. g. , carvedilol, propranolol, atenolol) have a large body of evidence in morbidity and mortality benefits (fewer symptoms, less disability and longer life) and shortacting nitroglycerin medications have been used since 1879 for symptomatic relief of angina.

Exercise is also a very good long term treatment for the angina (but only particular regimens - gentle and sustained exercise rather than intense short bursts), probably working by complex mechanisms such as improving blood pressure and promoting coronary artery collateralisation. l Identifying and treating risk factors for further coronary heart disease is a priority in patients with angina. This means testing for elevated cholesterol and other fats in the blood, diabetes and hypertension (high blood pressure), encouraging stopping smoking and weight optimisation. l

l The calcium channel blocker nifedipine prolongs cardiovascular event- and procedurefree survival in patients with coronary artery disease. New overt heart failures were reduced by 29% compared to placebo; however, the mortality rate difference between the two groups was statistically insignificant.

l or have back or shoulder pain (which may be attributed to arthritis). The amount of activity that is required to trigger an episode of angina and the symptoms involved vary from person to person and may also vary between episodes and over time. Since coronary artery disease tends to be progressive, angina may worsen over time – either with more severe symptoms, more frequent episodes, and/or less response to rest and treatment.

Eduction. l Roughly 6. 3 million Americans are estimated to experience angina. Angina is more often the presenting symptom of coronary artery disease in women than in men. The prevalence of angina rises with increasing age, with a mean age of onset of 62. 3 years. After five years post-onset, 4. 8% of individuals with angina subsequently died from coronary heart disease. Men with angina were found to have an increased risk of subsequent acute myocardial infarction and coronary heart disease related death than women. Similar figures apply in the remainder of the

l Western world. All forms of coronary heart disease are much less-common in the Third World, as its risk factors are much more common in Western and Westernized countries; it could therefore be termed a disease of affluence. The adoption of a rich, Westernized diet and subsequent increase of smoking, obesityand other risk factors, as chronicled in The China Study, has already led to an increase in angina and related diseases in countries such as China.

Literature. 1. http: //en. wikipedia. org/wiki/Angina_pecto ris#Treatment l 2. http: //labtestsonline. org/understanding/c onditions/angina l