Angina Pain and Related Cardiovascular Angina Pain and Related Cardiovascular ProblemsProblems

What is Angina Pain?What is Angina Pain?

A condition often referred to as A condition often referred to as

““angina pectoris” --refers to thoracic pain angina pectoris” --refers to thoracic pain originating from a lack of oxygen to the originating from a lack of oxygen to the heart muscle (ischemia) heart muscle (ischemia)

Described by a feeling of discomfort or Described by a feeling of discomfort or heavy pressure localized in the chest regionheavy pressure localized in the chest region

How it differs from a Heart Attack…How it differs from a Heart Attack…

Angina pain is a short pain resulting from the Angina pain is a short pain resulting from the muscle temporarily receiving insufficient muscle temporarily receiving insufficient amounts of oxygenamounts of oxygen

vs.vs.Myocardium infarction results in cardiac Myocardium infarction results in cardiac

arrest and permanent damage to the heart arrest and permanent damage to the heart muscle, results from a complete cut off of muscle, results from a complete cut off of oxygenoxygen

Types of Angina Types of Angina

1.) Angina of Effort- A medical condition that often results from 1.) Angina of Effort- A medical condition that often results from

atherosclerosisatherosclerosis

--arteries can supply sufficient oxygen to resting heart but fail to do so arteries can supply sufficient oxygen to resting heart but fail to do so during periods of exercise or stress resulting in a painful sensation during periods of exercise or stress resulting in a painful sensation

2.) 2.) Variant Angina- An uncommon condition that exists independently of Variant Angina- An uncommon condition that exists independently of atherosclerosis atherosclerosis

-arteries cannot supply enough oxygen to the -arteries cannot supply enough oxygen to the resting resting heart; the condition heart; the condition does not result from excessive work by myocardiumdoes not result from excessive work by myocardium

*can also occur as a result of eating (postprandial) and while sleeping *can also occur as a result of eating (postprandial) and while sleeping (nocturnal)(nocturnal)

Symptoms of AnginaSymptoms of Angina

Pain/heaviness under the sternum Pain/heaviness under the sternum Can be experienced elsewhere (back, Can be experienced elsewhere (back,

arms, neck, shoulders, or jaw regions)arms, neck, shoulders, or jaw regions)Breathlessness and FatigueBreathlessness and FatigueIncreased risk of heart attackIncreased risk of heart attack

Causes of Angina Causes of Angina

Excessive exercise and stress when Excessive exercise and stress when coupled with atherosclerosis coupled with atherosclerosis (effort)(effort)

Insufficient coronary arterial muscle Insufficient coronary arterial muscle spasms spasms (variant)(variant)

The difference between demand and The difference between demand and supply of blood/oxygen to myocardiumsupply of blood/oxygen to myocardium

---5% of angina cases actually result from a predisposed heart demanding an ---5% of angina cases actually result from a predisposed heart demanding an abnormal amount of oxygen to functionabnormal amount of oxygen to function

*more common in the adult population as risk for coronary heart disease *more common in the adult population as risk for coronary heart disease increasesincreases

Detection MethodsDetection Methods

Physicians Physicians

Electrocardiogram –non-invasive Electrocardiogram –non-invasive (85% accurate)(85% accurate)

Stress Tests Stress Tests

Angiograms –invasive Angiograms –invasive (used in other 15% of cases)(used in other 15% of cases)

Electrocardiogram Electrocardiogram

Electrocardiogram*- useful to confirm Electrocardiogram*- useful to confirm Angina pain and other abnormal featuresAngina pain and other abnormal features

-must be coupled with some sort of stress -must be coupled with some sort of stress test (before, during, and after)test (before, during, and after)

Echocardiogam- associates symptoms Echocardiogam- associates symptoms and ECG levels during a 24 hour period and ECG levels during a 24 hour period

(used with nocturnal angina)(used with nocturnal angina)

Angiogram Angiogram

a virtual x-ray of coronary arteriesa virtual x-ray of coronary arteriesImage is derived by the placement of a Image is derived by the placement of a

catheter in a major coronary arterycatheter in a major coronary arteryDye is injected to “see” the blood flow to Dye is injected to “see” the blood flow to

the heart the heart *Most accurate and effective way to *Most accurate and effective way to

determine presence and severity of anginadetermine presence and severity of angina

Risk FactorsRisk Factors

Cigarette Smoking Cigarette Smoking (results in atheroma)(results in atheroma)

High cholesterol intake High cholesterol intake (results in atheroma)(results in atheroma)

Extreme temperaturesExtreme temperaturesEmotional StressEmotional StressAlcohol AbuseAlcohol AbuseHeredity …ethnic predispositions/diabetes Heredity …ethnic predispositions/diabetes Personality TypePersonality Type

TreatmentsTreatments

Often can be alleviated within minutes by Often can be alleviated within minutes by relaxation/resting relaxation/resting

Intake of prescribed angina medications Intake of prescribed angina medications often consisting of nitroglycerin often consisting of nitroglycerin (reduces ischemia)(reduces ischemia)

Reduce risk factors through conventional Reduce risk factors through conventional treatmentstreatments

Surgical procedures increase blood flow to Surgical procedures increase blood flow to the heartthe heart

Conventional TreatmentsConventional Treatments

Exercise/yoga and even massage therapy Exercise/yoga and even massage therapy have been said to alleviate painful effectshave been said to alleviate painful effects

Behavioral counseling-reduce cholesterol, Behavioral counseling-reduce cholesterol, smoking, drinking, and obesity (i.e.- diet)smoking, drinking, and obesity (i.e.- diet)

Nitroglycerin meds.- increases diameter of Nitroglycerin meds.- increases diameter of blood vessels blood vessels (taken orally or transdermally)(taken orally or transdermally)

Beta blockers- decrease demand and Beta blockers- decrease demand and workload of myocardiumworkload of myocardium

Surgical TreatmentsSurgical Treatments

Coronary Bypass Surgery- blood vessel Coronary Bypass Surgery- blood vessel from leg often grafted on the blocked from leg often grafted on the blocked artery, increasing blood flow artery, increasing blood flow

Balloon angioplasty- catheter with small Balloon angioplasty- catheter with small balloon placed into coronary artery to balloon placed into coronary artery to expand blood vesselexpand blood vessel

Angioplasty and bypass surgery often Angioplasty and bypass surgery often followed by behavioral counseling to followed by behavioral counseling to reduce risk factors like obesity reduce risk factors like obesity

Final ThoughtFinal Thought

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

angina pain *angina pain *

Road MapRoad MapCoronary Heart DiseaseCoronary Heart Disease– What is it?What is it?

Risk FactorsRisk Factors– UnavoidableUnavoidable– Treatable or changeableTreatable or changeable

Myocardial InfarctionsMyocardial Infarctions– What is it?What is it?– SymptomsSymptoms– Treatment optionsTreatment options

What is Heart Disease?What is Heart Disease?

Called Coronary Heart Disease or Coronary Called Coronary Heart Disease or Coronary Artery DiseaseArtery Disease

Diagnosed when arteries that supply blood to Diagnosed when arteries that supply blood to heart muscle becomes hardened and narrowedheart muscle becomes hardened and narrowed– Caused by plaque on inner walls and called Caused by plaque on inner walls and called

atherosclerosisatherosclerosis– Eventually Heart suffers from lack of oxygen and causesEventually Heart suffers from lack of oxygen and causes

AnginaAnginaHeart Attack (Myocardial infarction)Heart Attack (Myocardial infarction)

Clogged arteriesClogged arteries

Who can develop Heart Disease?Who can develop Heart Disease?

Unavoidable Risk FactorsUnavoidable Risk Factors– AgeAge– SexSex– HeredityHeredity

Treatable Risk FactorsTreatable Risk Factors– SmokingSmoking– High Blood PressureHigh Blood Pressure– High Blood CholesterolHigh Blood Cholesterol– Physical ActivityPhysical Activity– Obesity Obesity – DiabetesDiabetes

Unavoidable Risk FactorsUnavoidable Risk Factors

Increasing AgeIncreasing Age – Fact of life, everyone – Fact of life, everyone gets older. 83 % of people who die from gets older. 83 % of people who die from Heart Disease is over 65Heart Disease is over 65

Being maleBeing male – Have a greater risk and die – Have a greater risk and die youngeryounger

HeredityHeredity -- Children with parents -- Children with parents suffering from Heart Disease; African suffering from Heart Disease; African Americans greater risk of High Blood Americans greater risk of High Blood Pressure and Heart DiseasePressure and Heart Disease

Risk Factors that can be changed or Risk Factors that can be changed or treatedtreated

SmokingSmoking – Smokers have increased risk 2-4 – Smokers have increased risk 2-4 times greater than non-smokerstimes greater than non-smokers

High Blood CholesterolHigh Blood Cholesterol – The greater – The greater amount of cholesterol greater increase risk of amount of cholesterol greater increase risk of heart diseaseheart disease

High Blood PressureHigh Blood Pressure – Greater the – Greater the pressure, the harder the heart must work, pressure, the harder the heart must work, causing heart to thicken and stiffercausing heart to thicken and stiffer

Treatable Risk Factors (cont)Treatable Risk Factors (cont)

Physical InactivityPhysical Inactivity – inactive lifestyle increases – inactive lifestyle increases risk of heart disease; regular moderate-to-risk of heart disease; regular moderate-to-vigorous physical activity helps prevent heart and vigorous physical activity helps prevent heart and blood vessel diseaseblood vessel disease

Obesity and overweightObesity and overweight – people with excess – people with excess body fat are more likely to develop heart disease body fat are more likely to develop heart disease and strokesand strokes

Diabetes mellitusDiabetes mellitus – Even when glucose levels – Even when glucose levels are under control, there is still an increased risk, are under control, there is still an increased risk, but risk is greater if left untreatedbut risk is greater if left untreated

Predicting who will develop heart diseasePredicting who will develop heart disease

Subjects: 2489 men and 2856 women 30 to 74 Subjects: 2489 men and 2856 women 30 to 74 yrs. Oldyrs. Old– Baseline readingBaseline reading– 12 years later12 years later

Subjects 383 men and 227 women developed heart diseaseSubjects 383 men and 227 women developed heart diseaseThose with heart disease were associated with high blood Those with heart disease were associated with high blood

pressure, total cholesterol, LDL and HDL, sex, pressure, total cholesterol, LDL and HDL, sex, Used prediction equation to predict likelihood of developing Used prediction equation to predict likelihood of developing

diseasedisease– Age, diabetes, smoking, blood pressure, total cholesterol, and LDL Age, diabetes, smoking, blood pressure, total cholesterol, and LDL

Results And DiscussionResults And Discussion

28 % of male and 29 % female cases attributed to 28 % of male and 29 % female cases attributed to blood pressure levels that exceeded normal blood pressure levels that exceeded normal high130/85high130/85

27 % of male and 34 % female cases attributed to 27 % of male and 34 % female cases attributed to high total cholesterol (greater than 200 mg/dL)high total cholesterol (greater than 200 mg/dL)

Study confirmed the medical guidelines for blood Study confirmed the medical guidelines for blood pressure, total Cholesterol, and LDL as accurate pressure, total Cholesterol, and LDL as accurate for predicting risk of middle-aged white populationfor predicting risk of middle-aged white population

Myocardial InfarctionsMyocardial Infarctions

Also known as an MI or heart attackAlso known as an MI or heart attackHappens when the blood supply to the heart is Happens when the blood supply to the heart is

blocked long enough to cause death of heart blocked long enough to cause death of heart tissuestissues

If enough permanent damage occurs, the If enough permanent damage occurs, the patient may die patient may die

Myocardial InfarctionMyocardial Infarction

Symptoms of MISymptoms of MI

AnginaAnginaPain or discomfort in upper arms, left shoulder, Pain or discomfort in upper arms, left shoulder,

back, neck, jaw or stomachback, neck, jaw or stomachDifficulty BreathingDifficulty BreathingSweating or “cold sweat”Sweating or “cold sweat”Fullness, indigestion, or heartburnFullness, indigestion, or heartburnFeeling LightheadedFeeling LightheadedExtreme weakness Extreme weakness Rapid, irregular heart rateRapid, irregular heart rate

Treatment OptionsTreatment Options

Before getting to the hospitalBefore getting to the hospital– Quick response time is criticalQuick response time is critical– Call 911 if observe symptoms and do CPR if Call 911 if observe symptoms and do CPR if

necessarynecessary– Can take asprin, heprin, antiplatelet drugs, Can take asprin, heprin, antiplatelet drugs,

therombic therapytherombic therapyAt the hospitalAt the hospital– AngioplastyAngioplasty– Bypass surgeryBypass surgery