What Is Angina Pectoris?

Angina Pectoris is a chest pain that occurs when the flow of blood and oxygen to the heart muscle is choked or disturbed, especially when the heart arteries are hardened or narrowed. Angina generally occurs in adults aged between 55 and 64 years, with the majority male sex.

There are two types of angina that can attack, namely stable angina and unstable angina. Stable angina is caused by certain triggers such as strenuous exercise, stress, digestive problems, or other medical conditions that push the heart to work harder. Cold weather can also be one of the triggers of angina symptoms occur. Chest pain usually will improve within 5 minutes after resting or taking medication. Although not harmful, stable angina can potentially lead to heart attacks or strokes if not treated properly.

Meanwhile, unstable angina is a chest pain that is felt without a clear initial cause and usually does not improve after resting or taking medication. The pain is experienced longer than stable angina, which is about 30 minutes. This is an emergency and requires immediate medical treatment.

Under certain conditions, the patient may also experience variant angina, or Prinzmetal angina, a severe pain that occurs when a person is at rest. This is triggered by convulsions or temporary narrowing of the arteries, and may subside with medication.

Causes Angina Pectoris
The heart is the main organ in the body, in which the circulation of blood and oxygen must always be smooth so that other organs can work properly. Blood flowed into the heart through two large blood vessels called coronary arteries. In a certain period of time, the arteries at risk of plaque-treated like fat, cholesterol, calcium and other substances that result in narrowed and blocked blood vessels (atherosclerosis). This condition causes the heart muscle to work more, especially during heavy activity, which in turn has the potential to cause symptoms of angina pectoris, or worse is coronary heart disease (CHD) .

The risk of a person experiencing angina pectoris increases as you enter old age, has a hereditary cardiac abnormality or symptoms of angina, and other medical conditions such as hypertension, high cholesterol, and diabetes. In addition, lifestyle is also a factor that can increase risk, such as smoking, excessive alcohol consumption, eating fatty foods, lack of exercise, obesity, and stress.

Symptoms of Angina Pectoris
Angina pectoris is generally characterized by chest pain such as pressure, weight, and dullness. Pain can also spread or only be felt in the left arm, neck, jaw, and back, especially in women. Some other symptoms that can be experienced include:
  • Hard to breathe.
  • Feel the pain like gastric acid (GERD) symptoms.
  • Nausea.
  • Dizzy.
  • Easily tired.
  • Restless.
  • Excessive sweating.
Immediately see a doctor or visit the nearest hospital if chest pain does not subside, even if you are taking rest or taking medication.

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Diagnosis of Angina Pectoris
Angina pectoris is not easy to diagnose because there are some diseases that have the same symptoms, such as gastric acid disease. In addition to performing physical tests and inquiring about the patient's health history and family, the following tests will also be conducted:
  • Blood pressure test using tensimeter to find out if the patient has hypertension.
  • Measure the weight and size of the hip to check if there is an obesity tendency.
  • Blood tests to monitor potential triggers, such as levels of cholesterol, glucose, C-reactive protein (CRP), and liver organ function.
  • Urine test to check the kidney function of the patient.
The following advanced tests may be performed if additional diagnostic references are required:
  • Electrocardiogram (EKG), to check the heart's electrical flow and monitor if there is an interruption in the heart rhythm.
  • Echocardiogram, the heart scan uses sound waves to identify damage to the heart muscle and stagnant blood flow.
  • X-rays and CT scans. This scan is done to check the condition of muscles, blood vessels and heart size, and lungs.
  • Advanced blood test, to check if there is a leak of cardiac enzyme in the blood.
  • Sports tolerance test (ETT), to monitor cardiac tolerance when exercising mild to severe. This test is generally done on a treadmill or static bike.
  • Myocardial perfusion scintigraphy (MPS), to check blood flow to the heart muscle during exercise and during rest, by injecting radioactive substances in the blood vessels and monitored using a special scanning device. MPS in patients who are not able to exercise, can be done by using drugs that can improve the work of the heart as while on the move.
  • Coronary angiogram, to check the condition of the heart arteries by injecting a special dye (contrast material) and monitored by inserting a thin and flexible tube (catheter) through a large blood vessel in the thigh or arm to the heart chamber. Although rare, these tests are at risk of complications such as heart attacks and strokes. Doctors will usually recommend this test if the diagnosis of angina has not been found or the patient has unstable angina.

Treatment of Angina Pectoris
Angina pectoris can be handled with:
  • Lifestyle changes. Patients are generally advised to quit smoking or stay away from cigarette smoke, eat nutritious and low fat foods in small portions, exercise according to doctor's instructions, and maintain glucose levels for diabates. Lifestyle changes are advised not only during treatment, but for the long term for the angina pectoris attack to decrease or stop completely.
  • Drugs When angina attacks, glyceryl trinitrate drugs can be taken to relieve symptoms in a short period of time. Glyceryl trinitrate is included in the nitrate class that serves to soothe and dilate blood vessels to facilitate blood flow to the heart. Side effects like dizziness and redness of the skin may occur. Avoid consuming alcohol, operating heavy equipment, or driving while in this treatment. Glyceryl trinitrate can be taken in two doses, as angina strikes and when symptoms do not subside within 5 minutes. If symptoms are still present, visit the nearest hospital for quick treatment. Glyceryl trinitrate can also be used as a deterrent just before exercising or doing other strenuous activities. Make sure you ask your doctor before taking this medicine. If angina is frequent, your doctor may prescribe one or more of the following medications:
    • Aspirin , including the class of antiplatelet drugs (blood thinners) that work to relieve or avoid blood clots, and reduce the risk of heart attack. Side effects that may be experienced are irritation of the stomach, nausea and digestive problems. Avoid giving these drugs to children or adolescents aged 16 and under before consulting a doctor.
    • Beta blockers (beta blockers), help lower blood pressure by inhibiting the effects of epinephrine or adrenaline hormones that can increase heart rate in excess. It also helps to dilate blood vessels and smooth blood flow. Side effects that may be experienced are easily tired, diarrhea, nausea, and cold sweat.
    • Anti-clotting drugs, used to inhibit blood clots by preventing blood platelet cells from sticking. Side effects that may be experienced are severe dizziness, bleeding, hair loss, and bruises on the skin.
    • Calcium channel blockers (calcium channer blockers). This drug serves to dilate blood vessels by relaxing the muscles of the artery walls. Possible side effects are facial redness, dizziness, and fatigue.
    • Statins, used to inhibit cholesterol-producing enzymes in the liver and reduce the risk of heart attack or stroke. It also helps the body absorb the accumulated cholesterol as a plaque attached to the artery wall, and provides other positive effects. Possible side effects include constipation, diarrhea, and abdominal pain.
    • The angiotensin-converting enzyme (ACE inhibitors), works by inhibiting angiotensin II hormone as a trigger for constriction of blood vessels and lowers blood pressure in the body. These drugs can reduce the blood supply to the kidneys, so it is advisable to check the condition of the kidney through blood and urine tests before and during taking this drug. Side effects that may be experienced are dizziness, fatigue, and dry cough which is generally only temporary.
    • Ivabradine. This medication lowers the rate of heart rate as a beta-blocking drug, but has more security for people with pulmonary infections, or other diseases that are not allowed to take beta-blocking drugs. Side effects that may be experienced are blurred vision or glare for some time. Patients are advised not to drive after taking this drug.
    • Ranolazine , used to relax the heart muscle and improve blood flow. These drugs are commonly prescribed for patients with heart failure and artemia because they do not affect heart rate. Side effects that may be experienced are dizziness, easy fatigue, and constipation.
    • Nicorandril. This drug contains a potassium channel activator that works dilate the arteries and blood circulation to the heart. Nicorandil is commonly used as a substitute for calcium channel inhibitors for patients with certain medical conditions. Side effects that may be experienced are nausea and dizziness.
  • Operation. If the angina pectoris gel does not subside with treatment, surgery may be recommended. There are two types of surgery for the case of angina pectoris, including:
    • Coronary artery bypass graft (CABG). Surgical action is performed by creating a new flow at the point of narrowing or blockage of the arteries through the transplantation of blood vessels from other limbs. This action is usually recommended for people with angina with diabetes, aged over 65 years, and has more than 3 blockages in the arteries.
    • Percutaneous coronary intervention (PCI). Surgical action also called coronary angioplasty is done by inserting a small balloon on the outside of the narrowed artery, and retained using an iron ring (sten) to smooth the blood flow again. This action is not recommended for patients with structural abnormalities of blood vessels.
  • Therapy and other medical measures. If treatment and surgery can not be performed or are not helpful, suggestions for cognitive behavioral therapy or cognitive behaviour therapy (CBT) may be an option. This therapy is done by changing the mindset of the patient with a positive response with the aim of reducing the symptoms associated with stress of the mind and facilitate the healing process. This therapy can also be done if the patient is depressed or anxiety due to symptoms of angina pectoris repeatedly attacked. Sometimes, acupuncture therapy becomes an alternative choice of therapy. It is advisable to consult a doctor before doing so, in order to avoid harmful side effects.

Angina Pectoris Complications
The most dangerous complication that may occur in angina is a heart attack . This condition requires immediate treatment at the hospital. Symptoms that can arise in a heart attack include:
  • Chest pain is suppressed for a long time and repeatedly.
  • Pain spreads to other limbs such as back, shoulders, arms, jaw, teeth, and stomach.
  • Prolonged stomach pain.
  • Feeling uneasy.
  • Experiencing a panic attack.
  • Nausea.
  • Gag.
  • Shortness of breath.
  • A cold sweat.
  • Fainting.
  • Have difficulty talking and moving.

Prevention of Angina Pectoris
Prevention can be done by making lifestyle changes, such as:
  • Quit smoking.
  • Reduce alcohol consumption.
  • Eat low-fat and high-fiber foods, such as brown rice, bread, pasta, vegetables, and fruits.
  • Reduce foods high in saturated and unsaturated fats such as sausages, fatty meats, meat pies, butter, cheese, lard, fried fish, avocados, cookies, biscuits, and foods containing pure coconut oil, palm oil, or olive oil.
  • Reduce salt consumption.
  • Maintain weight.
  • Do light exercise such as brisk walking, swimming, or cycling on a regular basis or as recommended by a doctor. Avoid exhausting sports, such as tennis or soccer.
  • Monitoring blood glucose, cholesterol, and blood pressure on a regular basis.

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