Angina pectoris, commonly referred to as angina, is a temporary pain or tightness that starts in the chest and sometimes radiates to other parts of the body, particularly the arms, neck, jaw or back. It comes on suddenly--often in response to exertion, emotional stress or exposure to cold--and is usually of short duration. It is caused by a reduction in blood flow through the coronary arteries, the blood vessels that nourish the heart muscle. This reduced blood flow results in a reduction in oxygen reaching a portion of heart muscle, which, in turn, causes the pain.
Although episodes of chest pain may be very frightening, it should be emphasized that angina is only one of many possible causes. Indigestion, anxiety, muscle disorders, infection or structural abnormalities are just a few of the many causes of chest pain. This is why a number of tests may be required before it is determined that the chest pains are, indeed, angina. Even then, there are different types of angina, and distinguished the specific type involved may be a factor in prescribing the most effective treatment.
Classic Angina Pectoris
The most common form of angina is associated with coronary artery disease. As we grow older, our blood vessels tend to "harden" or lose some of their elasticity, a process known as arteriosclerosis. They also may become narrowed or clogged with deposits of fatty material. These are gradual processes that may go on for years, even decades, without causing any problems or symptoms. But if the narrowing progresses to the stage where 75 percent or more of the artery is blocked, the result may be angina or a feeling of breathlessness. Typically, classic angina is brought on by exertion or other activities that cause the heart to work harder; for example, the increased blood flow required to digest a large meal. Cold weather, emotional upsets or anxiety are other common factors that may provoke angina.
Variant Angina Pectoris
Variant angina is not necessarily related to exercise or other stresses. It may come on while asleep or sitting quietly or performing exercise that is usually well tolerated. This type of chest pain, which is sometimes referred to as Prinzmetal's angina, has puzzled doctors for many years. Recent studies, however, indicate that it is often caused by a spasm or constriction in the coronary artery, which cuts off the blood flow and results in pain like that of classic angina.
Unstable Angina Pectoris
Some patients experience both classic effort-induced angina and variant angina, with attacks coming on during periods of exertion as well as during restful times. Others experience an acceleration of symptoms, with attacks occurring more ad more frequently after less and less exertion. These syndromes are generally referred to as unstable angina, which usually requires more intensive treatment because it is associated with a higher risk of heart attacks than classic, stable angina. It should be noted, however, that heart attacks often occur in people who have never experienced any chest pain, and, conversely, there are many people who live with angina for many years without having a heart attack.
Treatments of Angina Pectoris
In most instances, the angina will subside with rest. If an attack occurs, stop whatever you are doing and rest until it passes. Angina caused by coronary spasm may not respond as well to rest as classic angina. Aside from rest, there are three major approaches to treating angina: life-style changes, drugs and surgery.
Life-Style Changes
If you smoke, you should make every effort to stop. Smoking stimulates the heart to work harder; it also causes other changes that many researchers think may be instrumental in triggering chest pain and heart attacks. People who are overweight are usually advised to gradually lose weight by eating less and exercising more. However, a person with heart disease should not embark on a weight reduction or exercise program without close medical guidance. Avoiding stressful situations or learning relaxation techniques are still other life-style modifications that may be recommended.
Drugs to Treat Angina Pectoris
The two major classes of drugs used to treat angina are nitrates and beta blockers. Nitrates come in several forms: as nitroglycerin or other tablets that may be slipped under the tongue to bring relief during an attack, as an ointment to be absorbed through the skin to prevent or relieve an attack, as long-acting tablets or capsules to be taken orally to prevent an attack. Recently, still another form--a disc to be applied to the skin to provide a steady release of the drug over a period of several hours--has become available.
Beta-blocking drugs help prevent angina attacks by slowing the rate at which the heart beats, thereby reducing the heart's workload and lowering the amount of oxygen it needs. These drugs should be taken exactly as instructed, and should not be stopped abruptly.
A new class of anti-anginal drugs known as calcium-blocking agents appears to be particularly effective in controlling the type of angina associated with coronary spasm. All muscles require varying amounts of calcium in order to constrict; by reducing the amount of calcium that enters the muscle cells in the coronary vessel walls, the spasms that choke off the heart's blood supply may be prevented.
Surgical Treatment
In some patients, coronary bypass surgery may be recommended. This operation entails taking a portion of a vein, usually from the leg, and grafting it to the coronary artery to bypass the clogged area. Many factors are considered in deciding whether or not to operate, including the extent of coronary disease, degree of disability from the angina, and the age and general physical condition of the patient.
Summing Up
Angina is a common manifestation of a progressive narrowing of the coronary blood vessels. It also may be caused by a temporary spasm of these vessels. Most angina patients can be effectively treated through a combination of life-style changes and drugs. No one treatment works for all patients; each person must be evaluated by his or her doctor, who can then prescribe the most effective treatment.
Hospitalization - Admission Procedures
The procedures you follow on admission to a hospital vary from one hospital to another, but basically the process is the same in most institutions in the United States.
Care of the Dying - Role of Friends
The friend can show appreciation of the work being done by the family and offer to stay with the patient if the family needs a little time away from home.
Care of the Dying - Death of an Older Child or an Adolescent
From the age of three years onward, a child begins to understand the concept of death and dying. The dying child feels protective toward his or her parents. Although the child desperately needs to talk about what is going to happen, he or she may never get close to the subject. The child may attach himself or herself to a nurse or physician while still relying on the parents. By doing this, the child is sharing the emotional responsibility. The parents may find this difficult to accept, but must realize that someone else can perhaps give more help by listening dispassionately to the child's fears and anxieties.
