What is angina pectoris ?

Angina (angina pectoris) is chest pain or a temporary feeling of depression, which occurs when the heart muscle deprived of oxygen. Oxygen the heart needs to be determined by the severity of the heart (heart rate of speed and strength). Physical and emotional activity causes the heart to work harder and therefore lead to increased cardiac demand for oxygen. If the arteries are narrowed or blocked blood flow to the muscles that can not meet the needs of the heart for oxygen, then it could happen ischemia and cause pain.


CAUSE
Usually angina is the result of coronary artery disease.

Other causes are:

* Aortic valve stenosis (narrowing of the aortic valve)
* Aortic valve regurgitation (leakage of the aortic valve)
* Subaortik hypertrophic stenosis
* Arterial spasm (contraction while the arteries that occurs suddenly)
* Severe anemia.


SYMPTOMS
Not all people with angina experience ischemia. Ischemia is not accompanied by angina is called silent ischemia. Still not understood why ischemia is sometimes not cause angina. Usually people feel angina as feeling depressed or pain under the breastbone (sternum).

Pain can also be felt in:
- The left shoulder or left arm next to the
- Back
- Throat, jaw or teeth
- The right arm (sometimes).

Many patients describe the feeling as discomfort rather than pain.

Typical is that angina:
- Triggered by physical activity
- Lasted no more than a few minutes
- Would disappear if the patient rest.

Sometimes patients can predict the occurrence of angina after performing certain activities.

Angina is often worse if:
- Physical activity after eating
- Cold weather
- Emotional stress.

Variant Angina
Is the result of coronary artery spasm in the large surface of the heart, called variant as indicated by:
- Pain that occurs when the patient is resting, not when doing physical activity
- Certain changes in the ECG.

Unstable Angina
Angina is a pattern of symptoms changes. Characteristics of angina in a patient usually remains, therefore any change is a serious problem (eg pain becomes more severe, the attacks become more frequent or pain occur when you're resting). Such changes usually show a rapid progression of coronary artery disease, which has occurred due to blockage of a coronary artery or rupture of an atheroma formation .The risk is very high occurrence of heart attacks. Unstable angina is an emergency.


Diagnosis
The diagnosis is mainly based on symptoms. Among even during an attack of angina, physical examination or EKG showed only minimal abnormalities. During an attack, could be slightly increased heart rate, blood pressure increases and can hear the typical changes in the heartbeat through a stethoscope. During an attack, could be found of changes in the ECG, but between attacks, the ECG may show normal results, even in patients with severe coronary artery disease.

If symptoms are typical, the diagnosis is easily established. This type of pain, location and relationship with activities, meals, weather and other factors will facilitate the diagnosis.

Particular examination can help determine the severity of ischemia and the presence of coronary artery disease:

1. Exercise tolerance testing is an examination where the patient walking on a treadmill and monitored by an EKG. This examination can assess the severity of coronary artery disease and heart's ability to respond to ischemia. The results of this examination can also help determine whether or not performed coronary arteriography or surgery.
2. Radionuclide imaging is performed in conjunction with exercise tolerance testing can provide valuable information about angina. The depiction of radionuclides not only strengthen the ischemia, but also determine the areas and extent of the affected heart muscle and show the amount of blood to the heart muscle.
3. Exercise echocardiography is an examination in which an echocardiogram obtained by ultrasonic waves reflected from the heart. This examination may show heart size, heart muscle movement, blood flow through heart valves and valve function. Echocardiogram performed at rest and at peak activity. If there is ischemia, then the pumping motion of the left ventricular wall appears abnormal.
4. Coronary arteriography can be performed if the diagnosis of coronary artery disease or ischemia is uncertain. This check is used to determine the severity of coronary artery disease and to help determine whether coronary artery bypass surgery or angioplasty.
5. Continuous ECG monitoring with Holter monitors showed abnormalities of silent ischemia.
6. Angiography can sometimes find a spasm in the coronary arteries that do not have an atheroma.


TREATMENT
Treatment begins with an effort to prevent coronary artery disease, slowing progresivitasnya or against it by addressing risk factors. The main risk factors (eg increased blood pressure and cholesterol levels), treated as appropriate. The most important risk factor is cigarette smoking could be prevented.

Treatment of angina mainly depends on the weight and stability of symptoms. If symptoms are stable and mild to moderate, the most effective way is to reduce risk factors and take your medicine.

If symptoms worsen quickly, usually the patient immediately treated and given medication in hospital. If symptoms do not disappear with medication, dietary changes and lifestyle, then it could be used angiography to determine whether coronary artery bypass surgery or angioplasty.