Angina Pectoralis 心绞痛

ANGINA PECTORALIS
 - chest pain with exertion
- 3 types:
a. stable angina - chest pain with exertion, Relieved with Rest. It can predictable.
    - Provoked by 3 E:
      E = Eating
      E = Emotion
      E = Exercise

b. unstable angina - chest pain with exertion, DO NOT Relieved with Rest
   - Need TREAT IMMEDIATELY.

c. Prinztmetal / Variant angina - chest pain in cycle( occurs same time every day); may occur during rest. Due to vasospasm of coronary artery (due to smooth muscle of vessel wall contraction rather than reason of atherosclerosis plaque) --> lead to narrowing of coronary artery.
-In other words, means that PA can happen in the person without history of atherosclerosis,
- It's NOT predictable.
-Its more associate with SAD.
  S = Smoking
  A = Alcohol
  D= Drug Abuse
- Calcium channel Blocker (CCB) is DOC for the vasospasm of C.A.

Causes of AP
- result from heart require more oxygen from available.
- DEMAND > SUPPLY
- Eg. during exercise or work up, a person exerted more works and need more oxygen than supplied, results in lack of oxygen supplied to heart, and consequently lead to myocardium ischemia(lack of oxygen). ---> chest pain arises.

- Its also means coronary artery diseases.
- Refer to formation of atherosclerosis plaque (high rich in cholesterol) in the coronary artery( artery that responsible in delivering oxygen to hearts) ---> narrowing of coronary artery ---> decreases blood and oxygen delivered to heart --> heart receives no adequate oxygen and thus chest pain occurs.
- Sometimes, a heart artery is completed blocked by a plaque or clots. When this occurs, the blood flow to heart STOPS. Without blood,  the cells of affected heart muscles will permanently damaged. That called HEART ATTACK.

Symptoms
- severe chest pain, may radiate to the arms, shoulder, back of body, jaws and necks.
- some even feel indigestion or nausea or vomiting,
- feeling of tightness or heaviness in arms, elbow, and wrists. (mainly in left sides)
- fatigue and shortness of breath,
- symptoms usually occurs when a person exerts lots of physical efforts for few minutes. it goes away when person takes rest or take medications. Sometimes, it may occur during rest.

The signs of heart attack is quite similar to angina pectoralis.
So, How we gonna differentiate both?
there are three main differentiation:
1. the duration longer > 5 minutes,
2. Pain of heart attack is more severe.
3. Medications and rest do not relieve its pain.

However, if left untreated, angina may also lead to heart attack. Initiate treatment immediately once confirmed angina occurs.

Diagnosis??
The doctor may do several tests. An Electrocardiogram (ECG)is used to record heart rhythm.
A stress ECG may be done. during the test, the patient is asked to exercise on the treadmill or bicycle while an ECG is taken. Change in ECG pattern will help doctor to diagnose coronary artery disease.
An ECG is pain free and has no complications.
Complications are rare during stress ECG. if any problems, immediate treatment must be available.
Patient who cannot exercise will be given medication to make heart beat work faster. This medication helps to stimulate exercising.
an Echocardiogram is another test to measure heart structure and function. the doctor analyses its heart function image on the screen. Typically painless.
another test is called nuclear scan is used to study heart function. a small amount of radioactive material is injected into vein, and a camera will take picture of heart. the part of heart that do not getting enough oxygen will be showed up in the picture.