What is Angina? And What Is The Cure?


Angina refers to the pain arising from lack of adequate blood supply to the
heart muscle. Typically, it is a crushing pain behind the breastbone in the
center of the chest, brought on by exertion and relieved by rest. It may at
times radiate to or arise in the left arm, neck, jaw, left chest, or back. It
is frequently accompanied by sweating, palpitations of the heart, and generally
lasts a matter of minutes. Similar pain syndromes may be caused by other
diseases, including esophagitis, gall bladder disease, ulcers, and others.
Diagnosis of angina begins with the recognition of the consistent symptoms.
Often an exercise test with radioactive thallium is performed if the diagnosis
is in question, and sometimes even a cardiac catheterization is done if the
outcome is felt necessary to make management decisions. This is a complex area
which requires careful judgment by physician and patient.
Angina is a manifestation of coronary artery disease, the same disease
leading to heart attacks. Coronary artery diseas refers to those syndromes
caused by blockage to the flow of blood in those arteries supplying the heart
muscle itself, i.e., the coronary arteries.
Like any other organ, the heart requires a steady flow of oxygen and nutrients
to provide energy for rmovement, and to maintain the delicate balance of
chemicals which allow for the careful electrical rhythm control of the heart
beat. Unlike some other organs, the heart can survive only a matter of minutes
without these nutrients, and the rest of the body can survive only minutes
without the heart--thus the critical nature of these syndromes.
Causes of blockage range from congenital tissue strands within or over the
arteries to spasms of the muscular coat of the arteries themselves. By far the
most common cause, however, is the deposition of plaques of cholesterol,
platelets and other substances within the arterial walls. Sometimes the buildup
is very gradual, but in other cases the buildup is suddenly increased as a chunk
of matter breaks off and suddenly blocks the already narrowed opening.
Certain factors seem to favor the buildup of these plaques. A strong family
history of heart attacks is a definite risk factor, reflecting some metabolic
derangement in either cholesterol handling or some other factor. Being male,
for reasons probably related to the protective effects of some female hormones,
is also a relative risk. Cigarette smoking and high blood pressure are definite
risks, both reversible in most cases. Risk also increases with age. Elevated
blood cholesterol levels (both total and low density types) are risks, whereas
the high density cholesterol level is a risk only if it is reduced. Possible,
but less well-defined factors include certain intense and hostile or time-
pressured personality types (so-called type A), inactive lifestyle, and high
cholesterol diets.
Medications are increasingly effective for symptom control, as well as
prevention of complications. The oldest and most common agents are the nitrates,
derivatives of nitroglycerine. They include nitroglycerine, isosorbide, and
similar agents. Newer forms include long acting oral agents, plus skin patches
which release a small amount through the skin into the bloodstream over a full
day. They act by reducing the burden of blood returning to the heart from the
veins and also by dilating the coronary arteries themselves. Nitrates are
highly effective for relief and prevention of angina, and sometimes for limiting
the size of a heart attack. Used both for treatment of symptoms as well as
prevention of anticipated symptoms, nitrates are considered by many to be the
mainstay of medical therapy for angina.
The second group of drugs are called "beta blockers" for their ability to
block the activity of the beta receptors of the nervous system. These receptors
cause actions such as blood pressure elevation, rapid heart rate, and forceful
heart contractions. When these actions are reduced, the heart needs less blood,
and thus angina may be reduced.
The newest group of drugs for angina is called the calcium channel blockers.
Calcium channels refer to the areas of the membranes of heart and other cells
where calcium flows in and out, reacting with other chemicals to modulate the
force and rate of contractions. In the heart, they can reduce the force and
rate of contractions and electrical excitability, thereby having a calming
effect on the heart. Although their final place in heart disease remains to be
seen, they promise to play an increasingly important role.
When medications are unsuccessful, or if there is concern about an impending
or potential heart attack, coronary bypass surgery is highly successful in
reducing symptoms. Whether or not it prolongs