Angina Pectoris

Angina pectoris is the name of the pain, feeling of pressure or heaviness in the chest caused by coronary artery blockage. It happens when the heart muscle does not receive all the blood it needs to supply the heart muscle with oxygen. Angina pectoris is a symptom of myocardial ischemia (ischemia means lack of oxygen). This occurs when one or more arteries (coronary arteries) that provide oxygen to the heart muscle become narrow or blocked. When the heart muscle does not receive enough oxygen, people experience symptoms of angina pectoris. Angina pectoris can also occur in people with heart valve disease. Similarly, it can occur in people with an enlarged heart (hypertrophy) caused by heart disease or uncontrolled hypertension. However, coronary artery blockage is the most common cause of angina pectoris. Symptoms Angina pectoris is often described as an uncomfortable feeling of pressure, fullness, compression or pain in the middle of the chest. This discomfort can also be felt in the neck, jaw, shoulder, back or arm. Patients with angina pectoris may also complain of shortness of breath, nausea and anxiety or a feeling of imminent doom. There are many types of chest pain unrelated to angina pectoris. A few examples are acid reflux, pulmonary infections and pulled muscles. Sometimes it is difficult to differentiate between angina pectoris and chest pain unrelated to the heart. It is important to report your symptoms to your doctors, so that they can help you determine the cause of the symptoms. Angina pectoris can occur during activities with which the heart muscle needs more oxygen. Physical exercise, emotional stress and very hot or cold temperatures are examples of when the heart muscle needs more oxygen. People with angina pectoris are at greater risk of suffering a heart attack.

There are two categories of angina pectoris: stable and unstable.

Stable angina pectoris
Stable angina pectoris causes chest discomfort that occurs at regular intervals. It involves symptoms that tend to occur with the same intensity of physical activity, for example, climbing a flight of stairs. The stress caused by anger or discontent may also cause the symptoms. Patients with symptoms of angina pectoris should undergo an evaluation of their heart disease risk factors performed by their doctor. In addition, the doctor may take a medical history and conduct a physical exam to determine whether the symptoms suggest angina pectoris. If they consider that it is possible that you have angina pectoris, tests are normally done. Most frequently, the first test requested is an electrocardiogram (ECG). Sometimes, a chest X.ray is used to evaluate the size of the heart and to see if there are pulmonary problems that could cause the symptoms. In some people, a stress test with exercise is also needed to see if there is any change in the heart during exercise, or with the administration of medications that subject the heart to stress. An echocardiogram could be performed to take images of the heart and see if there is a structural problem. Catheterization of the heart may be necessary to determine whether a patient's symptoms are caused by the blockage of one or more coronary vessels.

Unstable angina pectoris
People with unstable angina pectoris experience chest pain unexpectedly and unpredictably. The first time that someone has angina pectoris it is usually considered unstable angina because its type is not known. In some patients, the symptoms could occur while they are at rest. The symptoms of unstable angina pectoris may be more severe than those of the stable form. The most common cause of unstable angina pectoris is coronary artery blockage (atherosclerosis), which limits the flow of blood to an area of the heart muscle. Another cause of the symptoms may be abnormal narrowing of an artery or partial blockage by a blood clot. An inflammation or infection can also lead to unstable angina pectoris. Unstable angina pectoris is a medical emergency. Patients with new or unstable angina pectoris should call 911 or their local emergency response service. Unstable angina can precede a heart attack. It can also cause serious heart arrhythmias (irregular heart beats), which in turn could lead to sudden cardiac death.

Prinzmetal's angina (or variant angina pectoris) is caused by coronary artery spasms, which tighten the coronary artery and reduce blood flow. This can cause chest discomfort. This tends to occur at rest. It is often related to atherosclerosis, and the spasms tend to occur near the area of the blockage, which limits the flow of blood more than the blockage itself.

Treatment of angina pectoris

Angina pectoris can be treated with medications that affect the flow of blood to the heart muscle, the heart's oxygen requirements, or both. The medications that affect blood flow are called coronary vasodilators and make the blood vessels relax. When this occurs, the space within the vessels (the lumen) grows larger. The blood flow improves, which allows more oxygen and nutrients to reach the heart muscle. Nitroglycerin is the medication most frequently used. It relaxes the blood vessels throughout the body, especially the veins. It also relaxes the coronary arteries slightly. In relaxing the veins, it decreases the volume of blood that returns to the heart and the heart's workload. By relaxing the coronary arteries, it increases the flow of blood to the heart.

The heart's oxygen requirements can also be adjusted with medications that lower blood pressure. Since the heart does not need to pump blood against so much pressure, the heart's workload and need for oxygen are reduced. Medications that slow the heart rate have a similar effect. For these effects, medications called beta-blockers and calcium antagonists (calcium channel blockers) are used. There are many beta blockers and calcium antagonists. The specific medication used is chosen depending on each patient's individual needs. Patients with angina pectoris often require heart catheterization. This procedure allows doctors to take images of the heart and the blood vessels that carry blood to the coronary muscle (coronary arteries) to see if they are blocked. This information can help your doctor determine whether you need a medication that improves the flow of blood to your heart muscle, whether you need a procedure called percutaneous angioplasty, in which the coronary blood vessel is opened with a special catheter, or whether you need open-heart surgery to restore blood flow to the coronary artery.


Atrial Fibrillation

Atrial fibrillation is a heart disorder in which the upper chambers, called atria, beat irregularly instead of normally. The beats are extremely fast and irregular, essentially a trembling movement. When this occurs, the atria do not pump well, and the blood is not pumped outside the atria toward the ventricles. Then the blood accumulates in the atria and may coagulate. If part of the clot breaks off and circulates with the blood, it starts to flow and may become trapped in an artery and stop the flow of blood to the part of the body to which this artery takes oxygen and nutrients. If it blocks the flow of blood to part of the brain, a stroke occurs.

Treatment of atrial fibrillation

Anticoagulant treatment may prevent clots from forming. In the initial treatment of atrial fibrillation, heparin or any similar medication may be used to reduce the risk of clots forming. These medications act fast. Generally, they are administered intravenously (inside a vein) or by injection. Later on, the medication that is most commonly used to prevent blood clots is warfarin. Warfarin is very effective in reducing the risk of stroke due to atrial fibrillation. Warfarin entails significant risks, and the patient must be carefully monitored by the doctor. Aspirin, although less effective in preventing stroke than warfarin, is also used to reduce this condition. Current studies show that anticoagulant treatment can prevent over half of the 80,000 strokes that occur each year due to atrial fibrillation.

If you have atrial fibrillation, the doctor may recommend that you take an anticoagulant. If you do, you need to know:

  • The risk of hemorrhage may increase. Careful periodic monitoring of blood concentrations and the right dose should be able to control this risk. Your doctor will tell you where to go for the monitoring.
  • When properly administered, it can prevent 20 strokes for every major hemorrhagic complication caused by the medication.
  • Most hemorrhages can be prevented and treated.
  • Certain medications may interfere with proper anticoagulation. Antibiotics and anticonvulsants are examples of medications that can cause problems. Talk to your doctor or pharmacist for him to give you more complete information.

Your doctor may also recommend that you undergo treatment to try to change your atrial fibrillation rhythm to normal. There are certain medications that can be used to try to get the rhythm back to normal. Other patients will need to undergo a procedure called cardioversion in which a discharge is administered to the heart for it to return to a normal rhythm. Medication may be used to try to get the heart to keep beating regularly. Cardiologists sometimes can determine what part of the heart is causing the atrial fibrillation. Then they can perform a procedure called ablation, which destroys this abnormal area of heart tissue and prevents the fibrillation from continuing. If the treatment succeeds in getting the heart back to the normal rhythm, you should be able to stop using anticoagulant medication without increasing your risk of stroke. Your clinical doctor or cardiologist can help you determine which treatment is best for you.


Heart Attack

A heart attack (myocardial infarction) occurs when the blood supply to a part of the heart muscle is seriously decreased or stops. The blood flow decrease or stoppage happens when there is a blockage in one or more of the coronary arteries that take blood to the heart muscle. This tends to occur due to an accumulation of plaque, which is known as arteriosclerosis (or also atherosclerosis). Finally, plaque can tear or break off and cause a blood clot and plug the artery. This causes the heart attack. The blockage of a coronary artery can also be called coronary thrombosis or coronary occlusion. If blood stops coming for more than a few minutes, the muscle cells are permanently damaged and die. This damage to the heart muscle can make the patient die or remain seriously disabled, depending on how much the heart muscle has been damaged.

Sometimes a coronary artery contracts momentarily or suffers a spasm. When this spasm occurs, the artery narrows and the blood flow to part of the heart muscle may decrease or stop. A prolonged severe spasm can cause a heart attack.


High Blood Pressure

Blood pressure is the pressure of the blood against the artery walls. The optimum blood pressure is below 120/80 mm Hg. High blood pressure, or hypertension, is a condition in which blood pressure levels exceed normal values. Blood pressure is indispensable for the blood to circulate throughout the body. If the blood does not circulate, the vital organs cannot receive the oxygen and nutrients they need to function. It is important to be informed about blood pressure and how to keep it at a healthy level. There is not a pair of fixed blood pressure figures, but a range. When the heart beats, it pumps blood to the arteries and creates pressure on them. This pressure comes from two forces. The first force is created when the blood is pumped to the arteries by the circulatory system. The second is created when the arteries resist the flood of blood.

When you are healthy, the arteries are muscular and elastic. They stretch when the heart pumps blood through them. How much they stretch depends on how much force the blood exerts.

Normally, the heart beats 60.80 times per minute. The blood pressure increases with each beat and decreases when the heart relaxes between one beat and the next. The blood pressure can change from one minute to the next, but normally, in an adult person, it should remain below 120/80 mm Hg. Blood pressure that is always between 120±139/80±89 is considered pre-hypertension, and if it is above 140/90 mm Hg, it is considered hypertension.

Systolic/Diastolic
When blood pressure is taken, you are given two figures. These are:

  • Systolic (the higher figure): represents the blood pressure when the heart beats.
  • Diastolic (the lower figure): represents that pressure when the heart rests between one beat and the next.

The systolic pressure is always stated first and the diastolic second. For example: in 120/80 (120 over 80), the systolic pressure is 120 and the diastolic is 80.

A blood pressure of 120.139/80.89 mm Hg is considered pre-hypertension. Blood pressure is considered high if it is 140/90 mm Hg or more.

High blood pressure increases the risk of heart attack, angina pectoris, stroke, heart failure and peripheral artery disease. High blood pressure could also increase the risk of contracting atherosclerosis. The risk of heart failure also increases due to the greater effort that high blood pressure requires of the heart.

Treatment of high blood pressure
Your doctor may choose one or more of the following courses of action to help keep your blood pressure under control.

Diet
High salt-content diets accelerate hypertension as we grow older. Consuming little salt can prove beneficial, especially for people sensitive to salt and the elderly. Even eliminating table salt and cooking salt can be beneficial.

What is recommendable is a diet low in saturated fat and with abundant whole grains, fruits and vegetables. Some suggested foods are: nuts, seeds, carrots, spinach, celery, mushrooms, beans, potatoes, avocados, broccoli and foods that contain a moderate amount of proteins (preferably fish, poultry or soy products).

Losing weight immediately reduces blood pressure and helps reduce the size of the heart. Losing weight can allow patients with mild hypertension to reduce [blood pressure] without risk or perhaps stop taking medication. An adequate amount of minerals such as potassium, magnesium and calcium can help reduce blood pressure. Most people should obtain this mineral through potassium-rich foods, such as potatoes, avocados, bananas, fat-free dairy products, red beads, oranges, prunes and melons. Calcium regulates the tone of the smooth muscle that covers the blood vessels. Hypertension itself causes the body to lose calcium. Vitamin C offers specific benefits for hypertension, since it prevents dangerous effects on nitric acid, the substance that keeps arteries flexible.

Smoking is a significant risk factor. Alcohol consumption can also increase the risk, unless it is consumed in moderation. The consumption of a few cups of coffee a day in healthy individuals is not very likely to cause damage. However, daily consumption of a large amount of caffeine can be dangerous. Hypertensive people should try to avoid caffeine completely.

Exercising regularly can help the arteries stay elastic. This allows for better blood circulation and helps keep blood pressure low. It is recommended to do moderate-intensity exercise to lower blood pressure more effectively than high-intensity exercise.

The medications designed to lower blood pressure can also be used to achieve your blood pressure objective. Your doctor may choose an antihypertensive medication that acts centrally on the heart to lower blood pressure. Otherwise, your doctor may choose an antihypertensive that acts peripherally dilating the arteries to reduce blood pressure. Talk to your doctor about these options.


Tobacco Use and Cardiovascular Diseases

Tobacco use, or the habit of smoking, is one of the main causes of cardiovascular disease. Approximately 30% of deaths due to heart disease in the United States are related to the habit of smoking cigarettes. There are various risk factors for heart diseases that patients can control. These include smoking, high blood pressure, high cholesterol, diabetes, obesity and lack of physical activity. When various risk factors are present, the risk increases greatly.

Tobacco use, even without other risk factors, increases the risk of coronary disease. Tobacco use increases blood pressure, decreases tolerance to exercise and increases the tendency for blood clots to form. It is one of the main causes of atherosclerosis, which is the accumulation of fatty deposits on the artery walls. When plaque is formed in the coronary arteries that take nutrients and oxygen to the heart muscle, the risk of heart attack increases. Tobacco use also increases the risk of coronary disease coming back after a heart bypass ("bypass") surgery. Tobacco use increases blood pressure and heart rate. It lowers the amount of oxygen that reaches the heart. It decreases good cholesterol (HDL). It also increases the risk of blood clots. Tobacco use together with a family history of heart disease seems to increase the risk to a great extent.

Certain studies have demonstrated that smoking is a significant risk factor for stroke (cerebral infarction). This is due to damage in the blood vessels that take blood to the brain, which causes plaque to form and increases the risk of clots forming that can prevent blood from reaching parts of the brain. When this occurs, that part of the brain dies, and that causes the symptoms of stroke. Women who take contraceptive pills and smoke have a much greater risk of cerebral infarct.Tobacco use also creates a greater risk of peripheral artery disease and aortal aneurism.


Stroke

Stroke is a disease due to damage in the blood vessels that take blood to the brain. A stroke occurs when an artery that takes oxygen and nutrients to the brain ruptures or is blocked (generally due to a clot). Due to this rupture or blockage, part of the brain does not receive the blood and oxygen that it needs. In not having oxygen, the neurons (nerve cells) in the affected area die in a few minutes. When the neurons die, the part of the body that they control stops working. The effects of a stroke are often permanent because the dead brain cells cannot be recovered and are not replaced by other cells. There are two types of strokes: ischemic (cerebral embolism) and hemorrhagic (cerebral hemorrhage or blood loss).

Ischemic stroke or cerebral embolism

Ischemic stroke is the most common type of stroke and accounts for 80 per cent of all cases. It is due to the tamponage of a blood vessel. It happens when a clot forms and blocks the flow of blood in an artery that takes blood to a part of the brain. Blood clots generally form when an artery is deteriorated due to the formation of fatty deposits within its walls, which is called atherosclerosis. A blood clot can form in the blood vessels that take blood to the brain due to the plaque blockage caused by the abnormal blood flow around the plaque. When this happens, it is called cerebral thrombosis. They can also form in other blood vessels that are not in the brain. If these clots break off and circulate through the blood, they can remain lodged or stuck in smaller blood vessels in their path, where the blood vessels are too small for them to pass. If the clot remains lodged in a blood vessel that takes blood to a part of the brain, a stroke is caused. This type of stroke is called cerebral embolism. Another place where clots can form is in the heart. This generally happens when the heart beats irregularly. The most common type of irregular heartbeat that causes this is called atrial fibrillation. In this heart problem, the atria (which are the upper chambers of the heart) do not beat regularly but fibrillate or "tremble" irregularly, which causes blood to build up and increases the risk of clots forming. These clots can break off and travel to the brain and cause a cerebral embolism, one type of stroke.

Thrombotic strokes (strokes caused by blood clots) often occur at night or early in the morning. Some thrombotic strokes tend to be preceded by a transitory ischemic attack. This is also known as AIT (TIA, in English) or "warning attack." This condition causes some of the same symptoms as a stroke but these are resolved within 24 hours. Patients who suffered a TIA are at great risk of having a stroke and must be evaluated by a doctor immediately.

Hemorrhagic stroke or cerebral hemorrhage

A hemorrhagic stroke (a stroke due to a hemorrhage in the brain) happens when a blood vessel that takes blood to part of the brain bursts. Hemorrhagic strokes have a much higher death rate than those caused by clots. There are two main causes of hemorrhagic stroke. Subarachnoid hemorrhages occur when a blood vessel on the surface of the brain bursts and bleeds within the space between the brain and the cranium. Cerebral hemorrhages occur when an artery in the brain bursts, allowing the blood to flow to the surrounding tissue. It can also be due to the rupturing of an aneurysm in one of the blood vessels inside the brain. Aneurysms are caused when there are weakened areas in an artery wall. The part where the artery wall is thinner and therefore weaker dilates like an inflated balloon. High blood pressure can worsen this problem. Aneurysms are not always dangerous, but if they are big enough, they are at risk of bursting. If an aneurism bursts in the brain, it causes a hemorrhagic stroke. When a cerebral hemorrhage occurs, the blood does not irrigate part of the brain and the cells do not receive the oxygen they need. The hemorrhage can increase the pressure in the surrounding brain tissue, which can interfere with the way in which the brain works. Serious or mild symptoms can occur, depending on the amount of pressure. The amount of blood lost will determine the seriousness of the symptoms and the amount of pressure on the surrounding brain tissue. In many cases, people who suffer cerebral hemorrhages die as a result of the increase in pressure in the brain. Patients who survive tend to recover better than those who had strokes caused by a clot. This is due to the fact that when a clot blocks a blood vessel, part of the brain dies, and the brain does not regenerate. When a blood vessel in the brain bursts, the pressure of the blood compresses part of the brain but some blood keeps flowing. If some blood keeps flowing, the brain tissue can survive and permanent damage may not occur. If the person survives, the pressure gradually returns to normal. When this occurs, the brain can recover some of its previous functionality.