Angina pectoris ??

A few week ago my friends suddenly die in her room, she said she just get exhausted and she just want to take a rest for a while. But when she's mom came to wake her up she's already gone. The doctor said it was Angina Pectoris that make she died.

so What is Angina Pectoris?

Angina pectoris, commonly known as angina, is severe chest paindue to ischemia (a lack of blood and hence oxygen supply) of the heart muscle, generally due to obstruction or spasm of the coronary arteries (the heart's blood vessels). Coronary artery disease, the main cause of angina, is due to atherosclerosis of the cardiac arteries. The term derives from the Greek ankhon ("strangling") and the Latin pectus ("chest"), and can therefore be translated as "a strangling feeling in the chest".

It is not common to equate severity of angina with risk of fatal cardiac events. There is a weak relationship between severity of pain and degree of oxygen deprivation in the heart muscle (i.e. there can be severe pain with little or no risk of a heart attack, and a heart attack can occur without pain).

Worsening ("crescendo") angina attacks, sudden-onset angina at rest, and angina lasting more than 15 minutes are symptoms of unstable angina (usually grouped with similar conditions as the acute coronary syndrome). As these may herald myocardial infarction (a heart attack), they require urgent medical attention and are generally treated as a presumed heart attack.

Symptoms

Most patients with angina complain of chest discomfort rather than actual pain: the discomfort is usually described as a pressure, heaviness, tightness, squeezing, burning, or choking sensation.

Go to a hospital emergency department if the patient has any of the following with chest pain:

  * Other symptoms such as:

  o sweating,

  o weakness,

  o faintness,

  o numbness or tingling, or

  o nausea

  * Pain that does not go away after a few minutes

  * Pain that is of concern in any way

Apart from chest discomfort, anginal pains may also be experienced in the epigastrium (upper central abdomen), back, neck, jaw, or shoulders, following skin dermatomes.

Typical locations for radiation of pain are arms (often inner left arm), shoulders, and neck into the jaw.

Angina is typically precipitated by exertion or emotional stress. It is exacerbated by having a full stomach and by cold temperatures. Pain may be accompanied by breathlessness, sweating and nausea in some cases. It usually lasts for about 3 to 5 minutes, and is relieved by rest or specific anti-angina medication. Chest pain lasting only a few seconds is normally not angina.

Myocardial ischemia comes about when the myocardia (the heart muscles) receive insufficient blood and oxygen to function normally either because of increased oxygen demand by the myocardia or by decreased supply to the myocardia. This inadequate perfusion of blood and the resulting reduced delivery of oxygen and nutrients is directly correlated to blocked or narrowed blood vessels.

Some experience "autonomic symptoms" (related to increased activity of the autonomic nervous system) such as nausea, vomiting and pallor.

Major risk factors for angina include cigarette smoking, diabetes, high cholesterol, high blood pressure, sedentary lifestyle and family history of premature heart disease.

A variant form of angina (Prinzmetal's angina) occurs in patients with normal coronary arteries or insignificant atherosclerosis. It is thought to be caused by spasms of the artery. It occurs more in younger women.

Diagnosis

In angina patients who are momentarily not feeling any chest pain, an electrocardiogram (ECG) is typically normal, unless there have been other cardiac problems in the past. During periods of pain, depression or elevation of the ST segment may be observed. To elicit these changes, an exercise ECG test ("treadmill test") may be performed, during which the patient exercises to their maximum ability before fatigue, breathlessness or, importantly, pain supervenes; if characteristic ECG changes are documented (typically more than 1 mm of flat or downsloping ST depression), the test is considered diagnostic for angina. The exercise test is also useful in looking for other markers of myocardial ischaemia: blood pressure response (or lack thereof, particularly a drop in systolic pressure), dysrhythmia and chronotropic response. Other alternatives to a standard exercise test include a thallium scintigram (in patients that cannot exercise enough for the purposes of the treadmill tests, e.g., due to asthma or arthritis or in whom the ECG is too abnormal at rest) or Stress Echocardiography.

In patients in whom such noninvasive testing is diagnostic, a coronary angiogram is typically performed to identify the nature of the coronary lesion, and whether this would be a candidate for angioplasty, coronary artery bypass graft (CABG), treatment only with medication, or other treatments. In patients who are in hospital with unstable angina (or the newer term of "high risk acute coronary syndromes"), those with resting ischaemic ECG changes or those with raised cardiac enzymes such as troponin may undergo coronary angiography directly.

Treatment

NITRATE MEDICATIONSNitroglycerin is usually given during an acute attack of angina. It can be given as a tablet that dissolves under the tongue or as a spray. There are also longer-lasting types that can be used to prevent angina.These may be given as pills, or applied as patches or ointments.
BLOOD THINNERS

A small, daily dose of aspirin has been shown to decrease the risk of heart attack. Patients who have had unstable angina or a heart attack may benefit from the addition of warfarin (ie, coumadin), though there is an increased risk of bleeding with this medication.

BETA-BLOCKERS and CALCIUM-CHANNEL BLOCKERS

When used regularly (not as treatment for acute angina), these medications may reduce the occurrence of angina.

CHOLESTEROL-LOWERING MEDICATIONS

These may prevent the progression of coronary artery disease and may even improve existing coronary artery disease.

ANGIOTENSIN-CONVERTING ENZYME (ACE)INHIBITORS and ANGIOTENSIN RECEPTOR BLOCKERS (ARBs)

These medications lower blood pressure and are especially beneficial for patients who had a heart attack in the past. They also decrease the workload on the heart.

SURGERY

Patients with severe angina or unstable, progressing angina may benefit from:

* Coronary artery bypass graft

* Coronary angioplasty

PREVENTION

If one already has angina, he/she can prevent its onset by being aware of the activities or conditions which tend to bring it on.

If one doesn't have angina, preventing the development and/or progression of coronary artery disease may reduce the chance of getting angina.

Steps to prevent coronary artery disease include managing risk factors:

* Maintain a healthy weight.

* Begin a safe exercise program with the advice of the doctor.

* Stop smoking.

* Eat a healthful diet, one that is low in saturated fat and rich in whole grains, fruits, and vegetables.

* Appropriately treat high blood pressure and/or diabetes.

* Appropriately treat abnormal cholesterol levels or high triglycerides .