Angina Pectoris

Angina Pectoris is the name given to a clinical syndrome used to describe discomfort due to transient myocardial ischaemia. The underlying cause may be Coronary atheroma. Spasm of coronary artery may also be underlying cause.

Factors that worsen Angina

Exercise
Anaemia
Hypertension
Hyperthyroidism
Tachycardia (increased heart rate)
Aortic valve disease

Features of of Angina
It is usually experienced as a sense of oppression or tightness in the middle of the chest ‘like a band round the chest’. It is induced by exertion and relieved by rest and lastsfor a few minutes.
The pain may be accompanied by discomfort in the arms more commonly in the left arm or even wrist or hands. The pain may radiate to neck or jaw or it may be present in the upper abdomen (epigastric region) or even back (interscapular region).
Situations precipitating Angina
Physical exertion like walking, or walking against wind, or while having a bath.
Cold exposure
Intense emotions
Heavy meals
Violent dreams
Lying flat

Relief of pain with Glyceryl trinitrate helps in diagnosis of Angina Pectoris.

Conditions that may mimic Angina Pectoris
Musculoskeleton pains: of the chest and back may at times confuse and create difficulty in the diagnosis of Angina. The pain of muscular origin is not totally relieved by rest and may persist even after rest. Local tenderness is present in case of pain of musculoskeletal in nature.
Pericardial pain: Pain of acute pericarditis is typically in the retrosternal region and often radiates to the neck and shoulders. It may be made worse by deep breath, movement or change of posture. A friction rub known as Pericardial Rub is diagnostic, and is best heard by a stethoscope at the left of lower sternum.
Oesophageal pain: Pain due to oesophagitis has a burning quality and is relieved by taking Antaacids. Oesophagial spasm pain may at times be indistinguishable from angina.

Risk Factors for Coronary Heart Disease

Smoking
Hyperlipidaemia
Hypertension
Diabetes Mellitus
Sedentary Lifestyle
Obesity

Diet defficient in Polyunsaturated fatty acids
Low Vitamin E & C
Blood Coagulation Factors Fibrinogen & Factor VII
High levels of lipoprotein (a), homocysteine, ApoB

Smoking has a definite dose related relationship with Ischaemic heart disease. The risk of death for smokers is highest in younger population.
Hereditary Hypercholesterolaemia ( Raised blood level of Cholesterol) : Patients with hereditary hypercholesterolaemia have high incidence of Coronary disease. Reduction of blood cholesterol has a definite effect in the reduction of morbidity and death from coronary heart disease.
It is estimated that the development of Ischaemic heart disease is controlled by both Genetic and Environmental factors, could be in the ratio of 40:60.
Major manifestations of Coronary Heart disease are Angina Pectoris & Myocardial Infarction

Normal Electrocardiogram