A type of chest pain caused by reduced blood flow to the heart.Angina is a symptom of coronary artery disease.

• Retrosternal transient pain, squeezing or pressure like appearing during exertion: radiating to neck, left shoulder or left arm, relieved completely with rest.
• Exercise stress test with ECG shows ST depression by 2 mm but 35 per cent of cases may have normal ECG (those only with single artery involvement).
• Coronary angiography shows stenosis of coronary arteries.
• Radio-isotope studies with thallium 201 are supportive.

Investigation:- ECG ,ECHOCARDIOGRAM ,TMT,TROP-I,CPK,CPK-MB,CORONARY ANGIOGRAPHY,CARDIAC COMPUTERIZED TOMOGRAPHY(CT)SCAN,CARDIAC MRI,CHEST C-RAY,NUCLEAR STRESS TEST.

Treatment:-

During attack:-
-Nitroglycerine under the tongue, acts in 1 to 2 minutes.
-Amyl nitrate pearls, crushed and inhaled acts in 10 seconds.
-Sorbitrate 10 mg or Monosorbitrate tab 20 mg three times daily orally or sublingually. Peritrate 1 tab daily.
-Calmpose 1 tab twice daily.
-Inderal 40 mg tab three times daily or Metoprolol 50-100 mg bd Propranolol (Inderal) is avoided if there is left ventricular failure and bronchial asthma, heart block or low blood pressure.

-Control hyperlipidemia with Gemifibrozil 300 mg 2 caps bd before meals or Lovastatin20-40mg OD /Atrovastan 5/10/20/40 mg od with dinner.

Respiratory angina:-

-Isoptin 1 tab three times a day, Sorbitrate 1 qid.
-Nifedipine 20 mg tds.
-Diltiazem 40-120 mg daily as 30 or 60 mg tds.
-Apply Nitrobid oint 2 percent on 2″ to 3″ of skin
surface and cover with a plastic wrap during sleep.

-Tab Aspirin 75-150 mg/day.

Nocturnal angina:-

-Hypnotex or Valium at bed time.
-Rule out early cardiac decompensation and if so start digoxin and diuretic.
Balloon angioplasty for proximal stenosis (excluding left main) or Nitroglycerine.


Coronary by pass surgery:-


-Disabling angina not responding to drugs.
-Unstable angina with repeated infarctions.
-Major stenosis (50-70%) of the proximal segment with a healthy distal segment.

Unstable angina:-


-Hospitalise in CCU.
-Rule out myocardial infarction.
-Bed rest.
-Oxygen inhalation.
-Tablet Sorbitrate one tab 3 hourly.
-Nifedipine 10 mg tds.
or Tablet Diltiazem 30-60 mg tds.
-Tab Propanolol 40 mg 1-2 tds.
-Tablet Aspirin 1 od.

If no response
Injection Nitroglycerine (nitro-bid) 5 ml IV infusion in 5 per cent Dextrose or normal saline at the rate of 2.5-5 mg/minute and gradually increase it.

Monitor heart rate and BP.

Medical procedures and surgery:-

Lifestyle changes and medications are frequently used to treat stable angina. But medical procedures such as angioplasty, stenting and coronary artery bypass surgery may also be used to treat angina.

  • Angioplasty and stenting. During an angioplasty — also called a percutaneous coronary intervention (PCI) — a tiny balloon is inserted into your narrowed artery. The balloon is inflated to widen the artery, and then a small wire mesh coil (stent) is usually inserted to keep the artery open.This procedure improves blood flow in your heart, reducing or eliminating angina. Angioplasty and stenting is a good treatment option if you have unstable angina or if lifestyle changes and medications don’t effectively treat your chronic, stable angina.
  • Coronary artery bypass surgery. During coronary artery bypass surgery, a vein or artery from somewhere else in your body is used to bypass a blocked or narrowed heart artery. Bypass surgery increases blood flow to your heart and reduces or eliminates angina. It’s a treatment option for both unstable angina as well as stable angina that has not responded to other treatments.
  • External counterpulsation (ECP). With ECP, blood pressure-type cuffs are placed around the calves, thighs and pelvis to increase blood flow to the heart. ECPrequires multiple treatment sessions. The American College of Cardiology, American Heart Association and other heart organizations say ECP may help reduce symptoms in people with refractory angina.

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