Angina Pain and Related Cardiovascular Problems

1. Angina Pain and Related Cardiovascular Problems

2. What is Angina Pain? • A condition often referred to as “angina pectoris” --refers to thoracic pain originating from a lack of oxygen to the heart muscle (ischemia) • Described by a feeling of discomfort or heavy pressure localized in the chest region

3. How it differs from a Heart Attack… • Angina pain is a short pain resulting from the muscle temporarily receiving insufficient amounts of oxygen vs. • Myocardium infarction results in cardiac arrest and permanent damage to the heart muscle, results from a complete cut off of oxygen

4. Types of Angina 1.) Angina of Effort- A medical condition that often results from atherosclerosis -arteries can supply sufficient oxygen to resting heart but fail to do so during periods of exercise or stress resulting in a painful sensation 2.) Variant Angina- An uncommon condition that exists independently of atherosclerosis -arteries cannot supply enough oxygen to the resting heart; the condition does not result from excessive work by myocardium *can also occur as a result of eating (postprandial) and while sleeping (nocturnal)

5. Symptoms of Angina • Pain/heaviness under the sternum • Can be experienced elsewhere (back, arms, neck, shoulders, or jaw regions) • Breathlessness and Fatigue • Increased risk of heart attack

6. Causes of Angina • Excessive exercise and stress when coupled with atherosclerosis (effort) • Insufficient coronary arterial muscle spasms (variant) • The difference between demand and supply of blood/oxygen to myocardium ---5% of angina cases actually result from a predisposed heart demanding an abnormal amount of oxygen to function *more common in the adult population as risk for coronary heart disease increases

7. Detection Methods • Physicians • Electrocardiogram –non-invasive (85% accurate) • Stress Tests • Angiograms –invasive (used in other 15% of cases)

8. Electrocardiogram • Electrocardiogram*- useful to confirm Angina pain and other abnormal features -must be coupled with some sort of stress test (before, during, and after) • Echocardiogam- associates symptoms and ECG levels during a 24 hour period (used with nocturnal angina)

9. Angiogram • a virtual x-ray of coronary arteries • Image is derived by the placement of a catheter in a major coronary artery • Dye is injected to “see” the blood flow to the heart • *Most accurate and effective way to determine presence and severity of angina

10. Risk Factors • Cigarette Smoking (results in atheroma) • High cholesterol intake (results in atheroma) • Extreme temperatures • Emotional Stress • Alcohol Abuse • Heredity …ethnic predispositions/diabetes • Personality Type

11. Treatments • Often can be alleviated within minutes by relaxation/resting • Intake of prescribed angina medications often consisting of nitroglycerin (reduces ischemia) • Reduce risk factors through conventional treatments • Surgical procedures increase blood flow to the heart

12. Conventional Treatments • Exercise/yoga and even massage therapy have been said to alleviate painful effects • Behavioral counseling-reduce cholesterol, smoking, drinking, and obesity (i.e.- diet) • Nitroglycerin meds.- increases diameter of blood vessels (taken orally or transdermally) • Beta blockers- decrease demand and workload of myocardium

13. Surgical Treatments • Coronary Bypass Surgery- blood vessel from leg often grafted on the blocked artery, increasing blood flow • Balloon angioplasty- catheter with small balloon placed into coronary artery to expand blood vessel • Angioplasty and bypass surgery often followed by behavioral counseling to reduce risk factors like obesity

14. Final Thought *We must take preventative efforts to help reduce the presence of Coronary Artery Disease, as it is the underlying cause of angina pain *

15. Road Map • Coronary Heart Disease • What is it? • Risk Factors • Unavoidable • Treatable or changeable • Myocardial Infarctions • What is it? • Symptoms • Treatment options

16. What is Heart Disease? • Called Coronary Heart Disease or Coronary Artery Disease • Diagnosed when arteries that supply blood to heart muscle becomes hardened and narrowed • Caused by plaque on inner walls and called atherosclerosis • Eventually Heart suffers from lack of oxygen and causes • Angina • Heart Attack (Myocardial infarction)

17. Clogged arteries

18. Who can develop Heart Disease? • Unavoidable Risk Factors • Age • Sex • Heredity • Treatable Risk Factors • Smoking • High Blood Pressure • High Blood Cholesterol • Physical Activity • Obesity • Diabetes

19. Unavoidable Risk Factors • Increasing Age – Fact of life, everyone gets older. 83 % of people who die from Heart Disease is over 65 • Being male – Have a greater risk and die younger • Heredity -- Children with parents suffering from Heart Disease; African Americans greater risk of High Blood Pressure and Heart Disease

20. Risk Factors that can be changed or treated • Smoking – Smokers have increased risk 2-4 times greater than non-smokers • High Blood Cholesterol – The greater amount of cholesterol greater increase risk of heart disease • High Blood Pressure – Greater the pressure, the harder the heart must work, causing heart to thicken and stiffer

21. Treatable Risk Factors (cont) • Physical Inactivity – inactive lifestyle increases risk of heart disease; regular moderate-to-vigorous physical activity helps prevent heart and blood vessel disease • Obesity and overweight – people with excess body fat are more likely to develop heart disease and strokes • Diabetes mellitus – Even when glucose levels are under control, there is still an increased risk, but risk is greater if left untreated

22. Predicting who will develop heart disease • Subjects: 2489 men and 2856 women 30 to 74 yrs. Old • Baseline reading • 12 years later • Subjects 383 men and 227 women developed heart disease • Those with heart disease were associated with high blood pressure, total cholesterol, LDL and HDL, sex, • Used prediction equation to predict likelihood of developing disease • Age, diabetes, smoking, blood pressure, total cholesterol, and LDL

23. Results And Discussion • 28 % of male and 29 % female cases attributed to blood pressure levels that exceeded normal high130/85 • 27 % of male and 34 % female cases attributed to high total cholesterol (greater than 200 mg/dL) • Study confirmed the medical guidelines for blood pressure, total Cholesterol, and LDL as accurate for predicting risk of middle-aged white population

24. Myocardial Infarctions • Also known as an MI or heart attack • Happens when the blood supply to the heart is blocked long enough to cause death of heart tissues • If enough permanent damage occurs, the patient may die

25. Myocardial Infarction

26. Symptoms of MI • Angina • Pain or discomfort in upper arms, left shoulder, back, neck, jaw or stomach • Difficulty Breathing • Sweating or “cold sweat” • Fullness, indigestion, or heartburn • Feeling Lightheaded • Extreme weakness • Rapid, irregular heart rate

27. Treatment Options • Before getting to the hospital • Quick response time is critical • Call 911 if observe symptoms and do CPR if necessary • Can take asprin, heprin, antiplatelet drugs, therombic therapy • At the hospital • Angioplasty • Bypass surgery