STABLE ANGINA | Dr.Jay Deshmukh MD, FCPS, MNAMS

What are the estimated prevalence and common symptoms of angina?

About 3 to 4 % of the population may have angina pectoris. Heavy central pain relieved on rest is the main symptom. This pain typically radiates to the left arm, and in-creases after meals and in cold weather. The pain may also radiate to the jaw and neck. Breathlessness on exertion may occur. This is known as the angina equivalent.

What are the examination findings in such individuals?

Usually, the clinical examination in uncomplicated stable angina is normal. Doctors look for hypertension, peripheral vascular disease, and diabetes.

What are the investigations typically done?

On fasting, a complete lipid profile, fasting, and post-meal blood glucose, haemoglobin, and kidney function estimation are necessary. These are the common risk factors that need to be taken care of.

What about ECG?

The ECG taken at rest is generally normal. This however does not rule out a serious heart ailment. An ECG on exercise is done to confirm the clinical diagnosis, assess exercise capacity, and also to determine prognosis. Myocardial perfusion imaging or Dobutamine stress echocardiogram may be used instead of an exercise in individuals
STABLE ANGINA who cannot exercise or those who have bundle branch issues on ECG. Chronic atherosclerosis of coronary arteries reduces blood flow to the heart. Increased myocardial oxygen demand on walking or exercise cannot be met. This results in myocardial ischaemia and chest pain. This is angina pectoral.

What are the other causes of chest pain during exercise?

Sometimes problems with microcirculation of the heart in middle-aged women can cause typical chest pain on exertion. They have a positive stress test. However, their coronary angiogram is normal. This is known as syndrome X. Individuals with hypertrophic cardiomyopathy, severe anaemia and aortic stenosis may have typical angina symptoms.

What is the treatment?

Avoiding exertion on a full stomach is important. Anti-angina drugs include nitrates, beta-blockers, and aspirin. Angioplasty is recommended if there is symptomatic angina with suitable lesions in one or two coronary arteries. An improved life expectancy has not been demonstrated.

What about coronary artery bypass grafting?

CABG improves life expectancy in patients with left main stem stenosis, and severe proximal three-vessel coronary artery disease, especially if the left ventricular function is impaired. Proximal LAD lesions with other vessels involved may be benefitted from CABG.

What are the complications of stable angina?

This may lead to unstable angina or heart attack, which is myocardial infarction or irregular heart rhythm. How to prevent angina? One must stop smoking completely. Treat high cholesterol and diabetes aggressively. Make sure that the blood pressure always remains under control. Weight reduction, and reducing salt intake, may help remotely.

What is the prognosis?

The prognosis is good. Cardiac catheterization is the best means to assess the risk and plan therapy. The mortality is 2% per year for a single vessel disease, to 20% per year if there is left main artery stenosis. Impairment of left ventricular function is an additional risk factor.

Categories : Health

Dr Jay Deshmukh is Chief Physician and Director, Sunflower Hospital, Nagpur Honorary Physician to Honorable Governor of Maharashtra and PondicherryCentral. Dr Jay Deshmukh is an M.B.B.S., M.C.P.S., F.C.P.S., M.N.A.M.S., MD From Internal Medicine – Bombay and New Delhi.

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