As described in the previous article Anatomy and Physiology of the Heart one of the main causes of angina is coronary artery disease (CAD).
Coronary artery disease is a condition in which there is a build up of fatty plaque that blocks the flow of blood through the arteries.
Generally speaking, when there is a blockage in the coronary artery that supplies blood to the heart muscle, there is a decrease in oxygen supply to the heart.
During physical activity, cells in the heart muscle (myocardium) may require additional oxygen and more blood. And so when there is already a blockage to the blood flow, this makes things worse because the oxygen supply is decrease and this can lead to oxygen deprivation of the heart muscle.
What happens next is that your body sends a message about this lack of oxygen and blood is translated by our brains as pain, but if you rest or take medication, the pain will go away.
Subsequently, an inadequate amount of oxygen supplied to body tissue is called ischemia, and we therefore use the term myocardial ischemia to mean that there is not enough oxygen being supplied to our heart muscle. Angina does not usually starve our heart cells of oxygen completely, so that they die but enough so that is injury to the cell.
Angina may also be caused by coronary artery spasm. This happens if any of the blood vessels that supply our heart muscle contract strongly. Such a contraction can cause a decrease or complete stop of the ow of blood to the heart, and this can lead to a heart attack. Coronary artery spasm can also be caused by the use of drugs like cocaine.
Who is at risk for angina?
For angina are similar to those for other heart disease, and can be divided into two categories: modifiable and non-modifiable risk factors.
|Modifiable Risk Factors||Non-modifiable Risk Factors|
|Smoking||Age – the risk increases for men over the age of 45 and for women over the age of 55|
|High sodium diet||Family history of CAD or stroke|
|High blood pressure||Gender, males have a higher chance of having angina than females|
(low density lipoprotein) cholesterol levels
|Low HDL (high density lipoprotein)cholesterol levels|
|Lack of exercise|
|Excessive use of alcohol|
DIAGNOSIS OF ANGINA PECTORIS
In order to ensure accuracy in the diagnosis of Angina pectoris, describing your symptoms as carefully as you can will be a big help to your physician in determining your health condition.
You will be required to tell your nurse practitioner or physician what you were doing when the pain occurred, what it felt like, where you feel the pain, and how long it lasts.
If it appears that you have unstable angina or that your angina is linked to a serious heart disease or condition, tests will be scheduled for you that will help confirm your diagnosis.
An ECG involves hooking you up to a machine that detects and records your heart’s electrical activity; this is a painless procedure and does not take very long.
During a stress test, you will exercise at increasing rates of exertion (generally by running on a treadmill); an ECG will monitor you the entire time so that the doctor can see what changes occur in your heart rhythm when you exercise.
- if the results of a stress test are not conclusive, or if you are unable to exercise, a nuclear stress test may be ordered. You will be injected with a special material (like thallium) and specially designed cameras will take pictures of your heart to see how well blood is flowing.
This test can show normal or abnormal movement in the heart muscle as your heart contracts, and involves having an echocardiogram while you are at rest, and then again while you exercise.
Computed tomography (CT) scan
A CT is like a high-speed x-ray and can show the doctor how much calcium is in your arteries; the level of calcium can help to show whether you have coronary artery disease
Confirming Angina Diagnosis and Cardiac Catheterization
If one or more of these tests do show that you have angina, the diagnosis might be confirmed by undergoing cardiac catheterization. A special dye will be injected into your arteries, and then photographs taken of them that allows the doctor to see if they are narrow.
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Pam is the founder and author of InfoWatchNurse and ThinkStethoscopes. Pam is an award-winning leader. In 2017, She pioneered the first ever peer tutoring program for nursing students at York University. She was also a Peer Tutor and Mentor for nursing students. Today, Pam creates posts and articles on health topics to give back to the nursing community. She blogs about nursing, health, nursing skills and other health related topics on her websites. You can connect with Pam on Linkedin and Instagram.