TEAR ALONG PERFORATION

MEDICAL ILLUSTRATION: © KEVIN A. SOMERVILLE 2003 Copyright Jobson Publishing L.L.C.,2003 the HeartIsBlocked Oxygen Supplyto should beawar by rest ormedication. Unstable canoccuratrest orduringexercise orstress. Patients withangina type ofanginaisunstableangina, inwhichstableanginaoccursmore frequently andmaynotberelieved of thecor at rest isknown asvariant orPrinzmetal’s angina. Variant anginaiscausedby aspasminoneormore of anginathatdonotfollow describedabove. theclassicpattern Angina thatoccurswhilethepatientis be carefully investigated itscauseandtreatment. by aphysiciantodetermine There are different kinds tissue thatshould symptomofatemporary totheheart muscle,butitisawarning lackofoxygen the angina isknown asstableangina.Unlike damageto attack, angina doesnotcausepermanent aheart period ofstress. Angina symptoms disappear afterthepatientrests ortakesnitroglycerin. This typeof requiresand mostoftenappearwhentheheart more thanusual,suchasduringexercise oxygen ora bloodtomeetitsneeds. enough oxygen-rich The symptomsofanginaare usually chestpainorpressure with cannot supplytheheart when thecoronary as myocardial ischemia.Simply put, anginaoccurs Angina conditionknown isasymptomofheart onary arteries, usuallyaresult arteries, ofatherosclerosisonary (hardening Another ofthearteries). common e of theirsymptomsandcontact their physicianifthesesymptomschangeorworsen. Angina Pectoris .S. U. Pharmacist A IN ECIGAID TEACHING PATIENT continued flow totheheartmuscle. vessel andrestrictsblood space insidetheblood diameter ofthetubular ) narrowsthe plaque (coronaryartery Build-up ofatherosclerotic • • Angina symptoms: (especially theleftarm) sometimes tothearms both sidesofchestand extendingacross under breastbone oppression orchoking Feeling ofheavyweight, PATIENT TEACHING AID

Being aware of changes in or worsening of angina symptoms is important, since stable angina can progress to , heart attack, or sudden death due to abnormal heart rhythm. For many patients, good control of angina symptoms depends on their taking their correctly.

Be Aware of Symptoms

Angina is not a disease but a symptom of a condition (ischemia) in which the heart muscle (myocardium) does not get enough oxygenated blood to do its work. There could be several rea- sons for this, but the most common is a blockage of the coronary arteries due to . For most patients, angina symptoms occur only when the heart needs more oxygen than usual. This situation can occur during exercise, with stress or strong feelings, during extremes in tem- perature or altitude, after a heavy meal, or while smoking. Most angina attacks occur between 6 am and noon. Classic symptoms: Angina is a common cardiac condition affecting more than six million Amer- icans. More than a half million patients are newly diagnosed each year. Patients at higher risk for angina are those with a family history of the disease, high risk for atherosclerosis, , high , , or who smoke. Patients with symptoms of angina often describe an ache or pressure in the chest just below the bone. This sensation can move to the left shoulder and arm, up into the jaw or teeth, through the back, or, less often, down the right arm. It usually begins with exercise, especially after one has eaten. It may also occur when walking out of a warm room into cold weather or wind. Angina pain can even be triggered by an intense emotion, such as fear or anger, or dur- ing sleep while dreaming. The symptoms of angina may cause the patient to fear a heart attack, but with classic, stable angina, chest pain goes away after rest or upon taking nitroglycerin under the tongue. Diagnosis: The diagnosis is made using information from the patient’s history, a physical exam- ination, and a variety of tests that can show the degree of myocardial ischemia in the heart mus- cle. For many patients, testing begins with an exercise stress EKG, or stress echocardiogram test. More invasive tests such as coronary angiography can provide detailed information about the amount of coronary blockage. Blood flow through the heart can be seen using sophisti- cated tomographic imaging (PET and SPECT scans). Treatment focuses on reducing the risk fac- tors and preventing or reducing the ischemia to the heart. Smokers with angina should stop smok- ing, and high blood pressure should be treated to avoid added stress on the heart. Lowering cholesterol levels can prevent further coronary atherosclerosis. A well-designed exercise program is also desirable. Drug therapy: Types of drugs used to treat angina include nitrates, beta-blockers, and calcium channel blockers. Nitrates dilate coronary blood vessels and relax smooth muscles, helping to bal- ance the heart’s demand for oxygen with the supply. The nitrates are available as short- and long- acting formulations. Short-acting nitroglycerin is dissolved under the tongue (sublingual) for the quick relief of angina pain or pressure. Most patients begin to feel relief within one to three min- utes. An additional tablet may be taken every five minutes for a total of three times. A short-act- ing oral spray is also available. These short-acting nitrates should be carried at all times so they are available in case of an attack, and a fresh supply should be ordered frequently to ensure potency. Long-acting nitrates, which are used to prevent angina attacks, include oral isosorbide, nitroglycerin ointment, and skin patches.

U. S. Pharmacist