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CHEMISTRY LEGEND

October 2018

Angina

Angina is a term for chest caused by an inadequate supply of blood and oxygen to the . It is usually associated with the narrowed found in coronary . This narrowing is caused by the buildup of plaques (thickenings in the lining) in the arteries, due to a process called . With angina, the affected person's heart may get sufficient blood for daily activities, but the arteries may not be able to deliver adequate blood and oxygen during times of increased demand, such as exercise, emotional or physical stress, and extremes of .

Classification of Angina

There are three main types of angina:

 Stable angina is characterized by predictable patterns of symptoms and periods of discomfort that occur during exercise or periods of stress. This pain is usually relieved with rest and/or treatment with nitroglycerin or another appropriate medication. Many people with this type of angina can live a relatively normal life for many years, but some will progress over time, or relatively rapidly, to . Stable angina is caused by the slow buildup of plaque composed primarily of fibrosis (scar tissue).  Unstable angina, one of the coronary that includes heart attack, is characterized by a change in the pattern of angina episodes, occurring more frequently, at rest, and/or not responding to treatment. It is usually a that the person's condition is worsening. The pain someone experiences with unstable angina may be more severe and prolonged than that of stable angina. People with unstable angina are at increased risk of a heart attack, severe cardiac , and . This is an acute emergency and should be evaluated and treated immediately. Unstable angina is caused by plaque that contains more lipid and debris than found in the plaque of people with stable angina. When some of this material leaks into the vessel, clots form.  Variant angina (Prinzmetal's angina) almost always occurs during periods of rest, usually at night. The is a of a coronary artery. Many people who have this type also have severe atherosclerosis in at least one major blood vessel on the heart. It can also occur, although much less often, in people with heart valve disease or uncontrolled high (), and may be seen with the use of cocaine and methamphetamines. This type of

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angina is caused by spasm of the arteries, temporarily narrowing them but without producing any permanent damage.

Signs and symptoms

Chest pain is the symptom, but it affects people differently. You may feel:

 Aching

 Burning

 Discomfort

 Feeling of fullness in the chest

 Heaviness

 Pressure

 Squeezing

Men often feel pain in their chest, neck, and shoulders. Women may feel discomfort in their belly, neck, jaw, throat, or back. You may also have , sweating, or .

The amount of activity that is required to trigger an episode of angina and the symptoms involved vary from person to person and may also vary between episodes and over time. Since tends to be progressive, angina may worsen over time – either with more severe symptoms, more frequent episodes, and/or less response to rest and treatment.

Causes

Angina is usually due to heart disease. A fatty substance called plaque builds up in your arteries, blocking blood flow to the heart muscle. This forces your heart to work with less oxygen. That causes pain. You may also have blood clots in the arteries of your heart, which can cause heart attacks

Other, less common causes of include:

 A blockage in a major artery of the lungs ()

 An enlarged or thickened heart (hypertrophic )

 Narrowing of a valve in the main part of the heart ()

 Swelling of the sac around the heart ()

 Tearing in the wall of the aorta, the largest artery in your body ()

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Diagnosis

1. Laboratory Tests

Cardiac biomarkers, proteins that are released when muscle cells are damaged, are ordered to help differentiate angina from a heart attack. These include:  Troponin - the most commonly ordered and cardiac-specific of the markers. Blood levels of troponin will be elevated within a few hours of heart damage and remain elevated for up to two weeks. Troponin tests are usually ordered initially in the ER when a person presents with symptoms of unstable angina and then a few more times in the next several hours to look at changes in concentrations. If the levels are normal, then it is much less likely that the symptoms and chest pain are due to heart muscle damage and more likely that the pain is due to stable angina. A rise and/or fall in the series of troponin results indicates a heart attack.  CK-MB - one particular form of the enzyme creatine kinase that is found mostly in heart muscle and rises when there is damage to the heart muscle cells; this test is used less frequently now.  Myoglobin - a protein released into the blood when heart or other skeletal muscle is injured; this test is used less frequently now  BNP or NT-proBNP - released by the body as a natural response to ; increased levels of BNP, while not diagnostic for a heart attack, indicate an increased risk of cardiac problems in persons with acute coronary .

2. Non-Laboratory Evaluations

A range of non-laboratory evaluations and tests may be used to assess chest pain and other symptoms. These include:  A , including an evaluation of risk factors such as age, coronary artery disease (CAD), , and smoking  A  An electrocardiogram (ECG or EKG) – a test that looks at the heart's electrical activity and rhythm

Treatment

Treatments for angina incorporate several different aspects. They include lifestyle changes, medications, and surgical procedures when necessary. Lifestyle changes are recommended to help reduce risk factors, to help slow the progression of underlying coronary artery disease (when present), and to help anticipate, control, and sometimes prevent angina episodes. These changes include controlling high blood pressure, reducing high cholesterol levels, exercising (under a healthcare provider's supervision), losing excess weight, and quitting smoking.

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References

1. https://en.wikipedia.org/wiki/Angina 2. https://labtestsonline.org/conditions-index 3. https://www.webmd.com/heart-disease/heart-disease-angina

Questions 1. Define the term . 2. Discuss the diagnosis of Angina. 3. How can Angina be treated?

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