Chest Pain-Angina Pectoris

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Anginapektoris; most often it is an irritating pain in the chest, which is felt by being pressed against a heavy stone in the chest, the pain point cannot be fully localized, and in some patients it can spread to the left arm, both arms, back, upper abdomen and neck.

This pain is one of the most important and most common symptoms of heart disease.

In cases where the arteries supplying the heart cannot meet the oxygen need of the heart due to reasons such as stenosis or obstruction, heart-induced chest pain or distress occurs and this is called medical language or latin angina pectoris . Angina Pectoris, especially at the time of admission, can be a sign of heart attack.

The fact that the coronary arteries supplying the heart cannot carry enough blood and oxygen to the tissues can be explained in three different scenarios:

  1. The formation of fatmolecules in the tissue beneath the endothelial layer, which is a thin membrane layer laying inside the coronary  arteries,  causes stenosis: In the coronary arteries, fat accumulation under the endothelium, the inflammation cells, connective tissue cells and calcium are added to the  atherosclerotic plaque . If this atherosclerotic plaque, ie, the arteriosclerosis plate , makes a constant contraction of a certain level, the need for blood increases significantly; In cases of severe exercise, cold weather, excessive power expenditure and increased stress, the atherosclerotic artery does not reach the need for increased blood muscle and thus angina pectoris occurs.
  2. Coronary artery contractions (coronary spasm): Coronary artery spasm may be in the vessels with atherosclerotic stenosis, or in the atherosclerotic vasculature that does not have any stenosis . Coronary artery spasm may be caused by cold, physical factors, emotional stress, smoking and a number of chemical substances.
  3. A number of clinical manifestations (deep anemia, rapid functioning of the thyroid gland, fever, arteriovenous fistula, since the disease, arrhythmia, and extreme anxietes – clinical manifestations, etc.) may lead to angina pectoris. In these cases, angina pectoris occurs not from the inadequate oxygen supply to the heart, but by an excessive increase in the oxygen consumption of the heart.

Angina pectoris / chest pain often presents as stable or stable angina.

  1. Stable (stable) angina pectoris:

Stable angina, where the need for oxygen increases (or immediately after)

It occurs. Increased oxygen consumption occurs in various situations where heavy load is placed on the heart, and the oxygen presenting to the heart muscle is inadequate and the heart muscle is perceived by the nerve (ischemia) and is transmitted electrically to the sensory region of the brain. Factors triggering angina pectoris;

  • Smoking or exposure to smoke
  • Walking uphill or uphill speed in hand
  • Eating a heavy meal and physical activity on food
  • Sexual intercourse (especially in the case of extramarital, inappropriate place and time of concern)
  • Severe affect changes (eg, irritation, grieving)
  • These are conditions that increase the heart load, such as sudden changes in temperature or height.
  • Cold weather and especially walking in cold wind

Stable angina attacks usually take a few minutes and pass in 1-2 minutes with sublingual medication or rest.

  1. Unstable anginapektoris:

It may be an unstable angina if there are chest pain that can occur even at unpredictable times or at rest, or if the feeling of discomfort does not improve with the medication or within 10 minutes of rest. Another indicator of unstable angina is the increase in the frequency and intensity of stable angina. Unstable angina is a dangerous condition indicating the progression of underlying coronary artery disease. Sometimes unstable angina; it may occur after plaque rupture in the coronary arteries. This leads to narrowing of the artery and further limiting blood flow to the heart. Impaired angina can also occur when a clot is formed on the damaged plaque. Because, unstable angina may be a precursor of heart attack and it may turn into a heart attack. Life-threatening arrhythmias may also occur. Some patients may have angina-free cardiac ischemia. This is called silent ischemia. This type of ischemia is diagnosed by electrocardiogram (ECG), exercise test or continuous ECG recording (holter monitoring).

Five types of angina pectoris have been described:

Efor angina: A common type of disease. Pain comes during physical activity. He is also referred to in the US as aya window disease ‘because of his appearance during a march and forcing him to stop frequently.

Cold angina: Cold air leads to contraction of the vessels. This narrowing affects the coronary arteries, resulting in angina pectoris.

The anger of excitement: Excessive emotions increase the oxygen requirement of the heart. Failure to adapt coronary arteries to increased need leads to anginapectomy.

The angina of relaxation: Occurs when there is no reason to cause an angina in sight. The seizures are repetitive and lasting forever.

Sleep-awakening angina: Seizures are observed at 4:00 pm, especially at night, and can rarely come in the afternoons. It has to do with efor the angina immediately with the intake of sublingual nitroglycerin. Hyperventilation (frequent and deep breathing) may occur due to the contraction of the coronary arteries as a result of the sudden increase in blood pressure.

False angina pectoris: In addition, there are chest pains that resemble angina attacks. Reflection of pain from non-cardiac organs to the chest may also be perceived as an angina seizure. These pains that do not originate from the heart are called ang pseudoangina pectoris Kal.

WHAT ARE THE TYPICAL PROPERTIES OF ANGINA PECTORIS?

Typical features of chest pain caused by narrowing or obstruction of coronary vessels;

  • It usually increases and spreads slowly.
  • Generally, when the pain gets tired, it starts with an excited, nervous, sadness and passes.
  • It usually occurs following a heavy meal.
  • A tiring job takes place by walk.
  • It is generally felt beneath the sternum behind the sternum bone, which is called the iman board, or slightly to the left of the midline.
  • Pain can rarely be a pain that spreads beneath the left breast. The pain in the cases where the heart muscle cannot be blooded tends to spread tothe arms, to the left and to the arms, to the neck and to the lower jaw, from both sides. Sometimes it can spread to the back and to the neck.

If these symptoms are present, it is necessary to apply the ECG, laboratory and imaging tests necessary to exclude a possible heart attack by contacting the nearest medical center.

Diagnosis:

The evaluation of the history of the patient (history) and the risk factors ( such as myocardial infarction ) of the patient are very important in the diagnosis of anginapektoris . The words used to describe the angina are in the form of pressure sensation, compressive, flammable, overwhelming, choking, or feeling pain. Since the place of the anus is unclear, the patient may not be able to tell where he came from, and he can show the middle of his chest by fisting his hands.

Besides the story, some tests are used for diagnosis:

  1. ECG
  2. Exercise test
  3. Stress echocardiography
  4. Nuclear imaging
  5. Multi-slice CT coronary angiography (Multislice computed tomographic coronary angiography or virtual multislice CT coronary angiography)
  6. Interventional Coronary angiography (imaging of the interior of the heart vessels)

Treatment:

Treatment of angina depends on the severity of the angina and the extent of underlying heart / vessel damage:

  1. Lifestyle changes should be made in all patients:

Lifestyle changes include: dieting that is compatible with heart health   ,  correcting cholesterol rate, regular  exercise  , control of diabetes, control of high blood pressure ( hypertension ), achieve and maintain healthy body weight, quit smoking  (or not to start), control of depression, stress  avoid

  1. Medication The
    medicines used to treat the angina increase either the amount of oxygen delivered to the heart muscle or the need for oxygen to the heart muscle.
  1. Balloon-stent therapy (Coronary angioplasty, stent)
  2. Bypass surgery
  3. Transmyocardialrevascularization (TMR)
  4. External cavity ablation (ECP or EECP).

PEDIATRIC PAINS RELATING TO HEART FAILURE:

Apart from heart disease, chest pain can cause many other causes:

  • Chest pain caused by reflux spasm and esophageal spasm
  • Tear of the main artery, inflammation of the membrane that surrounds the heart, inflammation of the heart muscle, other disorders related to the heart,
  • Inflammation of the pancreatic gland,
  • Stomach and duodenal ulcers,
  • Pulmonary diseases such as inflammation of the lung membrane
  • Gallbladder diseases, especially gallbladder stones,
  • Gastrointestinal spasms, gas and swelling problems such as indigestion,
  • Musculoskeletal or nerve pains,
  • Herpeszoster (shingles),
  • Anxiety, depression, cardiac psychosis, and psychogenic reasons for self-interest are among the causes of non-cardiac chest pain.

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