What is Angina?

The heart muscle has to work extremely hard, 24 hours a day. 4200 times every hour in order to keep the blood flowing through all parts of the body. Out of 5 liters of blood that it pumps every minute, it requires about 800 ml for itself every minute. The heart takes in this blood supply from three coronary arteries. When the arteries of the heart are blocked, the muscle does not get the required amount of blood and it gets severe pain. This pain is called angina.

______________________________________________________________________________ Angina most commonly occurs in the front of the chest, in the neck, the jaw, and the left arm. It can also mimic a general upper abdominal discomfort, which the patient often interprets as "gas". Sometimes the patient just feels uneasy and calls it "Gabhraman". Angina is the cry of the heart muscle for more blood. If angina is ignored, the patient can get a heart attack. Thus angina is a protective mechanism. It warns the patient to rest and to allow the heart muscle to recover. _______________________________________________________________________________ The feelings of angina vary from person to person. It may be described as: Indigestion. Tightness. Gabhraman or oppressive feeling. Dyspepsia or "Gas". Fullness of the "stomach". Numbness or tingling in any part of the arm. Choking. Pain in the Jaws, teeth or earlobes. Discomfort in the neck or between the shoulder blades. These feelings are termed as ''Angina Equivalents". _____________________________________________________________________________

Angina also manifests as shortness of breath. Typically after walking a few steps or yards or climbing a few stairs, the patient wants to rest for a while to catch his breath.

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1. Can Angina be treated by medicines ?

Yes. The first line of treatment for angina is with the help of medicines. About 70% of angina can be treated by medicines while awaiting definitive treatment.

2. Can medicines reduce the blockage of the arteries?

No. Medicines cannot reduce the blockage of the arteries.

3. Then how do medicines work?

Medicines can increase the blood flow through blocked vessels by
1 Thinning down the blood.
2 Dilating the blood vessels by taking away the spasm.
3 Medicines can also reduce the work done by the heart and therefore they can reduce the requirement of blood by the heart.
The commonly available tablets used for coronary artery disease are Beta Blockers: mainly reduce the work of the heart. They also reduce the heart rate so that more time is available for the blood to flow to the heart.

Calcium channel Blockers dilate the coronary arteries.
Sorbitrate and other nitrates dilate the arteries.

Aspirin (Losprin, dispyrin, Ecosprin, ASA) makes the blood thin. Plavix is a new tablet which has similar blood thinning effect.

There are two other groups of blood thinning tablets now available:

Clopidogrel (clopigrel, Plavix, Clavix, clopilet etc) and Ticlopidene (Tyklid, noklot, Ticlovas, etc.) Most patients having angina are on a combination of one or more of these medicines.
Please do not try to self medicate. If you do not like a particular medicine or it does not suit you, consult your doctor.

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What is Coronary artery Disease?

The heart receives its blood supply through coronary arteries. There are three main arteries of the heart. The Left artery, the right artery and the artery to the back of the heart or the circumflex coronary artery. The left artery and the artery to the back arise from a common stem called the left main stem. Thus the left main stem is a very important artery and it supplies blood to over 70% of the heart.

A blockage of this artery is called left main blockage, and this is the type of blockage that needs urgent surgery. In England or America such a patient is not allowed to go home and is operated upon as an emergency because if such a patient gets a heart attack, it can be life threatening. This disease is therefore called "Widowmaker Disease".
In India due to social circumstances like arranging funds, waiting for relatives, we often are forced to allow such patients to go home. But such patients are at a very high risk of getting a fatal heart attack within a few days or months.

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In some cases the left main stem is normal but both the left sided arteries are so severely diseased that this has also to be treated as a left main stem equivalent. Such patients are also advised urgent surgery.

What is unstable angina?
If a patient's chest pain is under control with medicines, he is said to have stable angina.

What is unstable angina?
If a patient gets more pain than he used to earlier, If he gets pain on shorter distances than before, if he gets pain at rest, or If he gets pain in spite of medical treatment, he is said to have unstable angina.

What is the significance of unstable angina?
A patient with unstable angina can get a heart attack at any time. He therefore needs urgent surgery.
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