Friday, November 25, 2011

Angina (Angina Pectoris) Unstable

The clinical condition characterized as the intermediate state between myocardial infarction and the more severe state of stable angina is termed as unstable angina. Previously, the term used for reducing the risk of myocardial infarction or death was ‘pre-infarction angina’. The pain syndromes following from myocardial ischemia are generally termed as ‘angina pectoris’. It is a state where the heart does not get ample blood supply to fulfill its requirements. This pain is termed as unstable angina for its unpredictable nature. The key symptoms of unstable angina are an indication of a heart attack and might also call for an emergency. It is, therefore, essential to go for immediate medical attention.

Chest pain, as termed in a lay man’s language, is a non-specific symptom and can occur as a result of cardiac and non cardiac causes. Unstable angina, on the contrary, is a term used to describe a wide range of coronary syndromes, from ST-segment elevation myocardial infarction (STEMI) to non-segment elevation myocardial infarction (NSTEMI). 

Being unpredictable by nature, the pain can arise anywhere at any unexpected time and can, normally, last for 5-20 minutes. During unstable angina, no enzymes and bio markers of myocardial necrosis are released during unstable angina thereby making it to be an acute coronary syndrome. Symptoms related to unstable angina can be different for every individual. The most common symptoms include tightness or heaviness in the chest area, feeling of pain or pressure, a severe feeling originating in the thoracic region and spreading in neck, jaw, throat, arm and shoulder region, unease below the sternum (breast bone), breathlessness, trembling, and a heart burning sensation. The symptoms of unstable angina are somewhat similar to those of stable angina. But in view of the fact that unstable angina attacks a person all of a sudden, it might cause high levels of anxiety. Other associated symptoms include profuse sweating, nausea, and light headedness. It is advisable to take nitroglycerin so as to subside the pain. 

An unexpected rupture of a plaque leading to a fast accretion of platelets, at the site of rupture, produces an obstruction to the blood flowing towards the coronary artery thereby leading to occurrence of symptoms in an unexpected and unpredictable manner. The development of these symptoms thus leads to unstable angina. However, the symptoms might seem to be new, more acute, and might even occur with little or almost no exertion, but, on the whole, they announce a medical emergency. This pain might or might not go away by the use of nitroglycerin for unstable angina is relatively less reactive to nitroglycerin than stable angina. The coronary artery can completely get choked by the unrestricted accretion of platelets at the site of plaque rupture thereby leading to an obstruction in oxygen supply and thus heart attack. Such a situation of unstable angina calls for an imperative medical counsel.

Unstable angina can  result from a number of factors like high levels of bad cholesterol and low levels of good cholesterol in the body, heavy smoking, hypertension or high blood pressure, irregular exercising, intake of diet containing high saturated fat and cholesterol, having a history of diabetes, overweight, genetic history of coronary artery disease in parents or siblings. Consuming recreational drugs or stimulants like ecstasy, cocaine, or molly might prevent the occurrence of coronary artery disease (CAD) but also increases the impact of any underlying CAD (coronary artery disease). 

The treatment of unstable angina involves performing numerous tests besides recording the complete medical history of the patient. This includes measuring the blood pressure to diagnose the illness and conducting a physical exam as well. The electrical activity of heart is monitored by ECG (Electrocardiogram) test. Certain ECG findings, when presented, might predict the risk of a heart attack. The cardiac blood tests look for the evidence supporting damage of heart muscle or occurrence of a heart attack. these blood tests are carried out at different time  intervals. The blockages present in the coronary artery are highlighted by angiography and cardiac catheterization. The catheterization involves introducing a catheter in an artery present in the arm region or the groin and injecting a contrast dye into it. The blockages are traced by taking x-ray pictures as the dye travels through the arteries. 

Another common test performed to check the reception of oxygen by the heart, during exercise, is the ECG test. As a part of this test, the patient is made to walk on the tread mill with an ECG monitor and the presence of CAD is reflected by the ECG patterns. Akin to ECG test, a nuclear stress test is performed which involves injecting a radioisotope into the veins and then making the patient run on the tread mill. After the exercise, the pictures of heart are taken thus reflecting the blockages. Another common test is the electrocardiograph test involving the use of ultrasound waves to take pictures of heart thereby detecting CAD.
The unstable angina features a threefold treatment aiming to stabilize plaques, if any, which might have occurred to avoid a heart attack, relieving symptoms, and treating the underlying CAD. 
Taking aspirin can be helpful in stabilizing plaque so as to check clotting. Drugs such as clopidogral, heparin, and platelet glycoprotein (GP) IIb/IIIa receptor blocker are also helpful in the process of checking clotting. Medicines like nitroglycerin are helpful in dilating the blood vessels and making the blood flow easy thereby decreasing the stress on heart during angina. The stress on heart is also reduced by administrating beta and calcium blockers during angina. Coronary angioplasty and bypass surgery are performed as a part of surgical treatment for blockages. 

The ailment can also be prevented by adopting certain changes in the lifestyle. These modifications include taking a healthy diet containing ample amount of fiber and low fat dairy products which are helpful in lowering the blood pressure. Moreover, the blood cholesterol levels can be reduced by following an exercise regime. Besides, it is also important to quit smoking to save yourself from the risk of experiencing a heart attack for smoking is responsible for damaging the blood vessel walls. Weight monitoring is also helpful in improving the cholesterol levels of the body.

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