Cardiovascular Diseases
Angina Pectoris
Angina may have similar symptoms to a heart attack, such as a crushing, squeezing pain in the chest; a feeling of pressure in the chest; and pain radiating in the arms, shoulders, jaw, neck, and/or back. However, unlike the chest pain associated with a heart attack, the pain from angina usually goes away within a few minutes with rest or with the use of nitroglycerin.
Angina pectoris (or simply angina) is recurring chest pain or discomfort that happens when some part of the heart does not receive enough blood and oxygen. Angina is a symptom of coronary heart disease (CHD), which occurs when arteries that carry blood to the heart become narrowed and blocked due to atherosclerosis.
Angina pectoris occurs when the heart muscle (myocardium) does not receive an adequate amount of blood and oxygen needed for a given level of work (insufficient blood supply is called ischemia). The following are the most common symptoms of angina. However, each individual may experience symptoms differently. Symptoms may include:
- a pressing, squeezing, or crushing pain, usually in the chest under the breast bone, but may also occur in the upper back, both arms, neck or ear lobes
- pain radiating in the arms, shoulders, jaw, neck, and/or back
- shortness of breath
- weakness and/or fatigue
The chest pain associated with angina usually begins with physical exertion. Other triggers include emotional stress, extreme cold and heat, heavy meals, excessive alcohol consumption, and cigarette smoking. Angina chest pain is usually relieved within a few minutes by resting or by taking prescribed cardiac medications.
The symptoms of angina pectoris may resemble other medical conditions or problems. Always consult your physician for more information.
An episode of angina does not indicate that a heart attack is occurring, or that a heart attack is about to occur. Angina does indicate, however, that coronary heart disease is present and that some part of the heart is not receiving an adequate blood supply. Persons with angina have an increased risk of heart attack.
A person who has angina should note the patterns of his/her symptoms - what causes the chest pain, what it feels like, how long episodes usually last, and whether medication relieves the pain. Call for medical assistance if the angina episode symptoms change sharply.
In addition to a complete medical history and medical examination, a physician can often diagnose angina pectoris by noting the patient's symptoms and how/when they occur. Certain diagnostic procedures may also determine the severity of the coronary heart disease, and may include:
- electrocardiogram (ECG or EKG)
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a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.
- stress test (usually with ECG; also called treadmill or exercise ECG)
A test that is given while a patient walks on a treadmill or pedals a stationary bicycle to monitor the heart during exercise. Breathing and blood pressure rates are also monitored. A stress test may be used to detect coronary artery disease, and/or to determine safe levels of exercise following a heart attack or heart surgery.
- cardiac catheterization
With this procedure, x-rays are taken after a contrast agent is injected into an artery to locate the narrowing, occlusions, and other abnormalities of specific arteries.
Specific treatment for angina pectoris will be determined by the physician based on:
- your age, overall health, and medical history
- extent of the disease
- your tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
The underlying coronary artery disease that causes angina should be treated by controlling existing risk factors: high blood pressure, cigarette smoking, high blood cholesterol levels, high saturated fat diet, lack of exercise and excess weight.
Medications may be prescribed for people with angina. The most common is nitroglycerin which helps to relieve pain by widening the blood vessels. This allows more blood flow to the heart muscle and decreases the workload of the heart.
EECP
Enhanced External
Counterpulsation (EECP) is commonly used to treat angina, particularly if
nitroglycerin does not provide adequate relief from your angina, you have
been told that you are not a candidate for bypass surgery or angioplasty,
you underwent bypass surgery or angioplasty in the past, and angina has
returned, or you want to explore all treatment options.
EECP is used to stimulate the opening, or formation of, small branches
of blood vessels (collaterals) to create a natural bypass around narrowed
or blocked arteries.
The term Enhanced External Counterpulsation describes what will
happen during treatment. Enhanced refers to the equipment that has
evolved over decades of research and development to become the
state-of-the-art treatment delivery system no used in EECP treatment
centers. External means treatment happens outside of your body and does
not require surgery.
Before we can understand the term counterpulsation, we have to
understand the cardiac cycle, the period from the beginning of one
heartbeat to the beginning of the next.
The EECP system compresses your lower limbs to increase blood flow
toward your heart. Each wave of pressure is electronically timed to your
heartbeat, so that the increased blood flow is delivered to your heart at
the precise moment it is relaxing.
When the heart pumps again, pressure is released instantaneously.
During counterpulsation the EECP system pumps when your heart is resting
and releases pressure when you heart is working. EECP treatment is
typically provided on an outpatient basis in 35 one-hour sessions over a
period of approximately seven weeks. Studies conducted at numerous
university medical centers and published in peer-reviewed medical journals
have demonstrated benefits including:
Elimination or decrease in exercise-induced signs of lack of oxygen to
the heart muscle (ischemia);
increased exercise tolerance;
elimination or decrease in episodes of chest pain;
decrease in need for anti-anginal medication.
EECP treatments are
provided at St. John's Clinic-Cardiology, which is located in St.
John's Clinic-National on the north side of St. John's main campus in
Springfield. The cardiology suite is on the third floor in suite 3200.
The north parking lot enables convenient parking with trams
transporting patients from the parking lot to Entrance B and/or C of
our building. Please take the elevator after entering either B or C
entrance and follow the signs on the third floor to arrive at Suite
3200. Out-of-town patients may arrange to have free (but very basic)
overnight accommodations at St. John's Hospitality House or utilize
free RV hook-up in St. John's south parking lot.
Once you have been determined to be a candidate for EECP treatment, it
is important that you understand the treatment schedule. At the EECP
center, your therapist will explain each step as you go through treatment.
Although treatment usually takes one hour, you should plan to spend
approximately 1 ½ hours at the treatment center. You may wish to bring a
book, magazine, or portable CD or tape player with earphones. You also may
wish to invite a family member or friend to accompany you.
You will be given a pair of stretch pants to wear at each treatment
session. Once you have changed your clothes, a therapist will weigh you,
and take your blood pressure. You will lie on a padded table in a treatment room. Three electrodes
will be applied to your chest to take a constant EKG reading during
treatment. A finger sensor, called a plethysmograph, will be placed over
your finger like a thimble. This sensor records tracings that represent
blood pressure. The therapist will wrap a set of inflatable cuffs around
your calves, thighs, and buttocks. You are likely to feel a sensation of a
strong "hug" moving upwards from your claves to thighs to buttocks during
inflation followed by a rapid release of pressure on deflation.
There are two other forms of angina pectoris, including:
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Variant angina pectoris
(or Prinzmetal's angina):
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Microvascular angina:
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- is rare
- occurs almost exclusively when a person is at rest
- often does not follow a period of physical exertion or emotional stress
- attacks can be very painful and usually occur between midnight and 8 a.m.
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- a recently discovered type of angina
- patients with this condition experience chest pain but have no apparent coronary artery blockages
- physicians have found that the pain results from poor function of tiny blood vessels nourishing the heart as well as the arms and legs
- can be treated with some of the same medications used for angina pectoris
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Online Resources of Cardiovascular Disease