Unstable angina

Unstable angina . It is a condition in which the heart does not receive enough blood and oxygen flow and may be the prelude to a heart attack.

Summary

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  • 1 Causes
  • 2 Symptoms
  • 3 Tests and reviews
  • 4 Treatment
  • 5 Forecast
  • 6 Possible complications
  • 7 When to contact a medical professional
  • 8 Prevention
  • 9 Alternative names
  • 10 Source

Causes

Angina is a type of chest discomfort caused by poor blood flow through the blood vessels (coronary vessels) of the heart muscle (myocardium).

The coronary artery disease due to atherosclerosis is by far the most common cause of unstable angina. Atherosclerosis is the accumulation of fatty material called plaque along the walls of the arteries. This causes these arteries to become less flexible and narrow, which interrupts blood flow to the heart , causing chest pain.

Angina can initially be considered stable, meaning that chest pain occurs only with activity or stress . The pain does not become more frequent or intense over time. Unstable angina is sudden chest pain that gets worse and worse. This pain:

  • Occurs without cause (for example, wakes you up)
  • Lasts more than 15 to 20 minutes
  • Does not respond well to a medicine called nitroglycerin
  • May occur in conjunction with a drop in blood pressure or significant respiratory distress

People with unstable angina are at increased risk of having a heart attack.
A coronary artery spasm is a rare cause of angina . Risk factors for coronary artery disease include:

  • Diabetes
  • Family history of coronary heart disease before age 50
  • Arterial hypertension
  • High LDL cholesterol
  • Low HDL cholesterol
  • Being male
  • Not getting enough exercise
  • Obesity
  • Advanced age
  • Smoking

Symptoms

Symptoms include:

  • Sudden chest pain that can also be felt in the shoulder, arm, jaw, neck, back, or other areas
  • Pain that feels like stiffness, tightness, compression; crushing, burning, choking, or grinding
  • Pain that occurs at rest and does not go away easily with the use of a medicine
  • Difficulty breathing

If you have stable angina, you may be developing unstable angina if your chest pain:

  • Start feeling different
  • Lasts more than 15 to 20 minutes
  • It happens at different times

Tests and exams

The doctor will perform a physical exam and check your blood pressure . You may hear abnormal sounds, such as a heart murmur or an irregular heartbeat, when listening to the chest with a stethoscope . Tests to diagnose angina include:

  • Blood tests to show if you have heart tissue damage or are at high risk for heart attack, including troponin I and T-00745, creatine kinase (CPK), and myoglobin
  • ECG
  • Echocardiography
  • Stress tests
    • pharmacological or chemical stress test (adenosine, dobutamine)
    • exercise tolerance test (stress test or exercise test on the treadmill)
    • stress echocardiography
    • thallium stress test
  • Stress tests without images (exercise test on the treadmill) or with images (nuclear stress test, stress echocardiography)
  • Coronary angiography (taking pictures of the arteries of the heart using X-rays and a dye; it is the best test to diagnose significant heart disease)

Treatment

Your doctor may order hospitalization to facilitate some rest and prevent complications. Anticoagulants (antiplatelet medications) are commonly used to treat and prevent unstable angina. Such medications include acetylsalicylic acid and the prescription drug clopidogrel. The acetylsalicylic acid (aspirin), and sometimes clopidogrel, can reduce the chance of heart attack in certain patients.

During an episode of unstable angina, you may receive heparin (or another anticoagulant) and nitroglycerin (sublingual or intravenously). Other treatments may include medications to control blood pressure , anxiety , abnormal heart rhythms, and cholesterol (such as statins).

Often, if a narrow or blocked blood vessel is found, a procedure called stent angioplasty may be done.

  • Angioplasty is a procedure to open narrow or blocked blood vessels that supply blood to the heart.
  • A coronary artery stent is a small, metal mesh tube that opens (expands) inside a coronary artery. A stent is often placed after angioplasty and helps prevent the artery from closing again. A drug-eluting stent contains medicine that prevents the artery from closing.

Coronary artery bypass surgery may be done for some people, depending on which and how many of their coronary arteries are narrow and the severity of the narrowing.

Forecast

The prognosis depends on many different things, including:

  • The severity of coronary artery disease
  • The severity of the most recent unstable angina attack
  • Whether or not you have ever had a heart attack
  • Medications you were taking when angina attack started
  • The pumping efficiency of the myocardium

Arrhythmias and heart attacks can cause sudden death.

Possible complications

Unstable angina can lead to a heart attack .

When to contact a medical professional

Seek medical help if you have unexplained new chest pain or pressure. If you have had angina before, call the doctor. Call the local emergency number if angina pain:

  • Does not go away after 15 minutes
  • Does not go away after three doses of nitroglycerin
  • It is getting worse
  • Returns after nitroglycerin relieved it at first

Call the doctor if:

  • If angina symptoms occur more often.
  • If you experience angina when sitting. This is called angina of rest.
  • If there is tiredness more often.
  • If you feel weak or dizzy, or pass out.
  • Is the heart beating very slowly (less than 60 beats per minute) or very fast (more than 120 beats per minute) or the palpitations are not constant.
  • If there are problems taking heart medications .
  • You have any other unusual symptoms.

If you think you are having a heart attack, you should seek immediate medical treatment.

Prevention

Lifestyle changes can help prevent some angina attacks. The doctor may request one:

  • Lose weight if you are overweight
  • Give up smoking

Likewise, strict control of blood pressure, diabetes and cholesterol levels must be maintained . Some studies have revealed that making a few lifestyle changes can prevent blockages from getting worse and can actually improve them.

If you have one or more risk factors for heart disease, talk to your doctor about taking acetylsalicylic acid (aspirin) or other medications to help prevent a heart attack. Aspirin therapy (75 to 325 mg daily) or a medicine called clopidogrel can help prevent heart attacks in some people. Acetylsalicylic acid therapy is recommended if the benefit is likely to outweigh the risk of gastrointestinal side effects.

Alternative names

Accelerating angina; Angina of recent onset; Progressive angina

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