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Why does Aortic Stenosis cause Chest Pain?

It’s been shown in angiographic studies in patients with aortic stenosis that the direction of flow can reverse in the large coronary arteries during the ejection phase of systole. This means that instead of the blood flowing from the coronaries to the heart wall, it gets ejected into the aorta!

That coupled with the increased demand of the heart muscle for oxygen, lead to the tendency for AS patients to experience chest pain.

And yes, it may be lethal even! It just reiterates that angina pectoris (anterior chest pain associated with inadequate oxygenation to the heart muscle) should never be taken lightly.

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October 20, 2008 · Filed under StopAngina

Less serious causes of chest pain

The less serious causes of chest pain include:

  • Costochondral Pain
  • Chest Wall Pain
  • Emotional Disorders
  • Esophageal Pain / Spasm

Other causes are :

  • Tracheobronchitis, pneumonia, pancreatitis, hiatal hernia, biliary colic, peptic ulcer disease, breast inflammation or tumor, herpes zoster (intercostal neuritis), Osteoarthritis of the cervical or thoracic spine, or a cervical disk disorder!

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October 16, 2008 · Filed under StopAngina

Potentially lethal causes of chest pain

The differential diagnosis of potentially lethal causes of chest pain are:

  • Myocardial Ischemia – including Angina Pectoris, and Acute Myocardial Infarction
  • Pulmonary Embolism
  • Aortic Dissection
  • Pleurisy
  • Mediastinal Emphysema
  • Tension Pneumothorax
  • Acute Pericarditis

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October 15, 2008 · Filed under StopAngina

What is acute coronary syndrome?

You might have heard of this medical term being tossed around… ACS… so… What is Acute Coronary Syndrome?

Acute Coronary Syndrome (ACS) is broken up into three parts.

1. Unstable Angina – which is angina which is worse than the patient’s typical angina pain, or is new onset and unstable, or happens at rest!
2. NSTEMI – Non-ST Elevation Myocardial Infarction. This is the baby-heart attack. Meaning that there is a blockage in one of your coronary arteries that needs to be fixed! Patients at this level are treated either medically or surgically by having PCI (Percutaneous Coronary Intervention).
3. STEMI – this is the real heart attack, where permanent damage has already been done to your heart, and you are in dire need of intervention!

But again, this isn’t something that you would diagnose by sitting at home. You need an EKG to see ST segment elevations or depressions… and you need blood work to tell if your cardiac enzymes are elevated!

So the difference between UA (Unstable Angina) and an NSTEMI is ??

POSITIVE CARDIAC ENZYMES in an NSTEMI! Yes, it’s that simple!

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October 14, 2008 · Filed under StopAngina

How to stop angina

Step 1
Go see your doctor, and stop looking up chest pain cures on the internet! Once you’re cleared by your physician, ask him or her about the following 10 suggestions:

Step 2
If you smoke, kicking the habit is a very important step on the road to stopping the pain of angina. Health professionals rate smoking as a ten, on a scale of one to ten for preventing angina. Smoking increases blood levels of carbon monoxide, which displaces oxygen, and since angina is an artery-clogged heart crying out for oxygen, smoking is clearly the worst thing you can do. Studies indicate angina patients who quit smoking have half the death rate of those who continue smoking.

Step 3
Think less is best when eating, this will mean less salt, less fat and less calories, just one overly fatty, overly salty meal can cause an angina attack because it raises your blood pressure suddenly.

Step 4
To control the level of fat in your diet, eat a diet containing less than 30 percent of calories from fat content. This will mean cutting back on foods containing saturated fat, like butter, that hardens at room temperature and cholesterol.

Step 5
Exercise angina away is a great way to relieve the stress your feeling, angina is not a reason not to exercise. Exercise helps you control your weight, lower your heart rate, and reduce your blood pressure, which will also help reduce your need for medication. But exercise needs to be combined with diet to be effective.

Step 6
Learning how to control your emotions, instead of them controlling you, will help you relax under difficult situations in which angina can occur. Working on resolving conflicts will do as much to improve your angina as if you took more drugs.

Step 7
If your angina is unstable, the kind that can occur without exertion, like when you’re resting or even sleeping, aspirin can be a lifesaver, some health professionals believe.

Step 8
Studies conducted in Canadian hospitals, found angina patients reduced their chances of heart attack by 51 percent by taking 4 buffered or coated aspirin tablets daily. But make sure consult your physician before starting any such regiment, this is because even though it’s an over the counter drug, aspirin can have side effects.

Step 9
If your angina attacks occur at night, tilting the head of your bed up 3 or 4 inches can reduce the number of attacks, according to health professionals. Sleeping in this position makes more blood pool in your legs, so not so much returns to the heart’s narrowed arteries and it may help reduce a need for nitro-glycerine.

Step 10
Simply sitting on the edge of your bed with your feet on the floor, if your angina attacks occur at night, can be equivalent to taking nitro-glycerine and if you don’t feel your symptoms begin to subside quickly, then reach for your medication.

Step 11
Many health professionals suggest getting a new outlook on life, to make some lifelong lifestyle changes, for angina patients to see the light at the end of the tunnel.

Taking expensive drugs and not making the necessary changes to your lifestyle is a concern to many health professionals today. A good attitude, the desire to live a healthier life, and the other necessary changes will come a whole lot easier.

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August 26, 2008 · Filed under StopAngina

More about Angina

ANGINA TREATMENTS

What is angina?

Angina occurs when the coronary arteries become narrowed and partially blocked, and significantly limit the blood supply to an area of heart muscle. The coronary arteries are the blood vessels which supply your heart muscle with oxygen so that it can pump blood around the body.

If a part of the heart muscle does not get enough oxygen for a while it will start to cramp. Waste products, which the blood would normally take away, build up. This causes pain in the muscle fibres which is felt as chest pain.

Why should angina be treated?

If the heart muscle does not get enough blood, which carries the vital oxygen it needs to work, it may begin to die. This is what a heart attack is. Doctors sometimes call it myocardial infarction.

Angina does not permanently damage the heart muscle, unless it progresses to a heart attack. The extent to which the coronary arteries are blocked will affect how much oxygen-rich blood can reach the heart muscle.

If you have angina, your doctor will want to treat it to:

provide you with relief from symptoms such as chest pain;

prevent further attacks from happening; and

avoid the risk of you having a heart attack.

Stable and unstable angina

Angina pain is usually brought on by exercise, stress, emotion or cold.

Stable angina eases when you rest. You will usually know what brings it on, such as walking up stairs or uphill. The pain usually goes after a few minutes — it should not last longer than 10 minutes. Your medication should take this pain away. Stable angina doesn’t usually damage the heart muscle.

Unstable angina is not as predictable. It may happen when one or more of the coronary arteries has become even more blocked than it was before. The angina pain may start in situations where it hasn’t happened before, or where you have had no noticeable exertion. For example, it may wake you in the middle of the night when you’re asleep. You may not be able to exert yourself as much as before without angina coming on. Unstable angina may lead to a heart attack. A change in the pattern of your angina is very important and you should visit your doctor as soon as possible.

Working with your doctor

It is important that you work with your doctor or specialist to help your angina. Let them know if you notice the angina coming more frequently or in situations which didn’t used to bring it on.

Experts in angina are continually looking at the best way to treat people with angina. The type of angina you have (stable or unstable) and the severity of it will guide your doctor or specialist in suggesting whether your condition can be managed with medications alone. If medications are not enough you might be a suitable candidate for bypass surgery or angioplasty.

Medications your doctor may prescribe for your angina

Most of the medications prescribed by your doctor for your angina are aimed at either:

making the heart pump more slowly so it doesn’t need as much oxygen; or

improving blood flow to the heart muscle so that it gets more oxygen.

Aspirin

Taking aspirin can reduce the risk of heart attack and death in people with angina when taken correctly. This is because it can prevent blood clots from happening which may block the coronary arteries, causing a heart attack. However, aspirin can cause stomach upset and gut disorders so ask your doctor whether aspirin is suitable for you. If it isn’t, you may be able to take a newer drug called clopidogrel (brands include Plavix and Iscover).

Nitrates

Nitrates have been used to treat angina for more than 100 years and are now available as patches, spray and tablets.

One of the mechanisms that helps nitrates to relieve angina is their ability to open up the coronary arteries and so increase blood flow to the heart muscle. They work very quickly to make it easier for the heart to pump.

Nitrates are used in 2 ways:

to relieve angina pain when it comes on; and

as maintenance medication to stop episodes of angina from happening in the first place.

Your doctor will probably prescribe a short-acting nitrate for you to use to stop an episode of angina once it starts. Sometimes short-acting nitrates are also taken as a precaution before doing any activity that is likely to bring on angina. These nitrates come in the form of tablets that you put under your tongue or in your cheek or a spray which you spray under the tongue.

If you do not get relief within 5 minutes, your doctor will probably advise that you use another tablet or have another spray. If this does not relieve the pain you may be having a heart attack and someone should call an ambulance immediately.

Sometimes you may feel dizzy or have a headache after using nitrates to stop angina. This is because the blood vessels to the brain are also opening up. You may need to sit or lie down for a few minutes.

Longer acting nitrates are used as ongoing maintenance medication to prevent angina from happening. These may take the form of patches or tablets.

As your body can get used to the effects of nitrates and stop responding to them, your doctor may advise you on specific times of day you should take them so that there is a gap when you are nitrate-free to stop the body becoming accustomed to the nitrates and developing tolerance to them.

Nitrates may be prescribed by your doctor on their own or to be taken with other medications for your angina.

Nitrates available include:

glyceryl trinitrate (brands include Anginine, Transiderm-Nitro, Nitro-Dur and Nitrolingual Pumpspray);

isosorbide mononitrate (brands include Imdur Durules and Monodur); and

isosorbide dinitrate (brands include Sorbidin and Isordil).

Nitrate tablets have a limited shelf life and your doctor or pharmacist may give you instructions on how to keep them. Follow these instructions carefully.

Nitrates and Viagra, Cialis or Levitra

People taking nitrates should not take Viagra, Cialis or Levitra because this could lead to a large, sudden and dangerous drop in blood pressure.

Beta-blockers

Beta-blockers slow the heart and lower the pressure in the arteries so the heart does not need as much oxygen as normal to pump. This makes it less likely that angina will occur, as the heart muscle should have enough oxygen to work effectively.

They certainly seem to reduce the occurrences of angina and give people a bigger capacity for exercise than they had. Beta-blockers also reduce the risk of dying from heart disease. However, some beta-blockers appear to be more effective in angina than others.

Beta-blockers which are used for angina include atenolol (brands include Tensig and Tenormin) and metoprolol (brands include Betaloc and Lopresor).

Like many drugs beta-blockers can have side effects. These may include: bad dreams, fatigue, dizziness, upset stomach and depression. Beta-blockers may not be suitable for people with asthma. Your doctor will be able to advise if beta-blockers are appropriate for you.

Calcium channel blockers or calcium antagonists

These medications reduce the heart rate and slightly enlarge the coronary blood vessels by slowing down the rate at which calcium enters the heart muscle and blood vessel walls. This has the end result of improving the blood flow to the heart muscle and reducing the workload on the heart.

Your doctor may prescribe a calcium channel blocker in conjunction with a beta-blocker. Among the most common side effects of the calcium channel blockers are headaches and dizziness.

Some of the calcium channel blockers available are: amlodipine (e.g. Norvasc); nifedipine (e.g. Adalat and Adalat Oros); diltiazem (e.g. Cardizem); and verapamil (e.g. Cordilox and Isoptin).

Nicorandil

Nicorandil (brand name Ikorel) is a newer medication for the treatment of stable angina. It works by opening the coronary arteries and relaxing muscle in the blood vessels and so reduces angina. Nicorandil comes as tablets. The most common side effects of nicorandil are headache and abdominal pain.

Perhexiline

Perhexiline maleate (brand name Pexsig) is used to treat moderate to severe angina which doesn’t respond to treatment with other angina medications or where other medications aren’t suitable. People who take perhexiline must have regular blood tests to monitor the level of drug in their body to make sure that it stays within acceptable levels.

Your doctor may prescribe perhexiline tablets in conjunction with other medications for angina. The most common side effects when starting perhexiline are nausea and dizziness.

Cholesterol-lowering medications

Your doctor may also suggest you take cholesterol-lowering medications, especially if you have unstable angina. This is to reduce the risk of your coronary arteries becoming more narrowed from build up of cholesterol.

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August 26, 2008 · Filed under StopAngina

What is Angina? How do I stop it?

Angina (an-JI-nuh or AN-juh-nuh) is chest pain or discomfort that occurs when an area of your heart muscle doesn’t get enough oxygen-rich blood.

Angina may feel like pressure or squeezing in your chest. The pain also may occur in your shoulders, arms, neck, jaw, or back. It can feel like indigestion.

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August 14, 2008 · Filed under StopAngina