Unstable Angina

Angina is a condition characterized by chest pain, discomfort, or pressure that occurs when there is an insufficient supply of oxygen to the heart muscle. Unstable angina is a type of angina that occurs at rest or with minimal exertion and is not relieved by medication. It is considered a medical emergency because it can lead to a heart attack or other serious complications.

Pathophysiology:

Unstable angina is caused by the formation of blood clots within the coronary arteries, which supply oxygen-rich blood to the heart muscle. These blood clots partially or completely block the flow of blood to the heart muscle, leading to a reduction in oxygen supply and resulting in chest pain or discomfort.

Signs and Symptoms:

The symptoms of unstable angina include:

  • Chest pain or discomfort, which may feel like a squeezing, pressure, fullness, or tightness in the chest
  • Pain that may radiate to the arms, neck, jaw, shoulder, or back
  • Shortness of breath
  • Sweating
  • Nausea or vomiting
  • Dizziness or lightheadedness
  • Fatigue

Investigation

To diagnose unstable angina, the doctor may perform several tests, including:

  • Electrocardiogram (ECG): This test measures the electrical activity of the heart and can detect abnormalities that may indicate a heart attack or unstable angina.
  • Blood tests: These tests can detect certain enzymes that are released into the bloodstream when heart cells are damaged.
  • Echocardiogram: This test uses sound waves to create images of the heart and can help identify problems with the heart’s structure or function.
  • Cardiac catheterization: This invasive test involves inserting a catheter into a blood vessel and threading it to the heart to look for blockages in the coronary arteries.
    Treatment:

The treatment of unstable angina may include:

  • Medications: Nitroglycerin and other medications may be prescribed to relieve chest pain and improve blood flow to the heart.
  • Angioplasty and stenting: In this procedure, a catheter with a balloon at its tip is inserted into a blocked coronary artery and inflated to widen the artery. A stent may also be placed to keep the artery open.
  • Coronary artery bypass surgery: In this surgery, a blood vessel is taken from another part of the body and used to bypass the blocked artery, restoring blood flow to the heart muscle.

Dos and Don’ts:

To prevent further episodes of unstable angina, it is important to:

  • Follow a healthy diet that is low in saturated and trans fats and rich in fruits, vegetables, and whole grains.
  • Exercise regularly, with guidance from a doctor or physical therapist.
  • Quit smoking and avoid exposure to secondhand smoke.
  • Manage stress through relaxation techniques or therapy.
  • Take medications as prescribed and attend all follow-up appointments with the doctor.

It is also important to avoid:

  • Heavy lifting or strenuous activity that can increase the workload on the heart.
  • Exposure to extreme temperatures or high altitudes, which can increase the risk of heart problems.
  • Non-prescription drugs or supplements without consulting a doctor, as they may interact with prescribed medications or worsen the condition.

Reference:

American Heart Association. (2022). Unstable Angina. https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain/unstable-angina

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