What is angina pectoris?
Angina pectoris is a pain in the middle of the chest (anginal pain) which occurs when the heart muscle does not get enough blood supplied to make the heart to do its job. This is usually caused by narrowing of the coronary arteries, often in combination with physical exercise or emotion which makes the heart beat stronger and therefore needs more oxygen. With decreasing oxygen demand of the heart disappears angina again.
The pain caused by a sudden blockage of a coronary artery by a blood clot (thrombus or embolism) in nature is similar to that of angina pectoris, but usually more severe and takes longer. When complete blockage of a barrel of a heart attack occurs.
Angina pectoris can be combated by dilating the blood vessels medication (disappears after administration of nitroglycerin, the typical angina pectoris pain) or by bringing back the effort. Also, the lowering of blood pressure causes the heart need to deliver less labor and will thus have an anti-angineus effect.
The risk of developing angina pectoris is increased if a person smokes, is too thick, or has a too high blood pressure. Also with diabetes mellitus, high cholesterol levels and clearly increased in people who have in the family at a younger age (for the 60th year of life) cardiovascular disease prevents the chance of developing angina pectoris.
Especially in people with diabetes (diabetes mellitus) happens that the pain is not felt by the patient, while there is indeed a shortage of oxygen to the heart muscle. Women often complain of breathlessness with exertion or feel dizzy instead of chest pain.
Also, spasms of the coronary arteries, instead of narrowing, may sometimes lead to anginal symptoms. This condition is called variant angina, or Prinzmetal's angina pectoris.
The diagnosis can usually be made by making an electrocardiogram (ECG) at a time when the patient feels the symptoms. A normal ECG during angina complaints, however, does not completely. When in doubt, will often perform an exercise test, such as a bicycle or a myocardial scintigraphy test. The coronary arteries can be imaged with a CT scan or a cardiac catheterization (Coronary angiography or CAG).
Differential diagnosis
Cardiovascular or lungs
- angina pectoris
- unstable angina - may resemble a heart attack
- stable angina - is less dangerous, but should definitely be investigated properly
- myocardial infarction ("heart attack")
- dissection of the aorta
- arrhythmias (as a result of oxygen deficiency by increased heart rate)
- pulmonary embolism
- pneumonia
- haemothorax
- pneumothorax and tension
- hyperventilation syndrome
- GERD
- ulcer
- gallstone
- pancreatitis
- panic Attack
- tietze syndrome - osteochondritis with pain at the level of the transition between bone and cartilage of the ribs
- bornholm disease - or pleurodynie, a viral infection with chest pain.
Approximation
Case history and clinical and technical research. In addition to blood tests and X-rays offer the electrocardiogram and clinical signs such as the sign of Levine useful information. The medical history of the family and predisposing factors and risk factors are taken into account. On suspicion of pulmonary embolism a scintigraphy can be performed.