Angina pectoris
Angina pectoris
Definition
Angina pectoris is a clinical condition characterized by discomfort or chest pain due to myocardial ischemia. Clinically indistinguishable forms of the two forms of angina, stable angina and the
unstable. Unstable angina is a more severe form that can be develop and / or an early form of myocardial infarction, so patients need to be checked and further observed in the hospital.
Cause
Ischemia occurs because the supply of oxygen carried by the coronary blood flow inadequate myocardial oxygen demand. This happens when the need increased myocardial oxygen (eg due to physical labor, emotional, thyrotoxicosis, hypertension), or when the coronary blood flow is reduced (eg in spasm or coronary thrombus) or in the event of both.
Clinical Overview
- The patient complains of chest pain of various shapes and locations.
- The pain begins as a feeling squeezed, pinched, or feel a burning sensation spread to the inside of the left arm and sometimes down to his shoulder, shoulder and left neck, even down to the left little finger.
- This feeling may also spread to the waist, throat, jaw and teeth There are also convey the right arm.
- Discomfort can also be felt in the gut, but is rarely felt in the area apex beat.
- The pain may be accompanied beberapan or one of the following symptoms: sweating chills, nausea and vomiting, weakness, palpitations and feeling faint (Fainting).
- In most cases of angina occur during physical activity (unstable angina).
- This attack will be lost if patients stop the physical activity and rest.
- The attack lasted only a few minutes (1-5 minutes) but can be up more than 20 minutes.
- Angina pain are constant. When such changes occur long attack increases, the pain is more severe, the onset threshold.
- Decreased or attack came when wake up, then the disorder should watch. This change may be a sign prainfark (angina not stable).
- A form of change (variant) called Prinzmetal angina usually arise when the patient is resting.
- Angina is said to gain weight when the next attack occurred after lighter physical work, such as after meals. It is also classified as unstable angina.
- Physical examination is generally not outside attack showed abnormalities
means. At the time of the attacks, increased heart rate, blood pressure
increased and in region of heart was beating hard precordium.
- On auscultation, heart sounds heard far away, heard the loud systolic mid or late systole and the fourth sound.
- Usually found risk factors: hypertension, obesity or diabetes mellitus.
Diagnosis
- Chest pain retrosternal
- Examination of the ECG Management
- Abnormalities of underlying angina pectoris should be sought, then reduced or treated. Factors that aggravate such as smoking, weight excessive, and coffee drinking habits should be avoided.
- High blood pressure is treated.
- Stress-controlled
- Unstable angina should be treated in the hospital.
Treatment of acute attacks
- Acute attacks overcome with the rest to the heart of diminished activity. Vasodilators work to improve the supply of oxygen and reduced cardiac oxygen consumption.
- Sublingual nitroglycerin from 0.15 to 0.6 mg is very effective. These tablets can be used several times a day with no side effects except for headache.
When the first tablet should be repeated not help, but if after repeated 3
time the symptoms did not decrease the possibility of infarction has occurred.
- Isosorbid dinitrat (ISDN) sublingual 2.5 to 5 mg which can also be repeated or oral tablets 5-30 mg.
2. Prevention of attacks
- Propranolol effective for angina pectoris because it can reduce labor
heart muscle, thereby reducing the oxygen demand of the heart. Clinical effects
propranolol is achieved when the heart rate at rest 60-70
beats / min.
Initial dose: 20 mg 2 x daily.
Maximum dose: 120 mg a day.
This drug should not be used in Prinzmetal angina.
- Nitrate old work: ISDN oral tablets 10-20 mg 2 x daily.
- Nifedipine 10-20 mg 4 times daily, or diltiazem 30 - 60mg three times daily, or verapamil 40 - 80 mg 3 times daily.
- Unstable Angina: need special care.
- Variant angina: a powerful dilator: nitrates, calcium antagonists, prazosin 0.5 - 1mg
3 x daily with titrasi.
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