Angina pectoris

*it is a clinical syndrome of discomfort due to transient myocardial ischaemia
*transient ischaemia is due to
1) obstruction of coronary flow by atheroma
2) coronary arterial spasm
3) risk factors -exercise, hypertension, AS, AR, hyperthyroidism
Clinical features
1- retrostermal pain which is squeezing crushing in character. It commonly radiates to left arm
2- Angina decubitus is a pain while lying flat
3- Nocturnal angina that occurs in aortic regurgitation which is characterised by paroxysmal nocturnal pain associated with nightmare dyspnea palpitation profuse sweating
4- Sprinz metal angina or variant angina is pain which comes capriciously due to coronary artery spasm &accompanied by transient ST segment elevation
5- on examination -*rise in blood pressure & heart rate *fourth heart sound *pansystolic murmur *paroxysmal splithng of second heart sound *relief of pain by cardiac sinus massage (Levine test )
 MANAGEMENT
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A) INVESTIGATIONS
*ECG- reversible ST segment elevation /depression with or without T wave inversion
*Echocardiography
*coronary coronary angiography
*CT&MRI are investigation  of choice
B) TREATMENT
*Aims of managements involves 3 phases
1- assesment of severity &extent of disease
2- measure to control symptoms
3- measure to improve life expectancy
*specto discribed under 3 headings
1) General measures
2)Drug treatment
3)Surgical treatment
GENERAL MEASURES
*proper counselling
*avoid walking after meal in cold, against wind
*control hypertension diabetes
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*correction of ppt factors
DRUG TREATMENT
1)Nitrates- glycerol trinitrate 500micro gm sublingual relieve pain
2) Beta blockers- they reduce myocardial oxygen demone by reducing heart rate
3) Calcium blockers indicated in if response to beta blockers inadequate / H/o of asthma /prinz metal's angina/sick sinus syndrome
4)Antiplatelet agents low dose aspirin 75 to 150 mg /day
SURGICAL TREATMENT
1)coronary artery bypass grafting by saphenous vein
2)percutaneous transluminal coronary angioplasty