Angina is characterized by chest pain or pressure in chest. It is one of the most prominent symptoms of coronary artery disease. Patient may also experience pain in left shoulder, neck and jaw. Lack of blood supply to cardiac muscles and reduced oxygen produces pain in chest.
Angina is classified into two types, stable angina and unstable angina. Stable angina is when patient has premonition of chest pain after doing hard physical work. With rest or after taking nitroglycerin tablet the symptoms of stable angina alleviate. Unstable angina is sudden and it usually occurs while resting.Most importantly medications do not relieve pain. Reduced blood flow is caused due to blockage in coronary artery by fatty material called plaque.
Unstable angina should be treated as emergency as it is a signal that your coronary arteries are becoming narrow and you may be prone to heart attack. In United States unstable angina is the leading cause of admission in CCU.
What Are The Causes Of Unstable Angina?
Unstable angina occurs when the blood flowing through the coronary arteries to the heart muscles is compromised. It occurs due to formation of a clot or a plaque in the coronary artery.It may be a partial blockage or complete block. This clot is formed of fatty material together with other substances. The clot may dissolve partially but may again develop obstructing proper blood flow resulting in angina.
Whenever such clot develops, patient experiences pain in chest due to less oxygen supply to the heart muscles.
Unstable angina is more common in men above the age of 45 and in women above the age of 55. The risk factor of unstable angina increases following people:
- Smokers and tobacco chewers.
- Hypertensive patients.
- High level of LDL (bad cholesterol).
- Low level of HDL (good cholesterol).
- Physically inactive people.
Signs And Symptoms Of Unstable Angina
The characteristic clinical feature of unstable angina is pain in chest. It may be severe pain in chest or discomfort depending on each individual and the amount of obstruction. Here are important symptoms of unstable angina:
- Chest pain usually occurs when patient is resting or at night while sleeping.
- Unstable angina pain is sudden in onset.
- Pain becomes worse with time.
- Squeezing pain in chest.
- Radiating pain in arm and neck or back.
- Increased perspiration.
- Breathing difficulty.
- Feeling too tired.
- Medicines do not give relief.
- It can precipitate into myocardial infarction (heart attack).
Diagnosis And Treatment Of Unstable Angina
Physicians diagnose unstable angina after taking medical history, physical examination and certain tests. Certain tests are biomarkers for cardiac disease. Blood tests for troponin, enzyme CKMB, are suggestive of angina and cardiac event. Abnormal ECG and echocardiogram further help for evaluating the condition.
Doctor may also suggest stress test which makes the heart work hard and signs of angina may become obvious. Lastly the confirming test is coronary angiography. It helps to find the exact location of blockage in the coronary vessel.
Patient with unstable angina that occurs suddenly needs hospitalization and continuous monitoring. The physician may start the treatment with blood thinning agents, medications to lower blood pressure, arrhythmia, pain killers etc.
In case if there is severe blockage than more invasive procedure may be required. These include percutaneous coronary angioplasty or coronary artery bypass graft surgery.