Category Archives: Heart Diseases

Valvular Heart Disease

How serious is Valvular Heart Disease? Let us understand

Heart Diseases

Valvular heart disease is a cardiovascular disease that occurs when one or more of the heart’s four valves do not open or close properly. When more than one valve is affected, it is termed multiple valvular heart disease. This disease typically occurs due to aging and can be treated by using medications and valve repair surgery. 

Valvular Heart Disease Types

  • Regurgitation results from leakage of the valve. There is a backward flow of the blood due to leaky valves that do not close properly. It generally results in reduced forward blood flow and results in volume overload in the heart. It is subdivided into four types depending on the valve affected :
    • Tricuspid valve regurgitation
    • Pulmonary valve regurgitation
    • Mitral valve regurgitation
    • Aortic valve regurgitation
  • Valvular stenosis ( narrowing of the valve ) – Narrowing the valve opening due to stiffening of the valve muscle limits blood flow out of the atria or ventricles. It is further classified as :
    • Tricuspid valve stenosis
    • Pulmonary valve stenosis
    • Mitral valve stenosis
    • Aortic valve stenosis 
  • Valvular prolapse – This condition occurs when the valve slips out of place or if the valve flaps do not close properly and disrupt the unidirectional flow of blood. The most common valvular prolapse is mitral valve prolapse.

What Causes Valvular Heart Disease?

  • This disease can occur due to congenital abnormalities or acquired causes that cause damage to the heart valves. 
  • Change in the heart valve structures due to aging is one of the main etiological factors of valvular heart diseases, but this is not the sole contributing factor.  
  • The other common causes of this disease are congenital valvular heart disease, bicuspid aortic valve disease, and Marfan syndrome.
  • Following are the health conditions that can also cause valvular heart disease:

What are the Risk factors?

  • Age – Older age people are more prone to getting this disease due to the “wear and tear” of advanced age and the enhanced calcium deposition in the valves. It, in turn, leads to stiffening or thickening of the heart valves.
  • Congenital abnormalities – Congenital birth defects affecting the size and structure of the heart valve increase the rate of valvular heart disease. Heart valve dysplasia, tetralogy of Fallot, and Ebstein’s anomaly are common predisposing factors. Do you know how serious is Congenital Heart Disease?
  • Metabolic disorders – Individuals with metabolic disorders such as high blood cholesterol and diabetes show a higher incidence of valvular heart disease than others.
  • Inflammatory disorders – Generalized inflammation of the heart due to bacterial infections can often lead to regurgitation through the valves. People with valvular endocarditis and rheumatic heart disease are at a higher risk.
  • Radiation therapy – Exposure to high–dose radiation that results in calcium deposits in the valve is also a risk factor.
  • Other diseases – Bacterial infections of the heart that can cause scarring of the heart valve and autoimmune diseases such as lupus also increase the risk of this disease.
  • Certain medications – Ergotamine derivatives such as cabergoline and pergolide used in treating Parkinson’s disease increase the risk of developing valvular heart disease.

Cardiac Problems

Valvular Heart Disease

Signs and symptoms:

  • Chest pain, discomfort, or tightness
  • Heart palpitations
  • Fatigue
  • Dizziness
  • Shortness of breath
  • Swelling in the extremities
  • Abdominal pain
  • Rapid weight gain
  • Fever

Complications

Other life-threatening complications that are more likely to occur due to valvular heart diseases include:

Diagnosis

  • The physician looks for abnormal heart sounds such as a characteristic heart murmur to diagnose this disease. Further diagnostic tests are then performed to identify the type of valve disease.
  • Diagnostic tests – The commonly recommended diagnostic tests are :
    • Electrocardiogram (ECG) – Abnormal heart rhythms and heart muscle damage are identified via this test.
    • Echocardiogram (Echo) – It is typically used to evaluate the heart valve function.
    • Transesophageal echocardiogram – This test is used to create images of the valves and chamber of the heart for diagnostic purposes.
    • Chest x-ray
    • Cardiac catheterization – This procedure is done to determine the type and extent of the heart valve disorder.
    • Magnetic resonance imaging (MRI)

Treatment of Valvular Heart Disease

The primary rationale behind the treatment of valvular heart disease is preventing the exacerbation of the disease and providing relief of symptoms. 

  • Medications –
  • Diuretics – Furosemide, torsemide, etc., to reduce the swelling and fluid buildup in the body by increasing urine output.
  • Vasodilators – Enalapril, fosinopril, etc., to relax the blood vessels and ease the work of the heart muscles.
  • Beta-blockers – Acebutalol, nebivolol, etc., to control heart rate and prevent abnormal heart rhythms.
  • Digoxin and calcium channel blockers like verapamil, diltiazem – These are given to reduce the symptoms of heart valve disease.
  • Surgery – 
    • Heart valve repair – This surgical procedure is done to ease the symptoms and rectify the abnormality of the heart valve. It generally includes remodeling the abnormal heart valves or inserting prosthetic rings to narrow the dilated valves.
    • Heart valve replacement – Severely malformed or destroyed valves cannot be remodeled or repaired and hence require replacement with a new valve. The new valve can be either animal valves, donated human aortic valves, or mechanical valves, although the latter is preferred over the others.
  • Non – surgical procedure – Balloon valvuloplasty is a non – invasive procedure used to treat stenosis. In this, a thin catheter with a balloon at the tip is inserted through the blood vessel to the narrowed valve and then inflated at this region to widen the valve opening. 

Read How is Valve Replacement Surgery performed?

Consult a cardiologist in Mumbai

When to see a doctor? :

Consult immediately with a cardiologist if there is a sudden aggravation of chest pain, shortness of breath, or an inability to maintain the regular activity level. The average cost of heart valve replacement surgery is around INR 2.5 L to 8.5 L. 

Prevention of Valvular Heart Disease

  • Living with valvular heart disease – 
    • Seek immediate medical care if the symptoms aggravate.
    • Getting vaccinated against flu and pneumonia to prevent serious complications.
    • Consuming a low–sodium diet.
    • Cardiac rehabilitation.
    • Getting regular exercise.
    • Quitting smoking.
  • Preventing valvular heart disease –
    • Being more active.
    • Limiting alcohol intake.
    • Managing stress.
    • Managing a healthy weight.
    • Eating a healthy diet.

Growing concerns of Sudden Cardiac Arrest in India

Heart Diseases,

A sudden cardiac arrest (SCA) or sudden cardiac death is a condition in which the heart suddenly stops beating. In turn, it prevents the flow of oxygen-rich blood to the brain and other organs. If SCA is not treated immediately, then the patient dies within minutes.

About 10% of the deaths in India is due to sudden cardiac arrest which is also the most common factor of death in the world.

Economic Times

Causes:

SCA occurs due to:

Risk factors:

  • Age – The risk of SCA increases with age due to the presence of other health conditions.
  • Gender – Men are more likely to be affected as compared to women. The risk of SCA in children is high if they have any inherited heart disease.
  • Ethnicity – African Americans and Blacks are at a higher risk, especially if they have other underlying conditions like hypertension, diabetes, and chronic kidney disease.
  • Ischemic heart disease – People with ischemic heart disease are at a higher risk.
  • Other heart conditions – Patients diagnosed with heart attack, heart failure, cardiac arrhythmias, coronary artery disease, and scarring or damage to the heart tissue have increased incidence of SCA.
  • Physical stress – Intense physical activity or exercise raises the risk in people who already have heart problems.
  • Unhealthy lifestyle habits – Obesity, smoking, sedentary lifestyle, and alcohol abuse elevate the risk of getting SCA.
  • Family history – People born with heart defects like coronary artery anomaly or those with a family history of arrhythmias are at a higher risk.
  • Drug abuse – Illicit drug use of cocaine and other addiction-forming drugs elevates the risk.
  • Medications – Certain drug overdose and medicine used to treat heart disease increases the risk.

What are the Signs and symptoms of Sudden Cardiac Arrest?

  • Dizziness or lightheadedness just before the patient faints
  • Loss of consciousness (fainting)
  • Unexplained shortness of breath
  • Racing heart
  • Chest pain
  • Seizures
  • Fatigue
  • Vomiting
  • Lack of palpable pulse
  • Nausea
  • Unable to breathe normally and make gasping noises

Complications:

Emergency treatment helps to prevent death due to SCA. After resuscitation, the following complications are associated with SCA:

  • Postcardiac arrest shock 
  • reduced heart function
  • Organ damage

Diagnosis: how is Sudden Cardiac Arrest diagnosed?

  • SCA happens without any warning and is rarely diagnosed as it is happening. Most often, it is diagnosed after it happens.
  • Diagnostic tests –
    • Electrocardiogram (ECG) – Detects the heart’s electrical activity and signs of heart damage due to ischemic heart disease.
    • Echocardiography (echo) – Helps identify areas of poor blood flow, previous injury to the heart muscle, and regions of the heart muscle that are not contracting properly.
    • Gated blood pool scan or MUGA (Multiple gated acquisition) tests – A radioactive substance is injected into the vein to show how well the heart pumps blood.
    • Cardiac Magnetic Resonance Imaging (MRI) 
    • Cardiac catheterization – To detect narrowed or blocked coronary arteries.
    • Electrophysiology study – To record how the heart’s electrical system responds to electrical stimuli and certain medicines.
    • Blood tests – The levels of potassium, magnesium, and other chemicals involved in the heart’s electrical signaling are detected.

Treatment: how is Sudden Cardiac Arrest treated?

  • Emergency treatment is done to restore the heart’s normal rhythm. Cardiopulmonary resuscitation (CPR) is immediately performed to keep blood and oxygen circulating to the brain and throughout the body.
  • Emergency treatment – Defibrillation is usually done to restore the vitals as well as consciousness immediately. CPR is performed till defibrillation can be done. 
    • Automated External Defibrillators (AEDs) – Untrained individuals can use a particular defibrillator to give electric shocks if a dangerous arrhythmia is detected.
    • Cardiopulmonary resuscitation (CPR) – The center of the chest is pushed down by at least 2 inches at the rate of 100 to 120 pushes per minute. The chest is allowed to come back to the normal position before the next push.
  • Surgical procedures – Long–term treatment in the hospital and other surgical procedures are done to treat the underlying condition responsible for the SCA. These include:
    • Coronary artery bypass grafting or coronary angioplasty – These restore blood flow via the narrowed or blocked arteries to treat the ischemic heart disease and prevent another SCA in the future.
    • Implantable cardioverter-defibrillator (ICD) – It is surgically placed in the skin in the chest to send electric shocks to control dangerous arrhythmias.
  • Medications to prevent sudden cardiac death –
    • Antiarrhythmic drugs – Lidocaine, amiodarone, etc. for acute and chronic therapy to prevent ventricular arrhythmias and sudden cardiac death.
    • Other drugs – Statins and drugs, acting on the renin-angiotensin-aldosterone system to treat the underlying heart conditions.

Prevention:

Living with SCA – 

  • Cardiac rehabilitation
  • Dietary intake rich in soluble fiber and low in saturated and trans fat
  • Managing a healthy weight
  • Managing stress
  • Quitting smoking

Preventing SCA –

  • Exercising regularly
  • Regularly taking the prescribed medicines to treat the underlying conditions
  • Controlling diabetes, high blood pressure, and high cholesterol
  • Limiting alcohol intake

When to see a doctor? :

Consult immediately with a cardiologist or cardiac electrophysiologist if chest pain or shortness of breath is experienced for prolonged periods. It is critical to call the emergency helpline number immediately if someone collapses or seems lifeless. The average cost of an AED for use at – home ranges from Rs. 65K to 2 lakhs. The price of a standard ICD surgery lies around Rs. 3.5 to 4.5 lakhs.

Heart Failure: a Chronic and Life-threatening Condition

Heart Diseases,

Heart failure (HF) is a chronic and life-threatening condition in which the heart cannot pump blood sufficiently to meet the body’s demands. It is also known as congestive heart failure and requires medical care.

Types:

  • Left-sided heart failure – Left ventricle of the heart cannot pump enough blood around the body leading to the accumulation of blood in the pulmonary veins.
    • Heart failure with reduced ejection fraction (HFrEF) or systolic failure – Left ventricle loses its ability to contract normally.
    • Heart failure with preserved ejection fraction (HFpEF) or diastolic failure – Left ventricle loses its ability to relax normally.
  • Right-sided heart failure – Right ventricle cannot pump sufficient blood to the lungs leading to the accumulation of blood in the veins.
  • Biventricular heart failure – Both sides of the heart are affected, and a build-up of fluid is seen.
  • Congestive heart failure (CHF) – Congestion in the body tissues occurs as the blood flow from the heart slows down and the blood returning to the heart via the veins backs up.

What Causes Heart Failure:

The main etiological factors are:

  •  Medical conditions that damage or overwork the heart, such as coronary artery disease or heart attack.
  •  Infection or injury that damages the heart.
  •  Blood clot in the lung.
  •  Faulty heart valves.
  •  Congenital heart disease.
  •  Arrhythmia.
  •  High blood pressure.
  •  Cardiac amyloidosis.
  •  Cardiomyopathy.
  •  Conditions that stiffen the heart chambers, such as obesity and diabetes.
  • Conditions that damage the lungs such as chronic obstructive pulmonary disease.

Risk factors:

  •  Age – Older adults and those above 65 years of age are at a higher risk due to aging–related changes of the heart muscle and the presence of other health conditions.
  • Genetics – Risk of HF is higher if there is a family history of heart failure. Gene mutations also raise the risk.
  •  Unhealthy lifestyle habits – Unhealthy diet, smoking, drug abuse, heavy alcohol consumption, and physical inactivity increases the risk.
  •  Medical conditions – Obesity, high blood pressure, diabetes, sleep apnea, atrial fibrillation, and serious lung disease also raise the risk.
  •  Medications – Diltiazem, verapamil, tricyclic antidepressants, antipsychotics, chemotherapy, and radiation therapy further elevate the risk.
  •  Ethnicity – African Americans are more likely to suffer from heart failure as compared to other races.
  •  Gender – Women are more susceptible to developing HFpEF while men are more likely to develop HFrEF. Men are more prone to heart failure at a younger age as compared to women.

What are the Signs and symptoms of Heart Failure?

  • Shortness of breath when active and resting
  • Swelling (edema) of feet, ankles, stomach, and lower back
  • Unusual tiredness
  • Water retention
  • Palpitations
  • Fatigue
  • Decreased stamina
  • Loss of appetite
  • Nausea
  • Chronic coughing

Complications:

The serious complications arising due to heart failure are:

  • Kidney or liver damage
  • Fluid buildup in or around the lungs
  • Malnutrition
  • Leaking heart valves
  • Sudden cardiac arrest
  • Cardiac arrhythmias
  • Pulmonary hypertension

Diagnosis: How is it diagnosed?

  • Medical history – The physician assesses symptoms, family history, and other risk factors.
  • Physical examination – Heart rate, blood pressure, heart sounds, and edema in the body are examined by the physician.
  • Diagnostic tests –
    • Blood tests – Electrolyte levels, kidney and liver function tests, complete blood count, C – reactive protein levels, and brain natriuretic peptide (BNP) are monitored.
    • Chest x-ray
    • Magnetic resonance imaging (MRI)
    • Breathing tests – To ascertain if the lung problem is responsible for breathlessness.
    • Radionuclide ventriculography – Radioactive substances are injected to see how well the heart chambers are functioning.
    • Cardiac catheterization with coronary angiography – Blockages in the coronary arteries and the parts of the heart that has weakened or damaged are identified.
    •  Holter or event monitor – Electrical activity of the heart is monitored for 24 to 48 hours while doing the normal daily activities.

Treatment: how is How is Heart Failure treated?

  • Improving the symptoms and preventing the aggravation of the disease are the main objectives of treatment.
  • Assessing the reversible risk factors is the other goal of treatment.
  • Implantable devices –
    • Implantable cardioverter-defibrillator (ICD) – To deliver an electric counter-shock to the heart when a life-threatening abnormal rhythm is detected.
    • Left – ventricular assist device (LVAD) – Implanted in end-stage heart failure patients when heart transplantation cannot be done.
    • Cardiac Resynchronization Therapy (CRT) – A pacemaker to make the ventricles contract in synchrony and improve heart function.
  • Surgical procedures –
    • Heart transplantation – Replacement of the damaged heart in severe, progressive heart failure patients with a healthy heart.
    • Percutaneous coronary intervention (PCI) or angioplasty – An inflated balloon pushes open the artery, and a stent is kept in place to reopen the blocked blood vessels.
    • Coronary artery bypass – Rerouting the blood supply around the blocked section of the artery to restore blood flow to the heart.
    • Valve replacement – Replacement of the defective or diseased valve with a good valve.
  • Medications –
    • Angiotensin – Receptor Neprilysin inhibitors – Sacubitril/valsartan reduces the risk of hospitalization for heart failure.
    • If channel blocker – Ivabradine to reduce heart rate.
    • Beta-blockers – Bisoprolol, metoprolol, etc., to lower heart rate.
    • Aldosterone antagonists – Spironolactone, eplerenone, etc., to remove extra sodium and fluid from the body.
    • Diuretics – Furosemide, bumetanide, etc. to treat edema.
    • Digoxin – To make the heartbeat stronger and pump more blood.
    • Other medications – Anticoagulants and statins.

Prevention:

  • Living with HF–
    • Heart-healthy diet
    • Managing a healthy weight and stress.
    • Quitting smoking.
    • Medical care for other conditions.
  • Preventing HF–
    • Increasing physical activity.
    • Controlling diabetes.
    • Lowering high blood pressure.
    • Lowering cholesterol

When to see a doctor? :

Consult with a cardiologist immediately if you have a chronic cough, high heart rate, and shortness of breath while lying down. The cost of heart transplantation surgery ranges around Rs. 20 to 25 lakhs.

References:

How do artery blockages lead to Heart Attack?

Heart Diseases,

A heart attack occurs when there is a blockage in the artery supplying blood and oxygen to the heart. Sometimes, there is the building of fatty deposits in heart arteries, causing plaque formation over time. A plaque rupture results in blood clot/s, potentially blocking the heart arteries, causing a heart attack.

In myocardial infarction, there is an insufficient supply of oxygen-rich blood flow to the heart muscle resulting in damage to that region. The heart muscle usually begins to die if the blood supply is not restored with treatment.

Types:

  • STEMI (ST-segment elevation myocardial infarction) Heart Attacks – ST segment is elevated in ECG as the coronary artery is completely blocked. A large part of the heart muscle does not receive blood.
  • NSTEMI (non-ST-segment elevation myocardial infarction) Heart Attacks – No change in the ST segment in ECG. Partial blockage of the coronary artery and less damage to the heart muscle.
  • Coronary artery spasm – Blood flow through the artery is restricted as the artery wall tightens, causing a heart attack.
  • Demand ischemia – Arteries are not blocked, but the heart’s demand for oxygen is more than that available in the body. 

What are the Causes of Heart Attack?

A heart attack occurs when the blood and oxygen supply to the heart muscle is cut off, resulting in damage to the heart muscle. This damage becomes irreversible if the blood supply is not restored within 30 minutes of blockage. The common causes of heart attack are:

  • Blockage of the coronary arteries by cholesterol and other substances.
  • Coronary artery disease or Atherosclerosis – Deposition of fat in the artery or plaque that may rupture and cause blood clot resulting in complete or partial blockage of blood flow through the coronary artery.
  • Spontaneous coronary artery dissection (SCAD) – Condition in which one or more of the coronary arteries tear.
  • Spontaneous coronary artery dissection (SCAD)
  • Severe spasm of the coronary artery.

Risk factors:

  • Age – Men above 45 years of age and women above 55 years are at a higher risk.
  • Family history – People with a family history of heart disease, especially those whose relatives were diagnosed before 55 years of age, show a higher incidence of a heart attack.
  • Medical conditions – Type 1 diabetes, high blood pressure, high levels of triglycerides, or LDL cholesterol are more likely to get a heart attack.
  • Unhealthy lifestyle habits – Smoking, excessive alcohol consumption, sedentary lifestyle, and a diet rich in saturated fat show a higher heart attack rate.
  • Preeclampsia – This condition develops during pregnancy and is characterized by a rise in blood pressure and excess protein in the urine. It increases the lifetime risk of a heart attack in women.
  • Metabolic syndrome – is another risk factor for heart attack, like obesity, high blood pressure, and high blood sugar are called. 
  • Gender – Men are more susceptible at a younger age as compared to women. The risk factor in women rises after menopause.

Signs and symptoms of Heart Attack

  • Pain or discomfort in the center or left side of the chest that lasts for more than a few minutes
  • Pain in one or both arms, back, shoulder, neck, jaw, and upper part of the stomach.
  • Shortness of breath
  • Unusual tiredness for no reason
  • Sweating
  • Nausea
  • Dizziness
  • No pain or an indigestion type of discomfort (seen in “silent heart attack”).

Complications:

Complications associated with a heart attack that requires medical care are:

  • ArrhythmiaComplete heart block
  • Heart failure
  • Cardiogenic shock
  • Heart rupture

Diagnosis:

  • Electrocardiogram (ECG) identifies signs of heart damage and that of previous or current heart attack as it records the heart’s electrical activity.
  • Blood tests – Levels of troponin, creatine kinase (CK) or CK–MB tests, serum myoglobin, and other proteins in the blood are evaluated to identify the heart damage and signs of a heart attack.
  • Coronary Angiography – Blockages in the coronary artery are determined using special x–rays and a catheter.
  • Echocardiogram (echo) – Soundwaves are used to identify which regions of the heart are damaged and their impact on heart functioning.

How is Heart Attack treated?

  • Restoring the blood flow to the heart muscle to limit the damage to the heart muscle is the primary goal of early treatment.
  • The other main treatment objectives are to relieve pain, preserve the heart muscle function, and prevent death.
  • Medical Procedures – 
    • Coronary angioplasty or percutaneous transluminal coronary angioplasty (PTCA) – A balloon is used to open the blood vessels. A stent is kept to keep the artery open. The different types of PTCA are:
      • Balloon angioplasty
      • Coronary artery stent
      • Atherectomy
      • Laser angioplasty
    • Coronary artery bypass grafting – Rerouting the blood to restore the blood supply to the heart muscle by bypassing the blocked section of the coronary artery.  
  • Medications – The different drugs used to treat and prevent heart attacks are:
    • Angiotensin-converting enzyme (ACE) inhibitors – Captopril, enalapril, etc. to lower blood pressure and reduce strain on the heart.
    • Anticlotting medicines – Aspirin, clopidogrel, etc., to prevent platelets from clumping and forming unwanted clots.
    • Anticoagulants – Dabigatran, edoxaban, etc., to prevent clot formation in arteries.
    • Beta-blockers – Metoprolol, acebutolol, etc., to decrease the heart’s workload and prevent another heart attack.
    • Statins – Atorvastatin, lovastatin, etc., to lower blood cholesterol levels to reduce the chances of another attack.
  • Emergency treatment – 
    • Intravenous therapy – Nitroglycerine to dilate the arteries, relieve the chest pain, and morphine to reduce the myocardial oxygen demand and ease the pain.
    • Oxygen therapy – To improve oxygenation to the damaged heart muscle.
    • Fibrinolytic therapy
    • Antiplatelet therapy
    • Monitor the heart and vital signs continuously.

How to prevent Heart Attack? How to live with it?

  • Living with a heart attack –
    • Regular checkup and medical follow up
    • Heart-healthy eating
    • Managing stress
    • Maintaining a healthy weight
    • Quitting smoking
  • Preventing a heart attack –
    • Cardiac rehabilitation to prevent another attack 
    • Increase physical activity
    • Improving mental health
    • Taking the prescribed medications

When to see a doctor? :

Contact a cardiologist or the local emergency number immediately if there is severe pressure or pain in the center of the chest that gets worse or doesn’t get better by taking nitroglycerin. The cost of coronary angiography ranges from Rs. 10K to 15 K, and that of bypass surgery lies around Rs. 3 to 4 lakhs.

References:

  • [1] – https://www.cdc.gov
  • [2] – https://www.heartfoundation.org.nz
  • [3] – https://www.hopkinsmedicine.org
  • [4] – http://www.secondscount.org
  • [5] – https://www.nhlbi.nih.gov
  • [6] – https://www.nhs.uk

Angina: a feeling of squeezing and chest pain

Heart Diseases,

Angina refers to chest pain or discomfort when there is an inadequate supply of oxygenated blood to the heart muscle. This inadequacy is frequently experienced during times of increased demand for oxygen, such as exercise or stress.

Types:

  • Stable angina – is predictable chest pain or discomfort during exercise or periods of stress and is minimal or non – existent at rest.
  • Unstable angina – Chest pain occurs unpredictably at rest or with minimal exertion and worsens or becomes more frequent with time.
  • Variant angina (Prinzmetal’s angina) – Rare painful attacks are experienced while resting, usually between midnight and early morning.
  • Microvascular angina (Cardiac syndrome X) – Chest pain occurs for more than 10 minutes and is observed during routine daily activity or stress.

Causes:

  • It occurs when the heart does not get an adequate supply of oxygenated blood. 
  • This is usually associated with narrowing of the coronary arteries due to plaque buildup. These plaques clog the arteries and reduce the blood flow to the heart. 
  • Damage to the tiny arteries, as seen in coronary artery disease and coronary microvascular disease, also contributes to angina.
  • Spasms of the coronary arteries are another causative factor of angina.

Angina: Risk factors

  • Age – Men above 45 years of age and women over 55 years of age are at a higher risk.
  • Obesity – Unhealthy eating habits and people with a BMI greater than 30 kg/m2 are at a higher risk. 
  • Occupational reasons – Working in construction sites, mines, working in a highly stressful environment, or being continuously exposed to radiation increases the risk of developing angina.
  • Genetics – Family history of early heart disease or premature cardiovascular disease increases the likelihood of getting angina.
  • Unhealthy lifestyle habits – Smoking, lack of sleep, drinking alcohol, physical inactivity, drug abuse, excessive stress, and chronic exposure to secondhand smoke are other risk factors.
  • Other medical conditions – Cardiomyopathy, high blood pressure, metabolic syndrome, and heart valve disease-raise the risk in patients.
  • Medical procedures – Coronary artery bypass grafting or stent placement may trigger angina in some cases.
  • Ethnicity – African Americans are more prone to getting angina as compared to Whites. 

Signs and symptoms:

  • Pressure, burning, or tightness in the chest
  • Chest pain or discomfort
  • Epigastric pain
  • Pain radiating to the left shoulder, arm, back, or jaw
  • Shortness of breath
  • Sweating
  • Fainting
  • Pain during regular daily activity

Complications:

Other life-threatening complications that are more likely to occur due to angina include:

Diagnosis of Angina

  • Medical history – The physician assesses signs and symptoms, family history, and other risk factors.
  • Physical examination – Blood pressure, heart rate, and other vitals are examined.
  • Diagnostic tests – The tests performed to diagnose angina are:
    • Blood tests – Blood levels of myoglobin, BNP (Brain natriuretic peptide), fats, glucose, cholesterol, sugar, and proteins are checked.
    • High–sensitivity cardiac troponin test – Blood levels of the cardiac biomarker troponin T are detected to diagnose heart damage and heart attacks more quickly.
    • Coronary angiography with cardiac catheterization – Blood flow and pressure in the heart are evaluated and examined for the presence of plaque buildup.
    • Hyperventilation testing – Rapid breathing under controlled conditions with medical monitoring done to assess changes in the ECG. This is used for the diagnosis of variant angina.
    • Provocation tests – Coronary arteries are checked to see if they spasm on the administration of acetylcholine. Coronary angiography is done for this purpose.
    • Exercise stress test – Functioning of the heart during exercise is tested. It helps to diagnose variant angina when done in the early morning.
    • Coronary calcium scan – The presence of calcium in the coronary vessels is detected as it is an indicator of plaque development.
    • Radionuclide imaging – Blood flow and narrowing of the blood vessels are visualized using a radioactive compound. 
    • Chest x-ray
    • Echocardiogram
    • Electrocardiogram (ECG)
    • Computed tomography angiography 
    • Magnetic resonance imaging (MRI)

Treatment of Angina

 The primary rationale behind treatment involves preventing or controlling angina episodes and providing relief of symptoms. It is also done to slow down the progression of the underlying heart diseases and reduce the risk factors in patients.

  • Cardiac procedures – 
    • Angioplasty or Percutaneous coronary interventions – Cardiac catheterization is done to open narrowed or blocked blood vessels to increase blood flow and decrease chest pain.
    • Coronary artery bypass grafting – Rerouting of blood around the clogged region is done to restore blood supply to the heart muscle.
    • Stent placement – Stents are kept to prevent coronary narrowing, thus helping relieve chest pain and improve blood flow.
    • Transmyocardial revascularization – Small holes are made directly into the heart muscle to relieve severe angina in very ill patients who cannot undergo angioplasty.
  • Medicines – Drugs that are frequently prescribed belong to the following classes:
    • Anticoagulants – Heparin, warfarin, etc., to prevent the formation of harmful clots in the blood vessels.
    • Antiplatelet drugs – Aspirin, clopidogrel, etc. to prevent clot formation in unstable angina.
    • Beta-blockers – Metoprolol, nadolol, etc., to relieve angina.
    • Calcium channel blockers – Verapamil, amlodipine, etc., to treat angina caused by the reduced blood supply to the heart muscle.
    • Statins – Atorvastatin, lovastatin, etc., to relieve blood vessel spams and lower the risk of a heart attack.
    • Vasodilators – Nitrates, including nitroglycerin, are used to relax and widen blood vessels and reduce cardiac workload.

Prevention:

  • Living with angina –
    • Eating a heart-healthy diet
    • Managing stress
    • Quitting smoking
    • Increasing physical activity
    • Managing a healthy weight
    • Regular health checkup and follow – up care
  • Preventing angina –
    • Keeping an account of the triggers of angina 
    • Reducing and managing stress
    • Avoiding exposure to extremes of temperature
    • Avoiding alcohol

When to see a doctor? :

Consult with a cardiologist immediately if a crushing sensation or stabbing chest pain is experienced for more than a few minutes and if it doesn’t disappear with rest or medications. The cost of angioplasty ranges from Rs. 1 to 3 lakhs. 

References: