Angina Pectoralis

About the condition

 Angina Pectoralis also is more of a symptom of coronary heart disease than a

condition.
 It is also a warning sign for a potential Myocardial Infarct (heart attack)
 It occurs when there is cardiac ischemia, where one or more of the heart’s arteries
are blocked or narrow limiting oxygen to the heart muscles
 This then causes chest pains which are then referred as Angina Pectoralis

Medical history and Risk Factors

 Patients with the following diseases are at risk Angina pectoralis:

 Coronary artery disease
 Peripheral artery disease
 Chronic kidney disease
 History of Cerebral infarction (stroke)
 Metabolic syndrome
 History of heart disease
 Hypertension
 Diabetes
 Other risk factors include:
 Obesity- which induces the heart to work hard to supply blood to the
body
 The use of Tobacco- either by chewing, smoking or long-term
exposure to second hand smoking which allows deposit of cholesterol
in arteries and damages the lining of arteries
 Age increase- aging degenerates many systems in the body increasing
the risk of developing varies conditions including Angina
 Emotional stress
 Medication- specific medication which cause the tightening of blood
vessels may trigger Angina such as migraine medication
 Drug abuse- using stimulants such as cocaine that cause blood vessel
spasms cause Angina
 Cold temperatures- which cause vasoconstriction
 Inactive lifestyle- can cause high cholesterol, diabetes and
hypertension

Onset/Timing/Duration
The onset, timing and duration of Angina varies on the type of Angina:

 Stable angina- most common and predictable as it happens in episodes of similar

chest pain. Occurs during and activity such as exercise, chest pains last for a short
period usually less than five minutes. May occur during cold weather or when
walking uphill. Pain subsides at rest and during cold weathers when patient is warm.
 Refractory angina- occurs in frequent episodes regardless of changes in lifestyle and
angina medication
 Unstable angina- very unpredictable and occurs at rest. Chest pain is more severe
and lasts longer than in stable angina. Episodes of pain may last more than 20
minutes, worsens with less physical effort. Pain does not subside at rest and usual
angina medication is ineffective. If pain does not subside meaning blood flow is still
blocked it may lead to a myocardial infarct. Unstable angina is a cause of concern
and may be sudden.
 Prinzmetal angina- not caused by coronary artery disease rather it is cause by
spasms in the heart’s arteries which reduce blood flow temporarily. Occurs overnight
and at rest in cycles with severe chest pains. Pain can be reduced by angina
medication.

Location/Radiation/Referral pattern

 Pain can be felt in the mid chest described as squeezing, pressing or crushing pain.
 Pain can be referred to upper back, arms, neck and earlobes

Myocardial Infarct
About the condition

 Occurs when there is a blockage of blood flow to the heart’s muscle.

 The blockage is caused by plaque in the heart’s arteries (atherosclerosis) which
rapture resulting in blood clot which cause the heart attack.
 Blood and oxygen are completely cut off causing death to the cells of the heart and
lacerations to heart muscles.
 Irreversible damage will begin within 30 minutes of blockage where heart muscles
affected will no longer work.

Medical history/risk factors

 Patients with a history of myocardial infarct are at risk

 Patients with inherited/acquired hypertension
 Age
 Patients with type 2 diabetes
 Obesity
  Alcohol and drug abuse
 Smokers
 Patients under a lot of stress
 Highly fat saturated diet

Onset/timing/duration

 The onset of myocardial infarction varies from each individual.

 The onset of myocardial infarction occurs with symptoms that only last for a few
minutes.
 These symptoms come and go and may occur intermittently over a few hours.
 The symptoms are usually mild at the beginning causing angina (chest pains) and
discomfort.
 Untreated heart attacks can lead to complications that are fatal, these complications
include:
 Sudden Cardiac Arrest- this is when the heart suddenly stops due to
an electric disturbance which lead to abnormal heart rhythm, this can
be fatal if left untreated.
 Heart failure- this occurs when there is a severe myocardial infarct.
Heart failure can be temporary meaning the damage to the heart was
reversable, or it can be chronic where there has been permanent
damage to the heart muscles. Heart failure means the heart cannot
pump blood efficiently around the body
 Arrhythmias- abnormal heart beats cause by an electric short circuit
 In some cases, myocardial infarct can be sudden cardiac arrest with severe pain with
no indicating symptoms.

Location/Radiation/referral pattern

 The pain location, radiation and referral pattern are the same as that in Angina
pectoralis
 Mild or severe chest pains
 Pain can be referred to jaws, neck, stomach, arms back and shoulders.
 In most cases pain is referred to the left arm
References
American Heart Association. (2015). Angina Pectoris (Stable Angina). Available from:
https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain/angina-
pectoris-stable-angina. [Accessed on 03 April 2022].

Harris, R.B. & Weissfeld, L.A. (1991). Gender differences in the reliability of reporting
symptoms of angina pectoris. Journal of clinical epidemiology, 44(10): 1071-1078.

Johns Hopkins Medicine. (2022). Heart Attack. Available from:

https://www.hopkinsmedicine.org/health/conditions-and-diseases/heart-attack.
[Accessed on 04 April 2022]

Panju, A.A., Hemmelgarn, B.R., Guyatt, G.H. & Simel, D.L. (1998). Is this patient
having a myocardial infarction?. Jama, 280(14): 1256-1263.

Reed, G.W., Rossi, J.E. & Cannon, C.P. (2017). Acute myocardial infarction. The
Lancet, 389(10065): 197-210.