Angina And Aging
Nursing Home Elderly Care
What is Angina?
By definition, angina is a fairly common type of chest pain that results from less than adequate blood supply to the heart muscles.
What Causes Angina?
For the most part, coronary artery diseases cause angina.Some coronary artery diseases include aortic stenosis, hyper tension, and hypertrophic cardiomyopathy. However, people with normal arteries can sometimes suffer with angina. The heart normally receives its blood supply from the coronary arteries during the relaxation phase of a heart muscle contraction (the pumping action of the heart). When the heart needs more blood, the vessels dilate. But, when plaque lines the vessels, they cannot dilate. They lose their flexibility. Therefore, disorders involving the condition of the coronary vessels cause low blood oxygen levels and poor circulation. An obstruction of the blood vessels results in a decrease in the blood supply to the heart muscles. This is called ischemia. What does an angina attack feel like? Most people experience angina pain behind the sternum (breastbone) or just to the left. Angina pain commonly radiates to the left shoulder/upper arm. Then it travels to the left elbow, wristand fingers. Angina pain may radiate to the right shoulder, neck,jaw or just above the stomach area. Patients say that angina pain is NOT sharp like a knife, but is felt in terms of a burning, pressing,aching, or pressure as experienced with gas or indigestion. Angina attacks may come on slowly or quickly. Usually the durationis less than 5 minutes, but can last as long as 15 to 20 minutes.Longer angina episodes may occur after experiencing an extreme emotional outburst or eating a large meal due to the extra demands placed on the heart. Signs and Symptoms of Angina Attacks If you experience the following signs or symptoms, you may be having an angina attack:
- difficulty breathing
- pale face/skin
- heart palpitations
- digestive disturbances
What Happens During an Angina Attack?
Angina attacks happen when the coronary artery is closed off (occluded).When this happens, heart cells become deprived of blood supplywithin only 10 seconds. Several minutes after the beginning ofthe angina attack, the heart decreases its pumping action. Subsequently,oxygen and glucose cannot feed the muscle. The cells then convert to a different kind of metabolism: anaerobic metabolism. This kindleaves lactic acid as a waste product. The heart muscle becomesless healthy and needs to work harder as it rids itself of thelactic acid. An angina attack is like an extreme case of musclecramping after doing too many sit-ups. Diagnosis of Angina For diagnosis of angina, your doctor may choose to use tests or x-rays to properly evaluate the condition of the heart muscles.An electrocardiogram (ECG) is a heart-monitoring test conductedwhile a patient is at rest or on a treadmill/bike during exercise.An angiogram is an x-ray test that allows the doctor to identifyblocked arteries in a patient who has been injected with a dye-likesubstance that defines blood vessels in the heart. Other variousradiology tests can be used to evaluate the heart muscle for areasof ischemia. Ischemia is a poor blood supply to heart tissue.
Risk Factors for Angina
There are some precipitating factors a patient should be able to recognize in order to successfully prevent an angina attack:
- Exertion - When the patient's level of physical energy is overly strenuous
- Emotion - When the patient's level of emotion becomes overwhelming
- Exposure - When either the patient's blood supply is decreased or the heart's need for more oxygen is increased, angina can occur.
Types of Angina
Stable Angina Once diagnosed, stable angina is a condition that the patientis able to manage. By understanding the pattern of onset and duration,the patient can respond to the signs and symptoms of stable anginaby using relieving factors such as rest and medication. Stable angina is reasonably predictable given certain stressors. Unstable Angina This is very unpredictable condition and can unexpectedly occurat night. Prinzmetal's Angina Prinzmetal's Angina has the classic signs and symptoms of angina,but happens at rest - usually in the early hours of the day. Prinzmetal'sAngina may be due to coronary artery spasms. Nocturnal Angina It is thought Nocturnal Angina angina is associated with REM(rapid eye movement) sleep - a phase of deep sleep. Intractable Angina Intractable Angina is chronic and incapacitating. Unfortunately,Intractable Angina of angina does not respond well to treatment. Post-Infarction Angina After a heart attack/MI (myocardial infarction) the residual damagescan result in episodes of Post-Infarction Angina.
Treatment of Angina
- relievingacute angina attacks
- preventing future angina attacks in order to preclude a heart attack
- prevent coronary artery disease
- resolve angina before actual heart damage occurs
Medications for Treating Angina The following medications may be recommended by your doctor for treating angina: Nitroglycerin - This drug reduces the oxygen requirements on the heart by dilating the blood vessels, decreasing blood pressure and the ventricular wall tension. Nitroglycerin pills are placed under the patient's tongue at onset of the symptoms. Beta Blockers - This drug reduces the oxygen requirements on the heart by blocking complex factors affecting how the heart contracts. Calcium Channel Blockers - This drug is used in combination with other drugs. This type of drug is involved in the electrical activity of the heart cells and contraction of the vessels. Anti platelet Medicine - i.e., Aspirin - It is said that in unstable angina, use of Aspirin can reduce the chances of a heart attack and therefore reduce mortality by 50 percent. Prevention of Angina For prevention of Angina, the American Heart Association recommends that a person seek prompt medical treatment for chest pain episodes. Additionally, the American Heart Association encourages people to work to reduce their coronary heart disease risk by lifestyle modifications. Daily exercise and weight management along with blood pressure management will go a long way to maximize cardiac circulation. Angina Statistics Stop smoking - reduces Angina risk by 37 percent Reduce cholesterol by 10 percent - reduces Angina risk by 20 percent Reduce blood pressure -especially the diastolic measure (bottom number) by 6 points - reduces Angina risk by 10 percent Exercise to Prevent Angina If you exercise vigorously at least 30minutes, 3-4 times a week, at 50-75 percent of the maximum heart rate by age, you will be able to substantially improve your health.(Even 30 minutes of strolling in the mall beats sitting on the couch!)
- your heart's ability to pump blood
- the amount of blood that the heart pumps per beat
- the levels of good cholesterol
- your survival chances after a heart attack
- your blood pressure
- the formation of blood clots that cut off circulation
- the chance of a stroke
- the rate of the heart at rest
- the risk of heart disease
Commitment to Nursing Home Residents and the Elderly
Nursing home lawyer, Jeffrey H. Rasansky has one mission: to fight for the rights of nursing home residents and their families, people just like you. Jeff has successfully represented victims of: personal injury, nursing home abuse, nursing home neglect,nursing home negligence, medical malpractice and product liability. Jeff Rasansky is licensed to practice before all state courts in Texas, the United States District Courts in the Northern and Eastern Districts of Texas and the Fifth United States Circuit Court of Appeals.