Editors: Alice P. Gallos and Margaret L. Jones
Book Description:
This new book provides up-to-date research on angina pectoris which and is a chest pain due to ischemia (a lack of blood and hence oxygen supply) of the heart muscle, generally due to obstruction or spasm of the coronary arteries (the heart’s blood vessels). Coronary artery disease, the main cause of angina, is due to atherosclerosis of the cardiac arteries. It is common to equate severity of angina with risk of fatal cardiac events. There is a weak relationship between severity of pain and degree of oxygen deprivation in the heart muscle (i.e. there can be severe pain with little or no risk of a heart attack, and a heart attack can occur without pain).

Table of Contents:
Preface

Expert Commentary

Anti-Xa Activity and the Onset of Clinical End-Points of Enoxaparin in Treatment of Acute Coronary Syndromes; pp. 1-9
(Mitrovska Slavica, Military Hospital, Dept. of Cardiology, Skopje, Macedonia, Jovanova Silvana, Institute for Heart Disease, Clinical Center, Skopje, Macedonia)

Research and Review Studies

Chapter I – Angina Pectoris: Etiology, Pathogenesis, Clinical Features and Treatment; pp. 11-48
(Nidal A. Asaad, Jassim M. Al-Suwaidi, Dept. of Cardiology and Cardiovascular Surgery, Hamad General Hospital and Weill Cornell Medical College, Doha, Qatar)

Chapter II – Endothelial Dysfunction in Stable Angina Pectoris: Potential Therapeutic Implications; pp. 49-75
(Dimitris Tousoulis, Nikolaos Papageorgiou, Marietta Charakida, Gerasimos Siasos, Christodoulos Stefanadis, Athens University Medical School, Athens, Greece)

Chapter III – Kounis Syndrome (Allergic Angina and Allergic Myocardial Infarction); pp. 77-150
(Nicholas G. Kounis, Dept. of Medical Sciences, School of Health Sciences, Patras Highest Institute of Education and Technology, Theoharis C. Theoharides, Dept. of Pharmacology and Experimental Therapeutics, Tufts Univ. School of Medicine, Boston, MA)

Chapter IV – Atherosclerosis, Understanding Pathogenesis – Challenge for Treatment; pp. 151-159
(Mitrovska Slavica, Military Hospital, Department of Cardiology, Skopje, Macedonia, Jovanova Silvana, Institute for Heart Disease, Clinical Center, Skopje, Macedonia, Matthiesen Inge, Karolinska Institute, Solna, Sweden, et al.)

Chapter V – The Role of Psychosocial Factors in Determining Cardiac Rehabilitation Attendance by Coronary Artery Disease Patients Following Surgery; pp. 161-181
(Michael O’Connor, School of Psychology, The University of Queensland, Brisbane, Queensland, Australia, Guy D. Eslick, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia, Natasha Koloski, School of Psychology, The University of Queensland, Brisbane, Queensland, Australia)

Chapter VI – Important Role of Rho-Kinase in the Pathogenesis of Coronary Artery Disease; pp. 183-189
(Yoshihiro Fukumoto, Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan)

Chapter VII – Angina; pp. 191-194
(William H. Wehrmacher, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL)

Chapter VIII – Angina Pectoris: Character and Location Among Those Presenting to Emergency Departments with Acute Chest Pain; pp. 195-209
(Guy D. Eslick, Department of Medicine, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia, Maria Chiu, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, Institute of Medical Science, University of Toronto, Ontario, Canada)

Chapter IX – Immunologic Mechanisms Involved in Ischemic Cardiopathy; pp. 211-242
(Jorge Delgado, National University of Mexico, Manuel Banos-Gonzalez, National Institute of Cardiology “Ignacio Chavez”, Carlos Ramirez-Velazquez, Allergology and Clinic Immunology Department, “20 de Noviembre” Medical National Center)

Chapter X – Atherosclerosis, Inflammation and Chlamydia Pneumoniae; pp. 243-259
(Giovanni Fazio, Maria Giovino, Loredana Sutera, Giuseppina Novo, Salvatore Novo, Division Of Cardiology – University of Palermo)

Chapter XI – Nitrate Tolerance and Cross-Tolerance in Long-Term Treatment of Patients with Stable Angina Pectoris; pp. 261-277
(Marek A. Kosmicki, Second Department of Coronary Artery Disease, Institute of Cardiology, Warszawa, Poland)

Chapter XII – Tako-Tsubo-Like Left Ventricular Dysfunction: Transient Left Ventricular Apical Ballooning Syndrome; pp. 278-294
(E. Vizzardi, G. Zanini, E. Antonioli, I. Bonadei, C. Fiorina, E. Chiari, A. D’Aloia, S. Nodari, L. Dei Cas, Section of Cardiovascular Disease, Department of Applied Experimental Medicine, Department of Cardiology, Brescia University Study of Bresia)
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The discomfort of angina is different in different people. Some people have angina when they overexert themselves, whereas others feel symptoms when they get very upset or excited. Most individuals eventually learn to anticipate which activities will cause distress.

Chest pain is the major symptom of angina. People who have angina often experience:

Crushing pain,
“Heaviness,” or
Tightness in the middle of the chest.

It may feel as if someone is squeezing or pressing on the heart, or it may feel like a stabbing pain or numbness. The sensation:

Ordinarily lasts from one to 10 minutes
May spread to the left shoulder, arm, and hand or to the neck, throat, and jaw

Sometimes there are additional symptoms such as:

Sweating
Nausea
Breathing difficulties

The features of a heart attack – which include chest pain, sweating, and nausea – resemble those of angina, although there are major differences between the two conditions.

Heart attack occurs when there is blockage of a coronary artery, and it may lead to permanent heart injury or death. In addition, heart attack lasts much longer than angina, and its symptoms generally continue even after a person rests.

The most common symptom of angina is a feeling of pain or discomfort in your chest. The pain can feel tight, dull or heavy and usually passes within a few minutes. This type of angina is known as stable angina.

The pain can spread from your chest to your left arm, neck, jaw and back. It usually follows a period of physical activity or emotional stress. In some cases, the pain can also develop after eating a meal or during cold weather. Factors that can cause the symptoms of angina to occur are called angina triggers.

Some people with angina may also experience symptoms of:

breathlessness
feeling sick
feeling unusually tired
dizziness
belching (burping)
restlessness

The onset of angina symptoms is sometimes known as an angina attack.
Unstable angina

The symptoms of unstable angina are the same as those of stable angina, but they do not follow the usual pattern. For example, in unstable angina the symptoms:

can develop without any angina triggers being present
can persist even when you are resting
can last longer than five minutes
may not respond to treatment with glyceryl trinitrate

Dial 999 to request an ambulance if you think that you or someone you are with is experiencing the symptoms of unstable angina.

If you know that you are not allergic to aspirin, and aspirin is easily available, chew an adult-size tablet while you are waiting for the ambulance to arrive. Aspirin helps to prevent blood clots and will reduce your risk of experiencing a heart attack or a stroke.

Angina Medications

Definition of Angina:

Angina pectoris is the medical term for chest pain or discomfort due to coronary heart disease. Angina is a symptom of a condition called myocardial ischemia. It occurs when the heart muscle (myocardium) doesn’t get as much blood (hence as much oxygen) as it needs. This usually happens because one or more of the heart’s arteries (blood vessels that supply blood to the heart muscle) is narrowed or blocked. Insufficient blood supply is called ischemia.

Typical angina is uncomfortable pressure, fullness, squeezing or pain in the center of the chest. The discomfort also may be felt in the neck, jaw, shoulder, back or arm. Many types of chest discomfort aren’t related to angina. Acid reflux (heartburn) and lung infection or inflammation are examples.
Drugs associated with Angina

The following drugs and medications are in some way related to, or used in the treatment of Angina. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.

The normal heart muscle s or myocardium are supplied by healthy blood vessels like coronary arteries, the blood supply caries the much need oxygen and nutrition for the cardiac muscles. With genetics and lifestyle playing major roles in the development of this disease, an abnormal amount of fats, platelets, and blood clots start to deposit on the walls of the coronary arteries, this cause the blood vessels’ diameter to shrink and in effect, reduces the amount of blood that is able to pass through it. As time goes by, more and more debris accumulate on the walls of the blood vessels and make the passage way of blood even tighter, when a person with this condition starts to do an activity that makes the heart go through an extra load, the oxygen and blood supply requirements of the heart muscles also increase, only this time, the adequate amount of blood can no longer pass through the narrowed blood vessels leading to an ischemia, this is where the chest pain comes in.

Angina pectoris occurs when the heart does not receive enough blood. People with coronary artery disease, a condition that narrows the arteries, may suffer from angina after a bout of physical or mental exertion or stress that increases blood demand to the heart. A person with angina often has recurrent symptoms that are predictable and follow a pattern, a condition called stable angina. However, angina symptoms that feel different than past angina pectoris flare-ups may indicate an additional cardiac problem.
Chest Discomfort

MayoClinic.com states that angina pectoris causes chest discomfort that feels like a heavy weight pressing down on the chest. A person with angina may develop chest pain or discomfort after physical activity or periods of emotional stress. Chest discomfort may feel heavy, squeezing or tight. A person may also experience stabbing or sharp pains in the chest, and discomfort may radiate to the arms, shoulders or neck. Women may feel pain radiate into the abdomen, back, jaw and neck, according to the National Heart, Lung and Blood Institute.

Angina pectoris-related chest pain is generally short-lived, lasting about five minutes, according to Mayo Clinic.com, and is relieved with rest or use of prescribed angina medications. A person who develops chest pain while at rest, instead of with activity, or who experiences pain that is not relieved with rest, may be at risk for further heart complications and should seek medical evaluation.
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Anxiety

A person with angina may also feel anxious. Reduced blood flow to the heart may slow circulation to the body, resulting in shortness of breath, as well. Trouble breathing, combined with chest discomfort and lack of circulating oxygen may result in anxiety and restlessness. The American Heart Association states that anxiety is prevalent among people suffering from angina. A person with angina may feel anxious over the possibility of having an angina attack and may feel increased anxiety when an angina attack occurs.
Additional Symptoms

The National Heart, Lung and Blood Institute states that additional symptoms of angina pectoris may develop, including nausea or feelings of indigestion or gas. Additionally, a person may experience sweating, dizziness, weakness or confusion during an angina attack. The institute warns that angina symptoms can vary from person to person, and may also represent additional medical problems besides angina. A person experiencing symptoms should seek medical evaluation to reduce the risk of complications.

Angina pectoris (AP) represents the clinical syndrome occurring when myocardial oxygen demand exceeds supply. The term is derived from Latin; the literal meaning is “the choking of the chest;” angere, meaning “to choke” and pectus, meaning “chest.” The first English-written account of recurrent angina pectoris was by English nobleman Edward Hyde, Earl of Clarendon. He described his father as having, with exertion, “a pain in the left arm…so much that the torment made him pale”.[1] The first description of angina as a medical disorder came from William Heberden. Heberden, a prodigious physician, made many noteworthy contributions to medicine during his career. He presented his observations on “dolor pectoris” to the Royal College of Physicians in 1768. Much of his classic description retains its validity today.[2]

Angina pectoris has a wide range of clinical expressions. The symptoms most often associated to angina pectoris are substernal chest pressure or tightening, frequently with radiating pain to the arms, shoulders, or jaw. The symptoms may also be associated with shortness of breath, nausea, or diaphoresis. Symptoms stem from inadequate oxygen delivery to myocardial tissue. No definitive diagnostic tools that capture all patients with angina pectoris exist. This, combined with its varied clinical expression, makes angina pectoris a distinct clinical challenge to the emergency physician. The disease state can manifest itself in a variety of forms:

Stable angina pectoris is classified as a reproducible pattern of anginal symptoms that occur during states of increased exertion.
Unstable angina pectoris (UA) manifests either as an increasing frequency of symptoms or as symptoms occurring at rest.
Prinzmetal angina or variant angina occurs as a result of transient coronary artery spasms. These spasms can occur either at rest or with exertion. Unlike stable or unstable angina, no pathological plaque or deposition is present within the coronary arteries that elicits the presentation. On angiography, the coronary arteries are normal in appearance with spasm on angiography.
Cardiac syndrome X occurs when a patient has all of the symptoms of angina pectoris without coronary artery disease or spasm.

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If patients with Angina pectoris continue to have angina despite maximally tolerated combinations of nitroglycerin medications, beta blockers and calcium channel blockers, cardiac catheterization with coronary arteriography is indicated. Depending on the location and severity of the Angina pectoris in the coronary arteries, patients can be referred for balloon angioplasty (percutaneous transluminal coronary angioplasty or PTCA) or coronary. Treatment options for Angina pectoris include: rest, medications (nitroglycerin, beta blockers, calcium channel blockers), percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft surgery (CABG). Percutaneous transluminal coronary angioplasty: Percutaneous transluminal coronary angioplasty (PTCA) is a non-surgical procedure that relieves narrowing and obstruction of the arteries to the muscle of the heart. This allows more blood and oxygen to be delivered to the heart muscle. PTCA is now referred to as percutaneous coronary intervention, as this term includes the use of balloons, stents, and atherectomy devices. PCI is accomplished with a small balloon catheter inserted into an artery in the groin or arm and advanced to the narrowing in the coronary artery. The balloon is then inflated to enlarge the narrowing in the artery. When successful, PCI can relieve chest pain of angina, improve the prognosis of patients with unstable angina and minimize or stop a heart attack without having the patient undergo open heart coronary artery bypass graft (CABG) surgery.

angina pectoris India,certified cardiac surgeons,certified surgeons India Angina pectoris treatment in India is provided at various hospitals that offer comprehensive surgical, medical and emergency services supported by state-of-the-art diagnostic and treatment facilities and innovative surgery techniques. Indian hospitals are proud to offer access to world class doctors, nurses and other healthcare professionals dedicated to patients welfare. Angina pectoris treatment in India is performed by certified Cardiac surgeons. Indian cardiac surgeons are world renowned and are aided by cutting edge technology and excellent nursing staff who provide all patients with the highest level of medical care. With overseas training and experience, Indian cardiac surgeons ensure that all of your needs will be met.

Computerized X-ray scan (ultrafast CT scan) is highly accurate in detecting small amounts of calcium in the plaque of coronary arteries. If an ultrafast CT scan shows no calcium in the arteries, atherosclerotic coronary artery disease is unlikely. Ultrafast CT scanning is useful in evaluating chest pain in younger patients (men under 40 and women under 50 years old). Since young people do not normally have significant coronary artery plaque, a negative ultrafast CT scan makes the diagnosis of coronary artery disease unlikely. However, finding calcium by this method is less meaningful in older patients who are likely to have mild plaquing simply from the aging process.

Even though an ultrafast CT scan is useful in detecting calcium in plaque, it cannot determine whether the calcium-laden plaque actually causes artery narrowing and reduces blood flow. For example, a patient with a densely calcified plaque causing minimal or no artery narrowing will have a strongly positive ultrafast CT scan but a normal exercise treadmill test. In most patients who are suspected of having angina due to coronary artery disease, an exercise treadmill study is usually the first step in determining whether any plaque is clinically significant. Newer very high speed CT scanners can actually detect true coronary artery plaques and lesions similar to coronary angiography.

Magnetic resonance imaging (MRI), using magnetism and radio waves, can be used to image (produce a likeness of) the blood vessels. Currently, the larger vessels, such as the carotid arteries in the neck, can be imaged using this technique. Future software and hardware improvements may allow screening of the heart’s arteries with magnetic resonance testing.

Aspirin appears to be just as effective as warfarin at preventing stroke and dying in patients with heart failure, a study has found.

Researchers followed more than 2,300 patients in 11 countries over a ten-year period to compare aspirin – which prevents clotting – and warfarin, which thins the blood.

Overall, they found that the combined risk of death, stroke and cerebral haemorrhage was 7.47 per cent per year for those on warfarin, and 7.93 per cent per year for those taking aspirin.

Warfarin users were almost half as likely to have a stroke as aspirin users, but more than twice as likely to suffer major bleeding – meaning the two results cancelled each other out.

The findings suggest that in heart failure patients with a normal heart rhythm, aspirin may be just as effective as warfarin, while removing the need for a prescription and regular blood tests.

Principal investigator Dr Shunichi Homma, from Columbia University Medical Centre, said: ‘Since the overall risks and benefits are similar for aspirin and warfarin, the patient and his or her doctor are free to choose the treatment that best meets their particular medical needs.

‘However, given the convenience and low cost of aspirin, many may go this route.’

The findings, which are published in the New England Journal of Medicine, could have important implications, as British Heart Foundation statistics suggest there are more than 27,000 new cases of heart failure in the UK every year.ADNFCR-554-ID-801356065-ADNFCR

Resource: http://www.netdoctor.co.uk/interactive/news/aspirin-as-effective-as-warfarin-for-most-heart-failure-patients-id801356065-t136.html