Angina Pectoris is chest pain due to reduced blood supply to the heart (myocardial ischemia), but without permanent damage.
Types of Ischemic Heart Disease (IHD):
- Angina Pectoris → Temporary chest pain, no heart muscle death.
- Myocardial Infarction (MI) → Severe ischemia, causing heart muscle death.
- Chronic IHD → Slow heart weakening after MI.
- Sudden Cardiac Death (SCD) → Due to fatal arrhythmia.
Mnemonic: "A-M-C-S" (Angina, MI, Chronic IHD, SCD)
TYPES OF ANGINA
1. STABLE ANGINA
("Effort Angina")
- Cause: Due to fixed blockage in coronary artery.
- Triggered by: Exercise, stress, heavy meals, cold exposure.
- Relieved by: Rest or Nitroglycerin.
- ECG: ST depression during stress.
Mnemonic: "E.S.R." (Effort, ST Depression, Relieved by Rest)
2. UNSTABLE
ANGINA ("Pre-Infarction Angina")
- Cause: Sudden rupture of plaque, forming a clot.
- Occurs at Rest, more severe & prolonged than stable angina.
- HIGH RISK of Heart Attack (MI)!
- ECG: ST depression, No Troponin Elevation.
Mnemonic: "U.R.G.E.N.T." (Unstable, Ruptured Plaque, Greater Risk, Emergency, No Troponin, Treatment Needed Fast)
3. PRINZMETAL
(VARIANT) ANGINA
- Cause: Coronary artery spasm (temporary narrowing).
- Occurs at Rest (Night or Early Morning).
- ECG: ST Elevation (No Clot, Just Spasm).
- Relieved by: Nitroglycerin, Calcium Channel Blockers (CCB).
Mnemonic: "P.R.I.N.Z." (Pain at Night, Resting Pain, Ischemia due to Spasm, Not Due to Blockage, Zero Clots)
SYMPTOMS OF
ANGINA
- Chest pain → Heaviness or tightness (retrosternal).
- Pain radiates to left arm, jaw, or back.
- Shortness of breath, sweating, nausea.
- Relieved by Rest or Nitroglycerin.
- Lasts <10-15 minutes (Unlike MI, which lasts longer).
Mnemonic: "C.H.E.S.T." (Chest Pain, Heaviness, Exertion Triggered, Short Lasting, Treated by Nitroglycerin)
DIFFERENTIAL
DIAGNOSIS OF CHEST PAIN
- Cardiac Causes: MI, Pericarditis, Aortic Dissection.
- Gastrointestinal Causes: Acid Reflux, Peptic Ulcer, Gallstones.
- Musculoskeletal Causes: Costochondritis, Rib Fracture.
- Pulmonary Causes: Pneumonia, Pulmonary Embolism.
Mnemonic: "C-G-M-P" (Cardiac, Gastro, Musculo, Pulmonary)
INVESTIGATIONS
FOR ANGINA
ECG:
- ST depression in stable & unstable
angina.
- ST elevation in Prinzmetal angina.
Cardiac Biomarkers (Troponin, CK-MB):
- Normal in Angina
(Elevated in MI).
Treadmill Stress Test:
- Positive if ST depression occurs on
exertion.
Echocardiography:
- Assesses heart function & detects
ischemia.
Coronary Angiography (Gold Standard Test!)
- Shows blockage & guides treatment.
Mnemonic: "E.T.E.C.A." (ECG, Troponin, Exercise Test, Echo, Coronary Angiography)
TREATMENT OF
ANGINA
1. IMMEDIATE
RELIEF (DURING ATTACK)
- Nitroglycerin (Sublingual) → Dilates coronary arteries.
- Rest → Reduces oxygen demand.
2. LONG-TERM
MANAGEMENT
Lifestyle Changes:
- Quit Smoking, Healthy Diet, Regular
Exercise.
Medications:
- Beta-Blockers
→ Reduce heart workload.
- Calcium Channel Blockers (CCB)
→ Prevents spasm (For Prinzmetal Angina).
- Aspirin & Clopidogrel
→ Prevent clot formation.
- Statins
→ Lower cholesterol.
Surgical Options:
- Angioplasty (Stent Placement) → Opens
blocked arteries.
- Coronary Artery Bypass Grafting (CABG)
→ For severe blockages.
Mnemonic: "N.L.M.S." (Nitroglycerin, Lifestyle, Medications, Surgery)
PREVENTION OF
ANGINA & HEART DISEASE
Control Risk Factors:
- Manage High BP, Diabetes, Cholesterol.
- Quit Smoking & Reduce Stress.
Healthy Lifestyle:
- Eat More Fruits, Less Junk Food.
- Exercise Daily, Maintain Healthy
Weight.
Regular Check-ups:
- Annual ECG & Cholesterol Check.
Mnemonic: "R.H.C." (Risk Factor Control, Healthy Lifestyle, Check-ups)
FINAL REVISION WITH MNEMONICS
Types of Ischemic Heart Disease = "A-M-C-S"
(Angina, MI, Chronic IHD, SCD)
Types of Angina:
- Stable = "E.S.R." (Effort, ST Depression, Relieved by Rest).
- Unstable = "U.R.G.E.N.T." (Unstable, Ruptured Plaque, Greater Risk, Emergency, No Troponin, Treatment Needed Fast).
- Prinzmetal = "P.R.I.N.Z." (Pain at Night, Resting Pain, Ischemia due to Spasm, Not Due to Blockage, Zero Clots).
- Symptoms = "C.H.E.S.T." (Chest Pain, Heaviness, Exertion Triggered, Short Lasting, Treated by Nitroglycerin).
- Differential Diagnosis = "C-G-M-P" (Cardiac, Gastro, Musculo, Pulmonary).
- Investigations = "E.T.E.C.A." (ECG, Troponin, Exercise Test, Echo, Coronary Angiography).
- Treatment = "N.L.M.S." (Nitroglycerin, Lifestyle, Medications, Surgery).
- Prevention = "R.H.C." (Risk Factor Control, Healthy Lifestyle, Check-ups).
