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DiseaseANGINA PECTORIS
  
Quotation“It is not the delicate neurotic person who is prone to angina, but the robust, the vigorous in body and mind, the keen and ambitious man, the indicator of whose engine is always at “Full steam ahead”.
  
DefinitionPraecordial pain brought on by effort, emotion, or eavy meals, and relieved by rest or nitrates, (referred to as Chronic Stable Angina) and caused by atherosclerotic plaque in the coronary artery and a spectrum of features portending myocardial infarction with increased frequency, severity, duration of attacks responding less well to nitrates, and occurring even at rest (referred to as unstable angina) due usually to plaque rupture.
  
PrognosisDepends upon to extent of coronary disease and LV function. Overall annual mortality is around 4%. Patients with angina and in heart failure usually have a poorer prognosis.
  
General Measures Control Systemic hypertension, left ventricular failure, Arrhythmias, and lipid abnormalities. Stop cigarette smoking. Avoid physical strain, and reduce mental stress. Approved exercise program. Decreases intake of coffee and tea. Reduce weight to required standard weight.
  
Advice to Patient The need for strict control of background illnesses like hypertension diabetes, and lipid disturbances.To quit smoking, follow moderation in alcohol intake, and avoidance of physical and mental stress. Progressive exercise programmes. Low fat, low cholesterol diet, weigh-loss diet if overweight, cut down coffee and tea consumptionProper use of nitrates – Sublingual .tablet to be used at onset of pain or prophylactically for expected pain, with the patient sitting or lying. If the pain is not relieved after using 2-3 tablets within 20 minutes, his usual attending doctor is to be intimated. Nitrate headache disappears after 3-4 days of use in almost all patients. Simple analgesics like paracetamol may be taken for relief of headache., Not to change body position suddenly, when on nitro-glycerine. Not to use additional Beta-blockers or Calcium channel blockers for pain relief without advice.Do not stop Beta-blockers abruptly.
  
Follow UpDepending upon severity of symptoms, and ‘stability’ on therapy.Daily checks if angina is suspected to be getting ‘unstable’ to decide on hospitalization.
  
PreventionMaintenance of ideal weight, control of hypertension, diabetes mellitus, and lipid levels. Regular exercise and to avoid cigarette smoking.
  
Reference FromAmerican College of Cardiology Website: www.acc.org
American Heart Association: http://www.amhrt.org/
   

 

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