Generality
Unstable angina is a severe form of angina pectoris.
Unlike milder angina pectoris episodes (stable angina), this form also causes chest pain at rest, which tends to progressively worsen over time.
The diagnosis of angina pectoris involves a rather complex examination and testing procedure, with the aim of accurately identifying the site, at the coronary level, where the anatomical and functional alteration is located.
Unstable angina therapy varies depending on how severe the coronary heart disease is and according to the symptoms.
Possible therapeutic options include both pharmacological treatments and surgical treatments.
Brief review of the term angina or angina pectoris
In medicine, the terms " angina " and " angina pectoris " indicate chest pain resulting from a reduced supply of oxygen to the heart muscle (or myocardium ), following a transient decrease in blood flow through the coronary arteries .
In other words, "angina" and "angina pectoris" refer to chest pain that affects people who are victims of transient ischemic phenomena affecting the myocardium .
Episodic phenomenon, angina is known to be the condition that, by gravity, precedes myocardial infarction ; in myocardial infarction, in fact, the reduction of blood supply to the myocardium, through the coronary arteries, is permanent and leads to death by necrosis of the aforementioned heart muscle.
Definition of ischemia
Doctors call ischemia the reduction of blood flow in a certain tissue or organ, such as to cause a decrease in the supply of oxygen and nutrients.
What is unstable angina?
Unstable angina is a particular form of angina pectoris, which is characterized by:
- A gradual worsening, over time, of chest pain;
- The appearance not only during physical efforts, but also in a state of rest;
- Episodes that, with time, become more and more frequent;
- Failure to respond to the most commonly used drugs in the presence of angina;
- A reduction in blood flow within the coronary arteries just below that which triggers myocardial infarction.
Stable angina
To fully understand what is unstable angina, it is necessary to take a step back and inform readers of the existence of another form of angina pectoris, less severe, called stable angina .
In stable angina, chest pain does not worsen over time, it only arises during physical efforts, it always appears with the same frequency, it responds positively to the most common drugs against angina pectoris and depends on a not particularly marked reduction of blood supply to the myocardium.
Having reported the characteristics of stable angina, although they are not properly the subject of this article, was fundamental for defining definitively unstable angina.
In a hypothetical scale of increasing gravity, unstable angina is located above stable angina, but under myocardial infarction.
Unstable angina is an emergency
Unstable angina is a medical emergency, therefore it requires immediate care.
Failure to resort to therapy promptly is very likely to be fatal.
Causes
The main cause of unstable angina is, as with the stable form and myocardial infarction, the so-called coronary artery disease or coronary artery disease ; in medicine, the terms coronary artery disease and coronary artery disease indicate any anatomical or functional alteration of the coronary arteries (which are the arterial vessels that feed the myocardium).
What causes coronary heart disease?
The cause of coronary artery disease is atherosclerosis .
Atherosclerosis is the phenomenon of hardening of the arteries of medium and large caliber, which involves, over time, the formation on the inner wall of the arterial vessels just mentioned of the so-called atheromas .
The atheros or atherosclerotic plaques are aggregates of lipid material (cholesterol), protein and fibrous which, due to the position they occupy, prevent the normal blood flow inside the arteries; moreover, they can be the object of inflammatory processes, which cause their fragmentation and dispersion into other blood vessels - this time smaller - with consequent occlusive effects.
Risk factors
They are risk factors for unstable angina:
- Diabetes mellitus;
- Obesity;
- A sedentary lifestyle;
- Hypertension;
- A family history of heart disease;
- Cigarette smoke;
- Hypercholesterolemia;
- High triglycerides;
- Advanced age.
As some readers may already know, these just listed are also risk factors of atherosclerosis, as well as of coronary heart disease.
Symptoms and complications
Unstable angina is a syndrome, or a set of symptoms and signs.
Of the various symptoms and signs that characterize unstable angina, the main one is undoubtedly chest pain ; this is followed by problems such as:
- Widespread pain in the shoulder, neck, arm and back. Generally, this painful sensation affects the left side of the human body;
- Nausea;
- Anxiety;
- Abnormal sweating;
- Dyspnoea (difficulty in breathing);
- Dizziness;
- Continuous sense of tiredness and fatigue.
Important
Many of the symptoms reported above are also found in the presence of stable angina.
The differences between stable and unstable angina lie in the severity of the symptoms.
Characteristics of chest pain in the presence of unstable angina
Chest pain produced by unstable angina varies from patient to patient: some patients describe it as overwhelming and pressing pain, others as burning pain and others as a sharp pain .
Readers are reminded that unstable angina is responsible for chest pain that:
- It tends to worsen over time (both in terms of intensity and duration);
- Does not respond to drugs normally effective against stable angina;
- It can also appear at rest, not only under stress;
- It tends to recur with a progressively greater frequency.
Complications
In the absence of adequate and timely treatment, unstable angina can develop into myocardial infarction, a condition in which the heart muscle receives so little blood that it undergoes death by necrosis. Myocardial death is an irreversible event and seriously compromises the functions of the heart, sometimes with a fatal outcome for the person concerned.
Other complications of unstable angina:
- Development of severe arrhythmias
- Heart failure
When should I go to the doctor?
Especially in a person at risk, it is a valid reason to immediately contact a doctor, or go to the nearest hospital, the appearance of chest pain, combined with other disorders such as, for example, dyspnea, nausea, sweating, sense of anxiety and dizziness.
Diagnosis
Given the danger of unstable angina, the diagnosis of the latter must be made quickly .
In general, the diagnostic procedure for detecting unstable angina begins with physical examination and medical history; therefore, it continues with the measurement of blood pressure, blood tests, an electrocardiogram and an exercise test; finally, it ends with an echocardiogram, the angioTAC and the coronarografia.
- Physical examination and anamnesis: they clarify the symptomatic picture and allow to identify the possible factors favoring the anginal episode;
- Blood analysis: these are mainly used to quantify creatine kinase levels and so-called cardiac biomarkers (eg troponin); high levels of creatine kinase and cardiac biomarkers are usually associated with damage to the myocardium;
- Blood pressure measurement: it allows to establish if the patient suffers from hypertension or not. Therefore, it further clarifies the state of health of the victim victim of the anginal episode;
- Electrocardiogram: evaluate heart rate. An abnormality in heart rate could be a sign of reduced myocardial blood supply;
- Echocardiogram: it is an ultrasound of the heart performed from the inside. It allows to identify possible coronary obstructions;
- AngioTAC: is a radiological exam that allows you to study blood circulation in arteries and veins. If referred to the coronary arteries, it allows therefore to clarify the blood flow inside these important arterial vessels and establish the extent of any occlusions;
- Coronarography: it is a radiological examination that allows to specifically analyze the blood flow inside the coronary arteries and to pinpoint the site of their eventual occlusion.
Therapy
Unstable angina therapy includes various treatments, the implementation of which varies according to the severity of the coronary occlusion detected during the diagnosis, and to the severity of the symptoms.
The treatments available for those suffering from unstable angina include:
- Administration of nitroglycerin ;
- The administration of anticoagulant drugs (eg: heparin) and antiplatelet drugs (eg: aspirin and clopidogrel);
- Coronary angioplasty combined with stenting ;
- Coronary bypass surgery .
In general, of the 4 treatments just mentioned, the first two are reserved for unstable angina cases considered less serious, while the second two are applied in the most severe unstable angina cases and at risk complications. However, it should be pointed out that there are circumstances in which the first two treatments must be followed by coronary angioplasty combined with stenting or coronary bypass surgery.
Nitroglycerin
Nitroglycerin is a drug used by doctors, due to its vasodilatory effects on the coronary arteries, only in the midst of an episode of unstable angina; in any other circumstance, moreover, it does not bring any benefit.
Anticoagulants and antiplatelet agents
Anticoagulants and antiplatelet agents are used to:
- Improve the symptomatology, in the midst of an episode of unstable angina;
- Reduce the atheroma that caused coronary occlusion;
- Prevent the formation of new atheromas.
Coronary angioplasty combined with stenting
Angioplasty is the medical procedure that allows you to eliminate or, at least, reduce the narrowing or narrowing of a blood vessel, by using a particular catheter.
Stenting, on the other hand, consists of placing a metal prosthesis ( stent ) inside a blood vessel - previously occluded and reopened by angioplasty - in order to keep it patent over time and avoid second occlusions.
As can be guessed, in the presence of unstable angina, coronary angioplasty combined with stenting has as its object the coronary artery victim of occlusion.
Coronary bypass
Coronary bypass surgery consists of creating a pathway for the passage of alternative blood to the occluded one, by inserting a new coronary vessel.
In other words, during a coronary bypass operation, the operating physician inserts a new coronary artery, the purpose of which is to replace the original occluded function due to an atheroma.
Coronary bypass is a somewhat delicate surgical procedure.
What affects the choice to resort to coronary bypass?
- Which arteries is blocked
- How many arteries are blocked
- Where the occlusion lies within the coronary artery
- The severity of occlusion
Other important remedies
Adopt a healthy lifestyle
For those suffering from unstable angina, it is very important to lead a healthy and well-being lifestyle; in practical terms, therefore, it is a good rule:
- Adopt a healthy diet and eat in a balanced way;
- Practice physical activity continuously (based on medical prescription);
- Not smoking;
- Reduce body weight (if overweight) and keep it normal;
- Learn to master stress through one of the many relaxation techniques.
Prognosis
Unstable angina is the signal of a very sick heart and that can develop, at any moment, conditions with fatal consequences for those who are its victims.
The probability that unstable angina is fatal - therefore it has a poor prognosis - is much greater, the more serious the coronary heart disease is at its origin.
Prevention
To prevent unstable angina, it is essential:
- Adopt a healthy diet;
- Eat in a balanced way, so as to maintain body weight in the norm;
- Not smoking;
- Practice physical activity with continuity;
- Periodically check blood pressure, cholesterol levels and triglyceride levels, starting from a certain age or if there is a family predisposition to diseases such as hypertension, hypercholesterolemia and high triglycerides.
As probably some readers will have noticed, the rules of prevention of unstable angina follow the preventive measures of coronary artery disease and atherosclerosis.
