Angina pectoris (synonym: Stenokardie, German: Brustenge) is a seizure-like narrowness in the chest.

Angina is a pain triggered in the chest by a circulatory disorder of the heart. Usually this is based on a circulatory disturbance narrow (stenosis) of a coronary vessel. At heart, blood flow and oxygen supply in a particular area of the heart suddenly and permanently interrupted because a coronary artery is completely blocked.

Pathophysiology

Angina pectoris is either by physical or emotional or psychological distress caused, usually in the context of a pre Koronarsklerose. A special form is the prince metal angina, here is a temporary ischemia of the myocardium by a spasm of the coronary arteries is triggered. The duration of a seizure varies between seconds and minutes.

Distinction of occurrence at rest (resting-AP), or under stresses (Stress-AP). From the rest-AP is an imminent danger from heart attack.

A distinction of AP and heart attack is possible sometimes with the drug Nitro lingual. When an AP-seizure medication may well help and pain and tightness in the chest after clearly. However, there is only in special cases to this kind of distinction to leave. The treatment of a suspected heart attack AP includes oxygen, venous access, aspirin, and heparin. The upper body is in high position to store the already weakened heart to charge less.

Forms of angina pectoris

* Load angina
* Nocturnal angina
* Stable angina (see below)
* Unstable angina (see below)
* Angina therapy
* Prinz Metal Angina
* Präinfarktangina (occurring before a heart attack)

Treatment options

* Rest (only during acute attack, not as a permanent therapy)
* Avoidance of severe physical or mental stress
* Oxygen
* Nitroglycerin
* Beta blockers
* Ivabradin (with intolerance of or contraindications to beta blockers, including Ivabradin is contraindicated in unstable angina and myocardial infarction)
* Sedative
* Acetylsalizylsäure
* Amyl, but because of the many side effects are no longer used to treat
* Aufdehnung a wreath tank using balloon dilatation (PTCA), and possibly insert a stent in a coronary angiography (see also cardiac catheterization, angiography)
* Bypass surgery
* Chelating therapy (efficacy is not confirmed, see chelation therapy)

Causes

* Stress
* Physical exertion
* Lavish meals
* Refrigeration
* Weather turnaround
* Alcohol
* Smoking

Symptoms

* Typically begin suddenly and last for seconds to minutes,
* Are often described as burning, “heartburn,” tearing-like cramping or pressure in the heart area described
* Are often behind the breastbone (retrosternal) felt, often radiating into the chest both sides, sometimes in both shoulders and upper arms, in the upper abdomen and back, through the neck to the mandible and in the entire left arm into the hand,
* Can only be made between the shoulder blades, in the stomach and chest in the right half occur.

Degree classification

* 0: Silent ischemia (chance finding)
* I: AP complaints only for severe physical exertion
* II: minimal interference in normal physical exertion
* III: substantial impairment in normal physical exertion
* IV: AP complaints at the lowest physical exertion or rest pain

Differential Diagnosis

* Gastrointestinal disorders such as gastro-oesophageal reflux, gastric ulcer, Cholecystitis, gastritis
* Pulmonary disorders such as pulmonary embolism, pneumothorax, pleurisy
* Pericarditis
* Myocardial infarction
* HWS BWS syndrome stable angina pectoris

A stable AP occurs when the nature of the attacks of pain is the same complaints and the appropriate counter measures (physical rest, medication) subside. The AP is often stable for more than 70% stenosis of at least one major underlying Koronargefäss unstable angina

As unstable AP is any sudden change in the clinical picture

* First occurrence of an AP
* AP alone
* Increase in seizure duration, seizure frequency and intensity of pain medication in case of insufficient effect

The unstable AP is usually a multi-vessel coronary disease or left Hauptstammstenose basis. An unstable angina is associated with a large heart attack risk associated. A patient, who is suffering under appropriate symptoms, usually requires immediate medical assistance.