ANGINA PECTORIS
Are also known as:
- Coronary heart disease
- “heart attack.
- a state that have various etiology, of which all result in interference on heart function that due to imbalance between oxygenation and oxygen demand.
a) angina: pain nature such as choking, stifling
b) pectoris: chest area
a state abnormal which occurred when availability shortage of blood supply to destruction result heart or artery obstruction which caused chest pain
A syndrome clinical that with a character with sense of pain press inchest area and breathless result less oxygen supply to myocardium.
Classification
1. Stable Angina:
- frequent involving old people
- there is disease risk factor
- symptom episodic, steady Pain beginning pattern and factor relieve unchanged per attack
- chest pain does not exceed 10 / 15 minutes.
2. unstable Angina :
- increase:- attack frequency
a) period
b)severity
- pain fail relieved by earlier way.
- difficult to predict following attacks
- might be happening while asleep (angina nocturnal).
3. nokturnal Angina
- chest pain at night
- angina either type unstable
- relieved when get up sit.
4. variant Angina (angina during rest)
- either unstable
angina type - frequent involve the young
- probably no risk factor
- pain that bad, may be repeat every day
- perhaps attached arrhythmia and creating death.
Predisposing factor
1. Activity or excess exercise
2. Bared to weather or cool thing
3. Eat fat content and high carbohydrate
4. Smoking habit
5. Emotional stress.
6. Other risk factors:
- sex: higher risky man
- increase of age : exceeding 45 years
- obesity
- origin
- diabetes mellitus disease.
Etiology:
1. Arteriosklerosis: thickening and arterial wall hardening due to lipid material deposition such as cholesterol which resulted coronary arterylumen narrowing.
2. Hypertension: heart hypertrophy increase oxygen demand by myocardium.
3. Aneurisme aorta: narrowing in coronary artery opening area.
4. Severe anaemia: oxygen temperament force reduction to myocardium
5. Regurgitasion aorta: depression in coronary artery
6. paroksismal atrium Takikardia: interruption of heart rhythm
7. Aortitis syphilis
8. Coronary artery spasm.
Patofisiologi
- coronary artery lumen narrowing
- when increase of activity, blood supply to myocardium decreasing
- hipoksia myocardium cell2 muscle
Are also known as:
- Coronary heart disease
- “heart attack.
- a state that have various etiology, of which all result in interference on heart function that due to imbalance between oxygenation and oxygen demand.
a) angina: pain nature such as choking, stifling
b) pectoris: chest area
a state abnormal which occurred when availability shortage of blood supply to destruction result heart or artery obstruction which caused chest pain
A syndrome clinical that with a character with sense of pain press inchest area and breathless result less oxygen supply to myocardium.
Classification
1. Stable Angina:
- frequent involving old people
- there is disease risk factor
- symptom episodic, steady Pain beginning pattern and factor relieve unchanged per attack
- chest pain does not exceed 10 / 15 minutes.
2. unstable Angina :
- increase:- attack frequency
a) period
b)severity
- pain fail relieved by earlier way.
- difficult to predict following attacks
- might be happening while asleep (angina nocturnal).
3. nokturnal Angina
- chest pain at night
- angina either type unstable
- relieved when get up sit.
4. variant Angina (angina during rest)
- either unstable
angina type - frequent involve the young
- probably no risk factor
- pain that bad, may be repeat every day
- perhaps attached arrhythmia and creating death.
Predisposing factor
1. Activity or excess exercise
2. Bared to weather or cool thing
3. Eat fat content and high carbohydrate
4. Smoking habit
5. Emotional stress.
6. Other risk factors:
- sex: higher risky man
- increase of age : exceeding 45 years
- obesity
- origin
- diabetes mellitus disease.
Etiology:
1. Arteriosklerosis: thickening and arterial wall hardening due to lipid material deposition such as cholesterol which resulted coronary arterylumen narrowing.
2. Hypertension: heart hypertrophy increase oxygen demand by myocardium.
3. Aneurisme aorta: narrowing in coronary artery opening area.
4. Severe anaemia: oxygen temperament force reduction to myocardium
5. Regurgitasion aorta: depression in coronary artery
6. paroksismal atrium Takikardia: interruption of heart rhythm
7. Aortitis syphilis
8. Coronary artery spasm.
Patofisiologi
- coronary artery lumen narrowing
- when increase of activity, blood supply to myocardium decreasing
- hipoksia myocardium cell2 muscle
- ischemia myocardium
- chemical agent2 release by iscemik tissue
- chemical agent2 release by iscemik tissue
- stimulation to nerve
- pain in chest.
Symptom and sign
1. Start by when activity
2. Chest pain:
- location: - restrosternum
- on sternum
- prekordium
- perhaps in epigastrium.
- nature:tight”, “heavy”, “choking”, “”sharp”, “stressed”,
- pain in chest.
Symptom and sign
1. Start by when activity
2. Chest pain:
- location: - restrosternum
- on sternum
- prekordium
- perhaps in epigastrium.
- nature:tight”, “heavy”, “choking”, “”sharp”, “stressed”,
- spread (frequent to left):
- upper arm, wrist, hand
- scapula / interskapula
- neck / chin.
- period: frequent 1-5 minutes, less from 15 minutes
- factor start:
- increase of activity
- emotional disturbance
- factor worsen:
- increase of activity exceeding beginning factor.
- factor relieve (quickly):
- rest
- stop activity
- medicine such as vasodilator (GTN)
3. Dyspnoea
4. Nausea / vomit
5. Diaforesis
6. Pallor
7. Headache, faint
8. Anxiety, fear
9. Fatigue
Investigation
1. Electrocardiogram:
- usually normal
- perhaps ST DEPRESION and T inverse during attack
- probably need “exercise ECG test” or “stress test”
2. Coronary angiography
- detect coronary artery narrowing.
3. Chest x-ray:
- detect hipertrrofi heart
4. Echocardiography:
- detect heart abnormality
5. Detect risk factor such as:
- Hb
- thyroxine level
- cholesterol level.
Difference Diagnosis
1. Muskulo-skeletal pain:
- myalgia
- kostokondritis
2. Gastro-usus track's interference:
- esophagitis reflux
- oesophagus spasm
- gastritis
3. Pericarditis.
Treatment
- objective:
- relieve pain
- reduce heart burden
1. Medicines:
a. Nitrates:
- Tab Glyceryl Trinitrate 0.5mg sublingual - relieve pain in 2 - 3 minutes
- limit to 3 tabs.
- Tab Isosorbide dinitrate 10mg
b. My Inhibitor:
- Tab Propanolol 20-40mg every 6 hours, or,
- Tab Metoprolol 50-100mg every 8 hours
c. Antagonist calcium:
- Tab Nifedipine 5-10mg every 8 hours.
- Tab Nicardipine 20-40mg every 8 hours
- Tab Verapamil 120-240mg every 8 hours
- Tab Diltiazem 60-120mg every 8 hours
2. ECG Supervision
3. vitals observation an hour once:
- pulse
- breathing.
- blood pressure
4. Increase of activity has been gradually
5. Surgery may be needed
- coronary bypass
“Percutaneous transluminal coronary angioplasty (PTCA)”.
Complication
1. Neurogenic shock
2. miocardium Infarksion.
Prognosis
- fairly good
- activity control and medical treatment can reduce attack frequency
- may be continuous to myocardial infarction.
- upper arm, wrist, hand
- scapula / interskapula
- neck / chin.
- period: frequent 1-5 minutes, less from 15 minutes
- factor start:
- increase of activity
- emotional disturbance
- factor worsen:
- increase of activity exceeding beginning factor.
- factor relieve (quickly):
- rest
- stop activity
- medicine such as vasodilator (GTN)
3. Dyspnoea
4. Nausea / vomit
5. Diaforesis
6. Pallor
7. Headache, faint
8. Anxiety, fear
9. Fatigue
Investigation
1. Electrocardiogram:
- usually normal
- perhaps ST DEPRESION and T inverse during attack
- probably need “exercise ECG test” or “stress test”
2. Coronary angiography
- detect coronary artery narrowing.
3. Chest x-ray:
- detect hipertrrofi heart
4. Echocardiography:
- detect heart abnormality
5. Detect risk factor such as:
- Hb
- thyroxine level
- cholesterol level.
Difference Diagnosis
1. Muskulo-skeletal pain:
- myalgia
- kostokondritis
2. Gastro-usus track's interference:
- esophagitis reflux
- oesophagus spasm
- gastritis
3. Pericarditis.
Treatment
- objective:
- relieve pain
- reduce heart burden
1. Medicines:
a. Nitrates:
- Tab Glyceryl Trinitrate 0.5mg sublingual - relieve pain in 2 - 3 minutes
- limit to 3 tabs.
- Tab Isosorbide dinitrate 10mg
b. My Inhibitor:
- Tab Propanolol 20-40mg every 6 hours, or,
- Tab Metoprolol 50-100mg every 8 hours
c. Antagonist calcium:
- Tab Nifedipine 5-10mg every 8 hours.
- Tab Nicardipine 20-40mg every 8 hours
- Tab Verapamil 120-240mg every 8 hours
- Tab Diltiazem 60-120mg every 8 hours
2. ECG Supervision
3. vitals observation an hour once:
- pulse
- breathing.
- blood pressure
4. Increase of activity has been gradually
5. Surgery may be needed
- coronary bypass
“Percutaneous transluminal coronary angioplasty (PTCA)”.
Complication
1. Neurogenic shock
2. miocardium Infarksion.
Prognosis
- fairly good
- activity control and medical treatment can reduce attack frequency
- may be continuous to myocardial infarction.
Author By, G Theibban Gopalasamy
Assistant Medical Officer
http://penolongpegawaiperubatan.blogspot.com/
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