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Cardiology

Angina

What Is Angina?

Angina (an-JI-nuh or AN-juh-nuh) is chest pain or discomfort that occurs if an area of your heart muscle doesn't get enough oxygen-rich blood.

Angina may feel like pressure or squeezing in your chest. The pain also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.

Angina isn't a disease; it's a symptom of an underlying heart problem. Angina usually is a symptom of coronary heart disease (CHD).

CHD is the most common type of heart disease in adults. It occurs if a waxy substance called plaque (plak) builds up on the inner walls of your coronary arteries. These arteries carry oxygen-rich blood to your heart.

Types of Angina

The major types of angina are stable, unstable, variant (Prinzmetal's), and microvascular. Knowing how the types differ is important. This is because they have different symptoms and require different treatments.

Stable Angina

Stable angina is the most common type of angina. It occurs when the heart is working harder than usual. Stable angina has a regular pattern. (“Pattern” refers to how often the angina occurs, how severe it is, and what factors trigger it.)

If you have stable angina, you can learn its pattern and predict when the pain will occur. The pain usually goes away a few minutes after you rest or take your angina medicine.

Stable angina isn't a heart attack, but it suggests that a heart attack is more likely to happen in the future.

Unstable Angina

Unstable angina doesn't follow a pattern. It may occur more often and be more severe than stable angina. Unstable angina also can occur with or without physical exertion, and rest or medicine may not relieve the pain.

Unstable angina is very dangerous and requires emergency treatment. This type of angina is a sign that a heart attack may happen soon.

Variant (Prinzmetal's) Angina

Variant angina is rare. A spasm in a coronary artery causes this type of angina. Variant angina usually occurs while you're at rest, and the pain can be severe. It usually happens between midnight and early morning. Medicine can relieve this type of angina.

Microvascular Angina

Microvascular angina can be more severe and last longer than other types of angina. Medicine may not relieve this type of angina.

Heart murmurs:

Heart murmurs are most often caused by defective heart valves. A stenotic heart valve has a smaller-than-normal opening and can't open completely. A valve may also be unable to close completely. This leads to regurgitation, which is blood leaking backward through the valve when it should be closed.

Murmurs also can be caused by conditions such as pregnancy, fever, thyrotoxicosis (a diseased condition resulting from an overactive thyroid gland) or anemia.

A diastolic murmur occurs when the heart muscle relaxes between beats. A systolic murmur occurs when the heart muscle contracts. Systolic murmurs are graded by intensity (loudness) from one to six. A grade 1/6 is very faint, heard only with a special effort. A grade 6/6 is extremely loud. It's heard with a stethoscope slightly removed from the chest.

What are innocent heart murmurs?

Innocent heart murmurs are sounds made by the blood circulating through the heart's chambers and valves or through blood vessels near the heart. They're sometimes called other names such as "functional" or "physiologic" murmurs.

Are innocent heart murmurs normal?

Innocent murmurs are common in children and are quite harmless. In any group of children, a large percentage is likely to have had one at some time. Innocent murmurs also may disappear and then reappear. Most innocent murmurs disappear when a child reaches adulthood, but some adults still have them. When a child's heart rate changes, such as during excitement or fear, the innocent murmurs may become louder or softer. This still doesn't mean that the murmur is abnormal.

Sometimes, when a doctor first hears the murmur through a stethoscope, he or she may want to have other tests done to be sure the murmur is innocent. After that, there's no need for a cardiac reevaluation unless the patient or doctor has more questions. The child doesn't need medication, won't have cardiac symptoms, and doesn't have a heart problem or heart disease. A parent doesn't need to pamper the child or restrict his or her diet or activities. The child can be as active as any other normal, healthy child.

 

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