Angina pectoris

History of medicine

The demonstrations private clinic of the angina pectoris were described for the first time in 1768 by William Heberden.

Physiopathology

The angor is with a myocardic ischaemia, generally secondary with a coronary sténose. This contracting of the feeder arteries of the heart is very often caused by the formation of a plate of athérome involving an inadequacy between the requirements out of oxygen for the myocardium and the contributions by coronary circulation.

Risk factors

Risk factors on which it is possible to act as prevention:

the tobacco
the arterial Hypertension
the Hypercholestérolémie
the Diabetes

Nonmodifiable risk factors:

the sex (the men are more touched by this cardiopathy)
the age
family antecedents

Other factor more discussed, the Stress and sedentariness pose the problem of a not very easy quantification of the latter. The Obésite is also a risk factor but whose independence is discussed (more strongly associated with arterial hypertension, the diabetes and the hypercholesterolemy). It is also the case of a rise in the Triglycéride S.

Symptoms

The stable angina pectoris, or angor occurs with the effort, obliging the patient to stop the effort (for example, walk in rise, in cold weather, vis-a-vis the wind). One observes a typical pain rétrosternale or thoracic left (more generally described under the term of major mediothoracic pain out of vice) with feeling of constriction and oppression irradiating towards the left shoulder and the jaw. It is not rare that the seat of the pain is epigastric.

One can estimate it of many stages.

Other circumstances of release:

the primo-décubitus (or first to sleep) (return accelerated of blood towards the heart)
digestion (consumption of energy by the digestive system)
the sexual relations
the emotions

The crisis must yield in a few minutes (for a stable angor), especially if it took Trinitrine there (coronary Vasodilator).

If the crises often return it rather acts of a unstable Angor (also called syndrome of threat ), making fear occurred of a myocardial infarction.

If the pain persists, it can be a question of a Myocardial infarction in the course of constitution.

Treatment

Treatment of the crisis

Stop of the effort
Taken of a derivative nitrated into sublingual
Trinitrine, coronary vasodilator

Basic treatment

Most of the time the realization of an electrocardiogram will not be of any utility for the diagnosis. The diagnosis of the stable angor is a diagnosis of interrogation. In all the cases:

Aspirine with small plate amount or other antiagrégant;
fight against the risk factors (stop of the tobacco, treatment of a diabetes, a hypercholesterolemy, of a ponderal overload, fights against sedentariness).

According to the cases:

medicamentous treatment by:

Beat-blocking
anti-ischemic (of which nitrated derivatives)

revascularisation of coronary by:

dilation (also called Angioplastie, with generally poses of a Stent;
aorto-coronary Bridging (surgery).

Unstable Angor

At this unstable stage of angor, a coronarography, (radiography of the coronary arteries), is practiced. It leads to 3 attitudes:

dilation of the narrowed artery, by a inflatable small baloon located on the probe, and poses then Stent, (small spring), intended to prevent the repetition of the contracting.
surgical act, by Bridging, intended to short-circuit the narrowed part.
pure medical attitude when the 2 preceding ones are impossible. The arteries are, in this case, too hails to be dilated or decked. The treatment rests then on the control of the coagulation, and the drugs intended to decrease the oxygen uptake by the cardiac muscle.

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