Unstable angina--chest pain that occurs more severely, more frequently, and/or at lower levels of activity or at rest--may be a warning sign of a potential heart attack, and may require emergency treatment. Indeed, any chest pain can be the sign of a serious problem. If you experience such symptoms, you should consult a doctor immediately. If you experience such symptoms, take an aspirin (unless you are allergic to aspirin) and immediately seek emergency medical treatment..
If you are diagnosed with unstable angina, you can expect to stay in the hospital for at least 24 hours.
You will be placed on a monitor to follow your heart rhythm. Blood tests will be drawn to look for signs of heart damage (heart attack). You will be treated with medications that will usually include aspirin and heparin (a clot-preventing medication) until you are pain-free for 24 to 48 hours. Your doctor will then decide if further tests are needed, such as a stress test or cardiac catheterization.
An important part of treating stable angina treatment involves improving other conditions that may worsen it, such as obesity, high blood pressure, diabetes, and high cholesterol. Your doctor can help you with treatment of these conditions.
Smoking cigars or cigarettes is one of the major causes of heart disease. Quitting smoking can ease symptoms and save your life. Talk to your doctor about smoking cessation medications and techniques. This is one of the most important things you can do for your health.
Making adjustments to your activities may also help ease the symptoms of angina. Monitor your symptoms and determine what seems to make your angina worse. For example, you may notice that you suffer from angina if you exert yourself early in the day, but then may be able to exercise without chest discomfort in the afternoon. If your angina tends to flare up after eating, avoid exertion immediately after mealtime. Performing certain activities at a slower pace can also make them more tolerable. However, if you find that you are limiting your lifestyle to the point where you are unable to do the things that you enjoy, you should contact your doctor. Adjustments in medications and other treatments can significantly relieve or reduce many people's angina.
A physician-approved exercise regimen is a great way to strengthen the heart and improve high blood pressure and diabetes. Consult with your doctor before starting an exercise program. He or she can help you understand your limitations and will design something specifically for you. Gentle, steady, aerobic activity, such as walking or bicycling, are usually the best for the heart.
Your doctor can also help you determine when and how to gradually increase the intensity of your workouts over time, and you can monitor your progress together.
Learning to manage and reduce emotional stress can also be an important part of controlling chest pain from angina. Exercise, stretching, and relaxation techniques may help manage stress. It is also important to try to avoid situations that are excessively stressful. Talk to your health professional for ideas on how to manage your stress.
Your doctor is the best source of information on the drug treatment choices available to you.
If you have angina or have had a heart attack, your doctor may recommend fish oil tablets, which may reduce your risk of dying from a heart attack in the future.
If unstable angina continues after you have received aspirin, heparin, and other medications in the hospital or emergency room, a procedure called cardiac catheterization (angiogram) may be required. An angiogram allows the doctor to view the outlines of the coronary arteries to identify blockages and to determine the severity of the blockages. During cardiac catheterization, the skin over one of the large leg arteries (femoral artery) is treated with local anesthetic, and then a hollow tube called a "sheath" is placed into the artery. Through this sheath, the doctor can pass thinner, longer hollow tubes called catheters up to your heart. The catheters deliver a liquid (known as contrast) to the coronary arteries that can be seen with x-rays. As the liquid is injected, an x-ray camera outside the body takes pictures of the heart. The images show the liquid moving through the arteries of your heart, and allow the doctor to determine if narrowing has occurred in your heart's arteries. You are awake during this procedure, as there is little discomfort once the leg artery is anesthetized. You may be given a sedative to make you more comfortable.
During cardiac catheterization, your doctor may be able to treat a blockage by using a balloon to press open the plaque (balloon angioplasty)Figure 03. Through the sheath in the leg, a miniature balloon attached to a catheter is passed through the leg artery until it reaches the heart. It is then passed into the diseased heart artery and positioned at the site of the blockage (plaque) requiring treatment. Once in position, it is temporarily inflated, which compresses the plaque against the walls of the artery, reducing the blockage and allowing more blood flow to the heart.
Small metal coils (stents) may also be placed at the site of the blockage to help keep the artery open. If a stent is placed, you may be treated with a medication such as the anti-clot medication clopidogrel (Plavix) for four to six weeks to help prevent re-occurrence of the blockage.
In general, angioplasty requires relatively short hospital stays (for example, one to two days), is less invasive than open heart surgery, and allows most patients to return to normal life quickly, usually within a week or so.
However, not all blockages can be treated with angioplasty, and some blockages can reoccur after treatment: up to 30% of blockages treated with angioplasty might worsen again and cause symptoms within the first 6-12 months. On the other hand, blockages that do not worsen within the first 6-12 months after angioplasty might remain open for many years.
Continued smoking is one of the main risks for re-closure of an artery treated with angioplasty and stenting, and therefore quitting smoking is essential.
Cardiac catheterization may also be done on a non-emergency basis for diagnosis of coronary heart disease if you have stable angina and are being considered for major surgery, or if your angina continues to be significant despite the use of medications.
You may be considered for open heart surgery, called coronary artery bypass grafting (CABG), to detour blood flow around the blockages in your heart arteries Figure 04. If you have severe disease of your heart arteries, or if your angina cannot be sufficiently treated with lifestyle changes, medications, and/or angioplasty, surgery may be recommended. Also, in some patients with unstable angina, surgery may be recommended to help prevent a heart attack.
Heart artery blockages are bypassed using a vein from the leg or an artery within the chest, creating an alternate route for blood flow to the heart muscle. CABG usually requires that the breastbone be cut and that the patient be placed on a machine to supply the body with blood during the surgery. In come cases, CABG can be performed without the breastbone being cut or without placing the patient on bypass, but this depends on the clinical situation, the patient, the surgeon, and the operating team.
The risks and benefits of CABG vary depending on the severity of the heart condition, the patient's overall health, and the skill and experience of the surgical team. Patients are generally in the hospital for a week or more, and recovery time at home is usually another six to eight weeks. Following recovery, most patients are able to have better, more active lives, usually with mild or no angina for many years.
Whether angioplasty or CABG can be performed depends on the nature of the blockages in the heart arteries and on the patient's overall health and lifestyle.
Figure 03. Balloon angioplasty (animation and audio)
Figure 04. Coronary artery bypass grafting surgery (CABG)(animation and audio)
Intake of fatty fish or fish oil tablets may reduce the risk of dying from a heart attack.
Patients who are using nitroglycerin should not take the anti-impotence drugs Viagra, Cialis, or Levitra. The two drugs together can cause death by suddenly lowering the blood pressure.
The prognosis, or future risk of death or a heart attack, in a person with angina depends on several factors. These factors include the condition of the left ventricle, the heart muscle chamber that pumps blood through the body, and the location and severity of blockages in the heart arteries. Smoking also increases the risk of death or a heart attack, and it is critical that you stop smoking if you have heart disease. Taking aspirin, beta-blockers, ACE inhibitors, cholesterol-lowering medication, and fish oil may also reduce the risk of death or a heart attack. In some patients, CABG surgery may also be recommended.
Most people with stable angina can live productively for many years.
Patients who have had an episode of unstable angina are at increased risk for major heart problems (such as a heart attack or death) over the next 6-12 months. Close attention to your doctor's recommendations is critical during this time.
Regular visits to your doctor are important so that your symptoms can be followed, to make sure you are tolerating your medications, and to treat your high blood pressure, high cholesterol, and diabetes, if you have these conditions. Stress tests may also be performed during your follow-up.
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