Angina-Angina pectoris unstable

Unstable angina is a term used to indicate a clinical condition which is the intermediate state between myocardial infarction and the more chronic state of stable angina. Earlier the term preinfarction angina was used for lessening the risk of myocardial infarction or death. Angina pectoris is a general term which is used to describe pain syndromes resulting from myocardial ischemia. It is a condition during which heart does not receive enough blood to meet its needs. Since, this pain occurs in an unpredictable fashion during unexpected times, such as rest, therefore is called unstable angina. The symptoms of unstable angina symptoms announce a medical emergency, and are a harbinger for a heart attack.  Therefore, medical attention should be sought immediately.

In a lay man's language chest pain as it is called is a nonspecific symptom and can result from cardiac or non cardiac causes. But unstable angina is a term used to refer to an array of acute coronary syndromes, which ranges from ST-segment elevation myocardial infarction (STEMI) to non-ST-segment elevation myocardial infarction (NSTEMI).

Begin erratic in nature the pain can occur anywhere, at any time unexpectedly. It generally lasts between 5to20 minutes. There occurs no release of the enzymes and bio markers of myocardial necrosis during unstable angina therefore it is considered to be an acute coronary syndrome. Symptoms linked with unstable angina can vary from person to person. The general symptoms are feeling heaviness or tightness in the chest area, feeling of pain or pressure, a crushing feeling that originates in the thoracic region and then spreads in neck, throat, jaw, shoulder and arm region, uneasiness below the sternum (breast bone), shortness of breath, palpitation, and a heart burning sensation. The symptoms of unstable angina are similar to stable angina. But since, unstable angina attacks a person unaware it leads to high levels of anxiety. Other symptoms like nausea, profuse sweating and light headedness are also associated with it. In order to subside the pain intake of nitroglycerin is generally recommended.

An abrupt rupture of a plaque which causes a speedy accumulation of platelets at the site of rupture, offers an obstruction to the flow of blood in the coronary artery. This leads to the development of the symptoms which occur in an unpredictable and unexpected manner and   culminate into unstable angina. The symptoms however, may be new, more acute, occur with little or no exertion but overall they declare a medical emergency. The pain may or may not subside due to nitroglycerin, unstable angina is comparatively less responsive to nitroglycerin than stable angina. Such an unrestricted accumulation of platelets at the site of breakage of plaque can choke the coronary artery completely which offers an impediment to the supply of oxygen and due to this one may experience a heart attack. Seeking a medical counsel in case of unstable angina is therefore imperative.

Several factors are instrumental in the incidence of unstable angina. Heavy smoking, high levels of bad cholesterol and low levels of good cholesterol in the blood, having high blood pressure or hyper tension, not exercising regularly, consuming diet high in saturated fat and cholesterol, being overweight, having a history of  diabetes mellitus ,genetic causes like having family members (especially parents or siblings) who have had coronary artery disease (CAD) or a stroke are some key factors which are also responsible for the development of Coronary artery disease. The consumption of recreational drugs or stimulants like ecstasy, molly, and cocaine though does not cause CAD but it magnifies the impact of any underlying Coronary artery disease.

The treatment of unstable angina follows diagnosis of the same. Many tests are performed in addition to recording the patient's complete medical history, conducting a physical exam, measuring the blood pressure for diagnosing the ailment. Electrocardiogram (ECG) test is performed to monitor the electrical activity of the heart. Certain ECG findings, when present envisage the risk of a heart attack. Cardiac blood tests, which look for the evidence that heart muscle has died or heart attack has occurred, are performed at various intervals. Cardiac catheterization and angiography are performed to highlight the blockages present in the coronary artery. During this a catheter is introduced in an artery present in the groin or the arm region and a contrast dye is injected into it. As the dye travels through the arteries, X-ray pictures are taken to trace the blockages. ECG stress test is another common test which is performed to check if the patient's heart receives enough oxygen during exercise. During this test the patient is made to walk on the tread mill wearing an ECG monitor and the ECG patterns reflect the presence of CAD. Similar to ECG test nuclear stress test is performed during which a radioisotope is injected into a vein and the person is made to walk on the treadmill. After the exercise pictures of heart are taken and the blockages are reflected. Echocardiograph test ,which uses ultrasound waves to take pictures of heart for detecting CAD.

The treatment for unstable angina is threefold and aims at stabilizing any plaques that may have ruptured in order to prevent a heart attack, relieving symptoms, and treating the underlying coronary artery disease (CAD). 

Stabilisation of plaque in order to check clotting can be achieved by chewing aspirin. Drugs like heparin, clopidogrel, and platelet glycoprotein (GP) IIb/IIIa receptor blocker also check the process of clotting. Medicines like nitoglycerin dilate the blood vessel and ease the flow of the blood thus decreasing the stress on heart during angina. Beta and calcium blockers are also administered during angina to reduce stress on heart. Blockages are surgically removed by performing coronary angioplasty and the bypass surgery.

In case certain lifestyle modifications are adopted they also help in prevention of the ailment. Intake of a healthy diet rich in fibres, low fat dairy products help lower the blood pressure. Following an exercising regime brings down the blood cholesterol levels. Quitting smoking helps save one from the risk of experiencing a heart attack as smoking damages the walls of the blood vessels. Monitoring weight also improves the cholesterol levels of the body.