Angina pectoris

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Sudden chest pain, localized behind chest bone, spreading to left arm and shoulder, lasts from 5 to 20 minutes, may imply angina pectoris

CORONARY or ischemia heart illness with clinical forms (angina pectoris, myocardium  infarction, hearth decompensation, hearth arrhythmia and heart death), represents most common heart illness and is a leading cause of death in this country. It is more common in men than in women, particularly after the age of 40. Most frequent cause of ischemia illnesses of heart is arthrosclerosis in coronary arteries leading to gradual narrowing (stenosis) of blood vessels and decreased supply of blood, oxygen and nourishing substances to the heart (ischemia).


Basic symptom of angina pectoris is chest pain, stitching, stirring and squeezing, or pressuring. Pain is localized behind chest bone, spreading to left arm and shoulder, sometimes to lower jaw, diffuse in chests or between dims. It lasts usually 20 minutes. In case of non-stable angina pectoris, the pain is not provoked by physical stress, it has the same characteristics, but lasts more than 30 minutes and does not release even after taking nitroglycerine. Pain strength varies from mild pressure to very strong pain followed by loud heart beating, sweating, sickness and impression of soon death ( unstable angina pectoris or myocardium infarction). Pain attack can be provoked by physical effort, emotional stress, sudden exposure to cold, heavy meal, exaggerated smoking and alcohol, sexual intercourse, bad dreams and sudden changes of weather conditions.


Precious data on coronary disease are to be found in carefully taken anamnesis data on present risk factors, such as increased blood pressure, diabetes, obesity, smoking, increased cholesterol in blood, stress, low physical activity, genetic precondition, etc. Physical examination and resting ECG are supplementary to the basic diagnostics.

ECG in most patients with stable angina pectoris is normal. Then, it is necessary to perform additional examinations, such as ultrasound of heart with pulse and color Doppler tests, aiming discovering the correct diagnosis. Additionally, it is necessary to perform exercise stress testing on ergometer(exercise bike) or treadmill, in order to provoke under gradual stress subjective or objective signs of heart ishaemia.
If ergometer results in submaximal or maximal stress exposure is negative, it is considered that there is no case of coronary disease.

The use of other diagnostic procedures (SPECT, MSCT or invasive coronagraph) is reserved for those patients who have already been diagnosed angina pectoris, as it is necessary to estimate the level of coronary artery narrowing and the function of left ventricle, so the level of possibility of infarction and sudden cardiac death.


Angina pectoris treatment starts with risk factors elimination, and then follows medical therapy, including preventing the attacks.

In angina pectoris attacks preventing, nitroglycerine is applied sublingually, most often as a spray which effects in 7 second, while it lasts between 15 to 30 minutes. It widens periphery venules and brings to increase of coronary flow leading to decrease heart stress and less need for oxygen. If the pain persists in spite of taken medicine, another dosage is to taken. If even that does not prevent pains, patient should be urgently taken to cardiologist for examination and further treatment.

In preventing the attack, we should apply those with lasting effect (isosorbiddinitrat - Isosorb, isosorbid-5 aminomononitrat – Monizol, molsidomin - Molicor) of the same sort as nitroglycerine, but starting in 30 minutes and in retard effect up to 24 hours.
Cardioselective beta blockages slower down heart frequence, lower the strenth of contactions, need for oxygen and blood pressure.

Ca antagonists (verapamil, diltiazem, nifedipin, amlodipin, lerkanidipin), bring to artery pressure decrease, lower the contraction force of heart muscle, slow down heart frequence and widen blood vessels. Coronary circulation is consequently better and the ischemic heart need for oxygen decreased.

Aspirin in dosage of 75 to100 mg daily, inhibits aggregation of thrombocites and prevents coronary thrombosis (myocardial  infarction).

Klopidogrel (Plavix, Zylt) 75 mg per day increases the effect of aspirin, inhibits thrombocits aggregation and prevents coronary thrombosis.
In-time diagnosis, reduction of risk factors, adequate therapy and regular cardiology control checks will prevent development of more serious forms of ischemical heart diseases.


Dr Goran Popović
Internal medicine specialistCardiologist



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