Kalp Krizinde Göğüs Ağrısı (Bölüm 2) What is the chest pain ?
Normal coronary arteries can open up and the heart can pump itself more blood during times of increased need. Unfortunately, over time, these arteries can develop internal blockages that slow the flow of blood through them.
When these blockages reach a certain degree – usually when the internal size of the artery is narrowed by about 70% or more – it becomes impossible for the heart to get enough blood during the times it needs more. These times of increased need include ;
- During exercise
- When performing physical work
- After eating
- When experiencing emotional stress or a sudden increase in blood pressure
With the relatively decreased blood flow and oxygen, the heart muscle produces chemicals that cause the pain. Stopping the exertion or work and placing nitroglycerine under the tongue helps restore the blood flow balance – symptoms are usually resolved in 5-10 minutes.
Angina is short for “angina pectoris,” which in Latin means “pain of the chest.” More specifically, angina is pain originating from the heart when it doesn’t get enough blood flow. Not entirely. While angina means literally “pain,” the term is used to describe any of the symptoms that can result from decreased blood flow to the heart. For many people this includes some type of chest discomfort, either as the main symptom or one of a combination of symptoms. Some describe pressure or tightness in the chest rather than pain, per se.
Angina is not the same as a heart attack, but the difference is only one of degree. Coonary artery disease (CAD) causes both conditions, but while angina is the result of the gradual development of partial blockages in the coronary arteries, a heart attack is caused by very sudden, total or near-total blockages in these vessels. Because CAD underlies both processes, those with angina are at increased risk for a heart attack, though about 50% of heart attacks occur in individuals who have had no prior angina or symptoms of heart disease.
A stable pattern of symptoms to which a person has become accustomed over time is called stable angina. With stable angina, a particular level of activity – for example walking up three or more flights of stairs – may predictably bring on a person’s symptoms. When he or she rests or takes a nitroglycerine tablet, the symptoms are relieved over a few minutes. There is no immediate need to treat stable angina (other than resting or using nitroglycerine when symptoms result), and patients with stable angina have been treated with medications only for many years.
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If the amount of coronary artery blockage increases rapidly, then angina symptoms may be brought on by lower and lower levels of exertion, or symptoms may be stronger, last longer, or take more time to resolve. When this progression happens over a matter of a few hours or days, or when a person experiences symptoms at rest, it is called unstable angina. Those with unstable angina are at very high risk for a heart attack require immediate treatment. When the blockage is total or near-total, a heart attack begins. Alternately, a person with long-term stable angina may gradually worsen over time, to the point of having unstable angina just on the basis of gradually worsening coronary disease.
In the first few days after a person experiences angina for the first time, it cannot be determined whether a person will have a stable pattern or will quickly develop an unstable one. For this reason, those with a new onset of angina, no matter how mild, are usually treated as though they have unstable angina.
There is another less common form of angina called “variant angina,” “atypical angina” or “Prinzmetal’s angina” (named for one of the doctors who first described it). It is caused by the spasming of an area of a coronary artery. The symptoms are similar to those of the other forms of angina, but usually occur at rest and may occur in younger persons and those felt to be at low risk for CAD (though cigarette smoking is associated with this form of angina, too). Though it sounds like unstable angina, the risk of heart attack is lower with variant angina because underlying rigid blood vessel blockage is not the problem and the spasm is reversible.
In any case, once angina is suspected, several tests help to evaluate things further – including confirming the diagnosis and determining the severity of the underlying CAD, which will help to determine the optimal treatment. In each case, deciding which test is best depends on the level of suspicion for CAD and angina and the suspected severity of the underlying problem.