Semey State Medical University Chair of Russian and Foreign languages SIW Theme: Angina pectoris Prepared by: Kadirbekova U.Zh. 226-GMF Checked by: Zhumaeva G.A. Semey 2017 year

Angina pectoris, commonly known as angina, is severe chest pain[1] due to ischemia (a lack of blood and hence oxygen supply) of the heart muscle, generally due to obstruction or spasm of the coronary arteries (the heart's blood vessels). Angina pectoris

* Coronary artery disease, the main cause of angina, is due to atheroscleros- is of the cardiac arteries. The term derives from the Latin angina ("infection of the throat") from the Greek γχόνη ankhone ("strangling"), and the Latin pectus ("chest"), and can therefore be translated as "a strangling feeling in the chest". Angina pectoris

* It is not common to equate severity of angina with risk of fatal cardiac events. There is a weak relationship between severity of pain and degree of oxygen deprivation in the heart muscle (i.e., there can be severe pain with little or no risk of a heart attack, and a heart attack can occur without pain). Angina pectoris

Worsening ("crescendo") angina attacks, sudden-onset angina at rest, and angina lasting more than 15 minutes are symptoms of unstable angina (usually grouped with similar conditions as the acute coronary syndrome). As these may herald myocardial infarction (a heart attack), they require urgent medical attention and are generally treated as a presumed heart attack.

Most patients with angina complain of chest discomfort rather than actual pain: the discomfort is usually described as a pressure, heaviness, tightness, squeezing, burning, or choking sensation.

* Apart from chest discomfort, angina pains may also be experienced in the epigastrium (upper central abdomen), back, neck area, jaw, or shoulders. This is explained by the concept of referred pain, and is due to the spinal level that receives visceral sensation from the heart simultaneously receiving cutaneous sensation from partsof he skin specified by that spinal nerve's dermatome, without an ability to discriminate the two.

* Typical locations for referred pain are arms (often inner left arm), shoulders, and neck into the jaw. Angina is typically precipitated by exertion or emotional stress. It is exacerbated by having a full stomach and by cold temperatures. Pain may be accompanied by breathlessness, sweating and nausea in some cases. It usually lasts for about 3 to 5 minutes, and is relieved by rest or specific anti-angina medication. Chest pain lasting only a few seconds is normally not angina.

Myocardial ischemia comes about when the myocardia (the heart muscles) receive insufficient blood and oxygen to function normally either because of increased oxygen demand by the myocardia or by decreased supply to the myocardia. This inadequate perfusion of blood and the resulting reduced delivery of oxygen and nutrients is directly correlated to blocked or narrowed blood vessels. Some experience "autonomic symptoms" (related to increased activity of the autonomic nervous system) such as nausea, vomiting and pallor.

Major risk factors for angina include cigarette smoking, diabetes, high cholesterol, high blood pressure, sedentary lifestyle and family history of premature heart disease.

* The electrocardiogram taken during the attack showed a disturbance in the coronary blood circulation. The most important readings of the electrocardiogram were either diminished or deviated. By having repeated the ECG after the end of the attack the cardiologist found the adequate reading of ECG to return to normal ones. The electrocardiogram investigation

Angina Stable angina Unstable angina

* This refers to the more common understanding of angina related to myocardial ischemia. Typical presentations of stable angina is that of chest discomfort and associated symptoms precipitated by some activity (running, walking, etc) with minimal or non-existent symptoms at rest. Symptoms typically abate several minutes following cessation of precipitating activities and resume when activity resumes. In this way, stable angina may be thought of as being similar to claudication symptoms. Stable angina

Unstable angina (UA) (also "crescendo angina;" this is a form of acute coronary syndrome) is defined as angina pectoris that changes or worsens Unstable angina

* it occurs at rest (or with minimal exertion), usually lasting >10 min; * it is severe and of new onset (i.e., within the prior 4–6 weeks); and/or * it occurs with a crescendo pattern (i.e., distinctly more severe, prolonged, or frequent than previously).

* UA may occur unpredictably at rest which may be a serious indicator of an impending heart attack. What differentiates stable angina from unstable angina (other than symptoms) is the pathophysiology of the atherosclerosis. In stable angina, the developing atheroma is protected with a fibrous cap. This cap (atherosclerotic plaque) may rupture in unstable angina, allowing blood Clots toprecipitate and further decrease the lumen of the coronary vessel. This explains why an unstable angina appears to be independent of activity.

* During the attacks of moderate pain no changes in the peripheral blood or elevation of body temperature were noted. However the temperature rose insignificantly and there was an accompanying slight leucocytosis when the attacks of pain were particularly severe. The doctor made the diagnosis of angina pectoris with a severe course. Its main cause was atherosclerosis of the coronary arteries.

Thank you for attention