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Amandeep Singh Pd.

Nov. 8th,2010 Mr. Maugeri

Causes of Angina: CHD starts when certain factors damage the inner layers of the coronary
arteries. These factors include smoking, high levels of fat and cholesterol in the blood, high
blood pressure, and a high level of sugar in the blood (due to insulin resistance or diabetes).
Other triggers of angina include:

• Emotional stress
• Exposure to very hot or cold temperatures
• Heavy meals
• Smoking

Risk Factors of Angina:

• Unhealthy cholesterol levels.

• High blood pressure.
• Cigarette smoking.
• Insulin resistance or diabetes.
• Overweight or obesity.
• Metabolic syndrome.
• Lack of physical activity.
• Unhealthy diet.
• Age. (The risk increases for men after 45 years of age and for women after 55 years of
• Family history of early heart disease.

Symptoms of Angina: Pain and discomfort are the main symptoms of angina. Angina often is
described as pressure, squeezing, burning, or tightness in the chest. The pain or discomfort
usually starts in the chest behind the breastbone. Pain from angina also can occur in the arms,
shoulders, neck, jaw, throat, or back. The pain may feel like indigestion. Some people say that
angina pain is hard to describe or that they can't tell exactly where the pain is coming from. Signs
and symptoms such as nausea (feeling sick to your stomach), fatigue (tiredness), shortness of
breath, sweating, light-headedness, or weakness also may occur.
Diagnosis of Angina:

Stress Testing

During stress testing, you exercise (or are given medicine if you’re unable to exercise) to
make your heart work hard and beat fast while heart tests are done. When your heart is
working hard and beating fast, it needs more blood and oxygen. Plaque-narrowed
arteries can't supply enough oxygen-rich blood to meet your heart's needs.

Chest X Ray

A chest x ray can reveal signs of heart failure. It also can show signs of lung disorders and other
causes of symptoms that aren't due to CHD. However, a chest x ray alone is not enough to
diagnose angina or CHD.

Blood Tests

Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood.
Abnormal levels may show that you have risk factors for CHD.

Treatment of Angina

Treatments for angina include lifestyle changes, medicines, medical procedures, cardiac
rehabilitation (rehab), and other therapies. The main goals of treatment are to:

• Reduce pain and discomfort and how often it occurs

• Prevent or lower the risk of heart attack and death by treating the underlying heart

Lifestyle Changes

Making lifestyle changes can help prevent episodes of angina. You can:

• Slow down or take rest breaks if physical exertion triggers angina.

• Avoid large meals and rich foods that leave you feeling stuffed if heavy meals trigger
• Try to avoid situations that make you upset or stressed if emotional stress triggers angina.
Learn ways to handle stress that can't be avoided.

Nitrates are the medicines most commonly used to treat angina. They relax and widen blood
vessels. This allows more blood to flow to the heart, while reducing the heart’s workload.
Nitroglycerin is the most commonly used nitrate for angina. Nitroglycerin that dissolves under
your tongue or between your cheek and gum is used to relieve angina episodes. Nitroglycerin
pills and skin patches are used to prevent angina episodes. These forms of nitroglycerin act too
slowly to relieve pain during an angina attack.

Congenital Heart Defect

Causes of CHD:

Heredity may play a role in some heart defects. For example, a parent who has a congenital heart
defect may be more likely than other people to have a child with the condition. In rare cases,
more than one child in a family is born with a heart defect. Children who have genetic disorders,
such as Down syndrome, often have congenital heart defects. In fact, half of all babies who have
Down syndrome have congenital heart defects. Smoking during pregnancy also has been linked
to several congenital heart defects, including septal defects.

Symptoms of CHD:

Many congenital heart defects have few or no signs or symptoms. A doctor may not even detect
signs of a heart defect during a physical exam. Some heart defects do have signs and symptoms.
They depend on the number, type, and severity of the defects. Severe defects can cause signs and
symptoms, usually in newborns. These signs and symptoms may include:

• Rapid breathing
• Cyanosis (a bluish tint to the skin, lips, and fingernails)
• Fatigue (tiredness)
• Poor blood circulation

Congenital heart defects don't cause chest pain or other painful symptoms.

Severe congenital heart defects are generally found during pregnancy or soon after birth. Less
severe defects aren't diagnosed until children are older.

Minor defects often have no signs or symptoms and are diagnosed based on results from a
physical exam and tests done for another reason.

Physical Exam

During a physical exam, the doctor will:

• Listen to your child's heart and lungs with a stethoscope

• Look for signs of a heart defect, such as cyanosis (a bluish tint to the skin, lips, or
fingernails), shortness of breath, rapid breathing, delayed growth, or signs of heart failure

Diagnostic Tests


Echocardiography (echo) is a painless test that uses sound waves to create a moving picture of
the heart. During the test, the sound waves (called ultrasound) bounce off the structures of the
heart. A computer converts the sound waves into pictures on a screen.

Echo allows the doctor to clearly see any problem with the way the heart is formed or the way
it's working.

The fetal echo usually is done at about 18 to 22 weeks of pregnancy. If your child is diagnosed
with a congenital heart defect before birth, your doctor can plan treatment before the baby is

EKG (Electrocardiogram)

An EKG is a simple, painless test that records the heart's electrical activity. The test shows how
fast the heart is beating and its rhythm (steady or irregular). It also records the strength and
timing of electrical signals as they pass through each part of the heart.

An EKG can detect if one of the heart's chambers is enlarged, which can help diagnose a heart

Chest X Ray
A chest x ray is a painless test that creates pictures of the structures in the chest, such as the heart
and lungs. This test can show whether the heart is enlarged or whether the lungs have extra blood
flow or extra fluid, a sign of heart failure.

Pulse Oximetry

Pulse oximetry shows how much oxygen is in the blood. For this test, a small sensor is attached
to a finger or toe (like an adhesive bandage). The sensor gives an estimate of how much oxygen
is in the blood.


Catheter Procedures

Catheter procedures are much easier on patients than surgery because they involve only a needle
puncture in the skin where the catheter (thin, flexible tube) is inserted into a vein or an artery.


A child may need open-heart surgery if his or her heart defect can't be fixed using a catheter
procedure. Sometimes, one surgery can repair the defect completely. If that's not possible, the
child may need more surgeries over months or years to fix the problem.


Atherosclerosis may start when certain factors damage the inner layers of the arteries. These
factors include:

• Smoking
• High amounts of certain fats and cholesterol in the blood
• High blood pressure
• High amounts of sugar in the blood due to insulin resistance or diabetes

When damage occurs, your body starts a healing process. The healing may cause plaque to build
up where the arteries are damaged.

Eventually, a section of plaque can break open, causing a blood clot to form at the site. A blood
clot will narrow the artery even more and may worsen angina (chest pain) or cause a heart attack
or stroke.
Risk Factors

• Unhealthy blood cholesterol levels. This includes high LDL cholesterol (sometimes
called “bad” cholesterol) and low HDL cholesterol (sometimes called “good”
• High blood pressure. Blood pressure is considered high if it stays at or above 140/90
mmHg over time. If you have diabetes or chronic kidney disease, high blood pressure is
defined as 130/80 mmHg or higher. (The mmHg is millimeters of mercury—the units
used to measure blood pressure.)
• Smoking. Smoking can damage and tighten blood vessels, raise cholesterol levels, and
raise blood pressure. Smoking also doesn't allow enough oxygen to reach the body's
• Insulin resistance. This condition occurs if the body can't use its insulin properly. Insulin
is a hormone that helps move blood sugar into cells where it's used.
• Diabetes. This is a disease in which the body's blood sugar level is too high because the
body doesn't make enough insulin or doesn't use its insulin properly.
• Overweight or obesity. The terms "overweight" and "obesity" refer to a person's overall
body weight and whether it's too high. Overweight is having extra body weight from
muscle, bone, fat, and/or water. Obesity is having a high amount of extra body fat.
• Lack of physical activity. A lack of physical activity can worsen other risk factors for
atherosclerosis, such as unhealthy blood cholesterol levels, high blood pressure, diabetes,
and overweight and obesity.
• Unhealthy diet. An unhealthy diet can raise your risk of atherosclerosis. Foods that are
high in saturated and trans fats, cholesterol, sodium (salt), and sugar can worsen other
atherosclerosis risk factors.
• Age. As you get older, your risk of atherosclerosis increases. Genetic or lifestyle factors
cause plaque to build in your arteries as you age. By the time you're middle-aged or
older, enough plaque has built up to cause signs or symptoms. In men, the risk increases
after age 45. In women, the risk increases after age 55.
• Family history of early heart disease.


Atherosclerosis usually doesn't cause signs and symptoms until it severely narrows or totally
blocks an artery. Many people don't know they have the disease until they have a medical
emergency, such as a heart attack or stroke.
Some people may have signs and symptoms of the disease. Signs and symptoms will depend on
which arteries are affected.

Coronary Arteries

The coronary arteries supply oxygen-rich blood to your heart. When plaque narrows or blocks
these arteries (a condition called coronary heart disease, or CHD), a common symptom is angina.
Angina is chest pain or discomfort that occurs when your heart muscle doesn't get enough
oxygen-rich blood.

Angina may feel like pressure or a squeezing pain in your chest. You also may feel it in your
shoulders, arms, neck, jaw, or back. This pain tends to get worse with activity and go away when
you rest. Emotional stress also can trigger the pain.

Other symptoms of CHD are shortness of breath and arrhythmias (ah-RITH-me-ahs).

Arrhythmias are problems with the rate or rhythm of the heartbeat.

Plaque also can form in the heart's smallest arteries. When this happens, it's called coronary
microvascular disease (MVD). In addition to angina and shortness of breath, coronary MVD also
may cause sleep problems, fatigue (tiredness), and lack of energy.

Carotid Arteries

The carotid arteries supply oxygen-rich blood to your brain. When plaque narrows or blocks
these arteries (a condition called carotid artery disease), you may have symptoms of a stroke.
These symptoms may include:

• Sudden weakness or numbness in the face or limbs, often on just one side of the body
• The inability to move one or more of your limbs
• Trouble speaking and understanding
• Sudden trouble seeing in one or both eyes
• Dizziness or loss of balance
• A sudden, severe headache with no known cause

Peripheral Arteries

Plaque also can build up in the major arteries that supply oxygen-rich blood to the legs, arms,
and pelvis. When this happens, it's called peripheral arterial disease. If these major arteries are
narrowed or blocked, it can lead to numbness, pain, and, sometimes, dangerous infections.

Physical Exam

During the physical exam, your doctor may listen to your arteries for an abnormal whooshing
sound called a bruit (broo-E). Your doctor can hear a bruit when placing a stethoscope over an
affected artery. A bruit may indicate poor blood flow due to plaque buildup.

Your doctor also may check to see whether any of your pulses (for example, in the leg or foot)
are weak or absent. A weak or absent pulse can be a sign of a blocked artery.

Diagnostic Tests

Your doctor may recommend one or more tests to diagnose atherosclerosis. These tests also can
help your doctor learn the extent of your disease and plan the best treatment.

Blood Tests

Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood.
Abnormal levels may be a sign that you're at risk for atherosclerosis.

EKG (Electrocardiogram)

An EKG is a simple, painless test that detects and records the heart's electrical activity. The test
shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the
strength and timing of electrical signals as they pass through each part of the heart.

An EKG can show evidence of heart damage due to CHD and signs of a previous or current heart

Chest X Ray

A chest x ray takes pictures of the organs and structures inside your chest, such as your heart,
lungs, and blood vessels. A chest x ray can reveal signs of heart failure.

Treatments for atherosclerosis may include lifestyle changes, medicines, and medical procedures
or surgery.

The goals of treatment include:

• Relieving symptoms
• Reducing risk factors in an effort to slow or stop the buildup of plaque
• Lowering the risk of blood clots forming
• Widening or bypassing plaque-clogged arteries
• Preventing atherosclerosis-related diseases

Lifestyle Changes

Making lifestyle changes often can help prevent or treat atherosclerosis. For some people, these
changes may be the only treatment needed.

Follow a Healthy Diet

A healthy diet is an important part of a healthy lifestyle. Following a healthy diet can prevent or
reduce high blood pressure and high blood cholesterol and help you maintain a healthy weight.

For information on healthy eating, go to the National Heart, Lung, and Blood Institute's
(NHLBI's) Aim for a Healthy Weight Web site. This site provides practical tips on healthy
eating, physical activity, and controlling your weight.

Quit Smoking
If you smoke or use tobacco, quit. Smoking can damage and tighten blood vessels and raise your
risk of atherosclerosis.

Talk to your doctor about programs and products that can help you quit. Also, try to avoid
secondhand smoke. For more information on how to quit smoking, see the NHLBI's "Your
Guide to a Healthy Heart."

Manage Stress

Research shows that the most commonly reported "trigger" for a heart attack is an emotionally
upsetting event—particularly one involving anger. Also, some of the ways people cope with
stress, such as drinking, smoking, or overeating, aren't healthy.

Learning how to manage stress, relax, and cope with problems can improve your emotional and
physical health. Having supportive people in your life with whom you can share your feelings or
concerns can help relieve stress.

Physical activity, medicine, and relaxation therapy also can help relieve stress. You may want to
consider participating in a stress management program.


To slow the progress of plaque buildup, your doctor may prescribe medicines to help lower your
cholesterol level or blood pressure or to prevent blood clots from forming.

For successful treatment, take all medicines as your doctor prescribes.