ABSTRACT:

To study angina pectoris,

its causes, its diagnosis
and its treatment.

NAME:
CLASS: 12
INVESTIGATORY PROJECT ROLL NO:
(BIOLOGY) CBSE ROLL NO:
YEAR: -
 ACKNOWLEDGEMENT

It is my foremost duty to express my deep gratitude to

Mr/s._____________, Principal, __________ School, for all the
facilities provided for this project work.
I would also like to express my sincere thanks to
Mr/s. ____________ my biology teacher, who guided me to
the successful completion of this project and always bless me
with their vital support, invaluable guidance, constructive
comments and constant encouragement.
I would also like to express my gratitude to my parents for their
support and valuable advice for the completion of this project.

INDEX
O. TOPIC PAGE NO.
1 INTRODUCTION 1

2 MAIN SYMPTOMS 2

3 THE MAJOR TYPES 4

4 MAJOR RISK FACTORS 6

WHY IS IT IMPORTANT TO
5 9
ESTABLISH DIAGNOSIS?

6 DIAGNOSIS 10

7 TREATMENT 12

8 CONCLUSION 14

9 BIBLIOGRAPHY 15
 INTRODUCTION
Angina pectoris, commonly known as angina, is chest pain due to
ischemia (a lack of blood, thus a lack of oxygen supply and waste
removal) of the heart muscle, generally due to obstruction or spasm
of the coronary arteries (the heart's blood vessels). Coronary artery
disease, the main cause of angina, is due to atherosclerosis of the
coronary arteries 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). Worsening 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.

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 MAIN SYMPTOMS
Angina is chest discomfort that occurs when there is decreased
blood oxygen supply to an area of the heart muscle. In most
cases, the lack of blood supply is due to a narrowing of the
coronary arteries as a result of arteriosclerosis.
Angina is usually felt as:
• pressure,
• heaviness,
• tightening,
• squeezing,
• Aching across the chest, particularly behind the breastbone.

This pain often radiates to the neck, jaw, arms, back, or even the
teeth.
Patients may also suffer:
• indigestion,
• heartburn,
• weakness,
• sweating,
• nausea,
• cramping, and
• shortness of breath.
Angina usually occurs during exertion, severe emotional stress, or
after a heavy meal, when the heart muscle demands more blood
oxygen than the narrowed coronary arteries can deliver. Angina
typically lasts from 1 to 15 minutes and is relieved by rest or by

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placing a nitroglycerine tablet under the tongue, which relaxes
the blood vessels and lowers blood pressure. Both rest and
nitroglycerine decrease the heart muscles demand for oxygen,
relieving angina

THE MAJOR TYPES

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1. Stable angina
2. Unstable angina
3. Microvascular angina
1. Stable Angina:
Stable angina is the most common type of angina, and what most
people mean when they refer to angina. People with stable angina
have angina symptoms on a regular basis and the symptoms are
somewhat predictable (for example, walking up a flight of steps
causes’ chest pain). For most patients, symptoms occur during
exertion and commonly last less than five minutes. They are relieved
by rest or medication, such as nitroglycerin under the tongue. Stable
angina is one of many causes of chronic chest pain.
2. Unstable Angina:
Unstable angina is less common but more serious. The symptoms
are more severe and less predictable than the pattern of stable
angina. Pain is more frequent, lasts longer, occurs at rest, and is not
relieved by nitroglycerin under the tongue (or the patient needs to
use more nitroglycerin than usual). Unstable angina is not the same
as a heart attack, but warrants an immediate visit to your physician
or hospital emergency department as further cardiac testing is
urgently needed. Unstable angina is often a precursor to a heart
attack.

3. Microvascular Angina:

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Microvascular Angina or Angina Syndrome X is characterized by
angina-like chest pain, but has different causes. The cause of
Microvascular Angina is unknown, but it appears to be the result of
poor function in the tiny blood vessels of the heart, arms and legs.
Since Microvascular angina isn't characterized by arterial blockages,
it's harder to recognize and diagnose, but its prognosis is excellent.

MAJOR RISK FACTORS

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 Age (≥ 55 years for men, ≥ 65 for women)
 Cigarette smoking
 Diabetes mellitus (DM)
 Dyslipidemia
 Family History of premature cardiovascular disease (men <55
years, female <65 years old)
 Hypertension (HTN)
 Kidney disease (microalbuminuria or GFR<60 mL/min)
 Obesity (BMI ≥ 30 kg/m2)
 Physical inactivity

Conditions that exacerbate or provoke angina

 Medications
 vasodilators
 excessive thyroid replacement
 vasoconstrictors
 polycythemia, which thickens the blood causing it to slow its
flow through the heart muscle.

One study found that smokers with coronary artery disease had
a significantly increased level of sympathetic nerve activity
when compared to those without. This is in addition to
increases in blood pressure, heart rate and peripheral vascular
resistance associated with nicotine which may lead to recurrent
angina attacks. Additionally, CDC reports that the risk of CHD
(coronary heart disease), stroke, and PVD (Peripheral vascular
disease) is reduced within 1–2 years of smoking cessation. In
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another study, it was found that after one year, the prevalence
of angina in smoking men under 60 after an initial attack was
40% less in those who had quit smoking compared to those
who continued. Studies have found that there are short term
and long-term benefits to smoking cessation.

Other medical problems

 profound anemia
 uncontrolled HTN
 hyperthyroidism
 hypoxemia

Other cardiac problems

 tachyarrhythmia
 bradyarrhythmia
 valvular heart disease
 hypertrophic cardiomyopathy

A Major Cause: Coronary Artery Disease

Coronary arteries supply oxygenated blood to the heart muscle.
Coronary artery disease develops as cholesterol is deposited in
the artery wall, causing the formation of a hard, thick substance
called cholesterol plaque. The accumulation of cholesterol
plaque over time causes narrowing of the coronary arteries, a
process called arteriosclerosis. Arteriosclerosis can be
accelerated by smoking, high blood pressure, elevated
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cholesterol, and diabetes. When coronary arteries become
narrowed by more than 50% to 70%, they may no longer be
able to meet the increased blood oxygen demand by the heart
muscle during exercise or stress. Lack of oxygen to the heart
muscle causes chest pain (angina).

WHY IS IT IMPORTANT TO
ESTABLISH DIAGNOSIS?

Angina is usually a warning sign of the presence of significant

coronary artery disease. Patients with angina are at risk of
developing a heart attack (myocardial infarction). A heart attack
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is the death of heart muscle precipitated by the complete
blockage of a diseased coronary artery by a blood clot.
During angina, the lack of oxygen (ischemia) to the heart
muscle is temporary and reversible. The lack of oxygen to the
heart muscle resolves and the chest pain disappears when the
patient rests or takes nitroglycerine. In contrast, the muscle
damage in a heart attack may be permanent, if there is a delay
in obtaining emergency treatment. The dead muscle turns into
scar tissue when healed. A scarred heart that results from a
heart attack cannot pump blood as efficiently as a normal heart,
and can lead to heart failure. Many patients with significant
coronary artery disease have no symptoms at all, even though
they clearly lack adequate blood and oxygen supply to the heart
muscle. These patients have "silent" angina. They have the
same risk of heart attack as those with symptoms of angina.

DIAGNOSIS

The electrocardiogram (EKG or ECG) is a recording of the

electrical activity of the heart muscle, and can detect heart
muscle which is in need of oxygen. The EKG is useful in showing
changes caused by inadequate oxygenation of the heart muscle
or a heart attack.

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1. Exercise stress test
In patients with a normal resting EKG, exercise treadmill or
bicycle testing can be useful screening tools for coronary artery
disease. During an exercise stress test (also referred to as stress
test, exercise electrocardiogram, graded exercise treadmill test,
or stress ECG), EKG recordings of the heart are performed
continuously as the patient walks on a treadmill or pedals on a
stationary bike at increasing levels of difficulty. The occurrence
of chest pain during exercise can be correlated with changes on
the EKG, which demonstrates the lack of oxygen to the heart
muscle.
When the patient rests, the angina and the changes on the EKG
which indicate lack of oxygen to the heart can both disappear.
The accuracy of exercise stress tests in the diagnosis of
significant coronary artery disease is 60% to 70%.

2. Stress echocardiography
Stress echocardiography combines echocardiography
(ultrasound imaging of the heart muscle) with exercise stress
testing. Stress echocardiography is more accurate than an
exercise stress test in detecting coronary artery disease. When
a coronary artery is significantly narrowed, the heart muscle
supplied by this artery does not contract as well as the rest of
the heart muscle during exercise. Abnormalities in muscle
contraction can be detected by echocardiography. Stress
echocardiography is about 85% to 90% accurate in detecting
significant coronary artery disease. When a patient cannot
undergo exercise stress test because of neurological or
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orthopedic difficulties, medications can be injected
intravenously to simulate the stress on the heart normally
brought on by exercise. Heart imaging can be performed with a
nuclear camera or echocardiography.

3. Cardiac catheterization
Cardiac catheterization with angiography (coronary
arteriography) is a technique that allows X-ray pictures to be
taken of the coronary arteries. It is the most accurate test to
detect coronary artery narrowing. Coronary arteriography gives
the doctor a picture of the location and severity of coronary
artery disease. This information can be important in helping
doctors’ select treatment options.

4. CT coronary angiogram
CT coronary angiography is a procedure that uses an
intravenous dye that contains iodine, and CT scanning to image
the coronary arteries. While the use of catheters is not
necessary (this procedure is considered "noninvasive"), there
are still some risks involved, including:
• patients allergic to iodine;
• patients with abnormal kidney function; and
• radiation exposure.

TREATMENT
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The most specific medicine to treat angina is nitroglycerin. It is
a potent vasodilator that makes more oxygen available to the
heart muscle. Beta-blockers and calcium channel blockers act to
decrease the heart's workload, and thus its requirement for
oxygen. Nitroglycerin should not be given if certain inhibitors
such as Sildenafil (Viagra), Tadalafil (Cialis), or Vardenafil
(Levitra) have been taken within the previous 12 hours as the
combination of the two could cause a serious drop in blood
pressure. Treatments are balloon angioplasty, in which the
balloon is inserted at the end of a catheter and inflated to
widen the arterial lumen. Stents to maintain the arterial
widening are often used at the same time. Surgery involves
bypassing constricted arteries with venous grafts. This is much
more invasive than angioplasty.

The main goals of treatment in angina pectoris are relief of

symptoms, slowing progression of the disease, and reduction of
future events, especially heart attacks and, of course, death.
Beta blockers (e.g., carvedilol, propranolol, atenolol) have a
large body of evidence in morbidity and mortality benefits
(fewer symptoms, less disability and longer life) and shortacting
nitroglycerin medications have been used since 1879 for
symptomatic relief of angina. Calcium channel blockers (such as
nifedipine and amlodipine), isosorbide mononitrate and
nicorandil are vasodilators commonly used in chronic stable
angina. A new therapeutic class, called if inhibitor, has recently
been made available: ivabradine provides pure heart rate

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reduction leading to major anti-ischemic and antianginal
efficacy.

ACE inhibitors are also vasodilators with both symptomatic and

prognostic benefit and, lastly, statins are the most frequently
used lipid/cholesterol modifiers which probably also stabilize
existing atheromatous plaque. Low-dose aspirin decreases the
risk of heart attack in patients with chronic stable angina, and
was previously part of standard treatment; however, it has
since been discovered that the increase in hemorrhagic stroke
and gastrointestinal bleeding offsets this gain so they are no
longer advised unless the risk of myocardial infarction is very
high. Exercise is also a very good long-term treatment for the
angina (but only particular regimens - gentle and sustained
exercise rather than intense short bursts), probably working by
complex mechanisms such as improving blood pressure and
promoting coronary artery collateralization.

CONCLUSION

Angina pectoris is a chest pain caused by decrease oxygen

supply to the heart muscle. ECG, stress test and blood test are

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important in the diagnosis of angina. It is managed with rest,
medication and surgery.

BIBLIOGRAPHY

The following sources of information have been used for the

completion of the project: • www.google.com
• www.wikipedia.com
• www.medscape.com
• www.emedicinehealth.com
• www.medicinenet.com
• Angina pectoris by Alice Gallo, Margaret L. Jones
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