Angina pectoris is chest pain or discomfort. A person may feel pain when insufficient oxygen-rich blood reaches the heart muscle. This reduced blood flow is caused by coronary heart disease (CHD), an accumulation of plaque inside the coronary blood vessels.

1. Angina pectoris is chestpain or discomfort.A person may feel pain when insufficientoxygen-rich blood reaches
the heart muscle. This reduced blood flow is caused by coronary heart disease(CHD), an accumulation of plaque
insidethe coronary blood vessels.
Angina that occurs unpredictably or duringrestis called unstableangina.Sometimes, unstableangina can result
from a temporary blood clotthat suddenly blocks blood flowto the heart. The pain subsides when the clot
dissolvesand blood flowresumes.
If a person has experienced angina after exertion, called stableangina,and anginasymptoms begin to lastafter
exerciseor occur at rest, the angina may have become unstableangina.This usually means an artery has narrowed
further, often because of a blood clot. If an episodeof unstableangina is thefirstinstanceof angina a person
experiences, it is called new onset unstableangina.
The goals of angina medication and treatment are to relieve ischemia,thereby reducingthe frequency and severity
of angina attacks and preventing a heart attack. Itis importantto know in advancethe various sideeffects of any
medication and to be awareof serious sideeffects that may require medical attention. Some medications can
interactwith substances in a way that can alter the effect the medication has on the body, so people with angina
should tell their physician aboutother prescriptions,their alcohol consumption,or any herbal supplements they
take.
Angina
Angina is chest pain or discomfortcaused when your heart muscledoes not get enough oxygen-rich blood. The
pain is usually triggered by physical activity or stress,relieved by rest, and typically only lastsfor a few minutes
(angina attack).It may feel likepressureor squeezing in your chest. The discomfortmay radiateto your shoulders,
arms,neck, jaw,or back. Angina pain may even feel likeindigestion.However, angina is nota disease.Itis a
symptom of an underlyingheart problem and is usually a symptom of coronary heartdisease(CHD).
Heart diseases were the third common causes of death in Hong Kong in 2012.Among these heart diseases,CHD
was the dominatingcomponent which made up 68% of heart diseasedeaths.CHD happens when a sticky
substancecalled plaquebuildsup in the arteries that supply blood to the heart. As a result, the arteries are
hardened and narrowed, and blood flowis reduced and the heart musclecannot get enough blood. If blood flow
does not improve, heart muscledeprived of oxygen dies – a heart attack. Risk factors that increaseyour risk of
CHD and angina includetobacco use,diabetes, high blood pressure, high blood cholesterol level, personal or family
history of heart disease,older age, lack of exercises,obesity and stress.Some of these factors areavoidableor
treatable.
There are three main types of angina:
 Stable angina: The most common type and has a regular pattern. Attacks occur due to an obvious trigger
(such as exercise).Rest and medicines usually help.
 Unstable angina: More unpredictableand the most dangerous.Attacks occur without any obvious trigger
and continue despite resting or medicine. It is a sign that you could have a heart attack soon. If there is a
change in your usual pattern of angina and an attack lasts longer than expected, itmay be unsta ble
angina.Itis a medical emergency and should be admitted under hospital care.
 Variant angina: Rare. Attacks usually occur when you are resting.Medicines can help.

2. Many people with chest pain fear a heart attack. However, there aremany possiblecauses of chestpain.Any
organ or tissuein your chest can be the source of pain,includingyour heart (e.g. angina,pericarditis),lungs (e.g.
pulmonary embolism), oesophagus (e.g. gastroesophageal reflux),ribs (e.g. inflammation of ribs),muscles or
tendons (e.g. strain of muscleand tendons between the ribs),or nerves (e.g. shingles).Therefore, you should
consultyour doctor for a diagnosis if you havechest pain.
Treatment of angina
Treatment for angina aims to relieve the symptoms duringan angina attack,reduce the number of angina attacks
that a person has and reduce the risk of further complicationssuch as a heartattack or stroke. A number of
medications can be used to achieve these. Some of these areonly taken when needed, whileothers are taken
everyday. If the symptoms do not respond to medication, doctor may recommend surgery to widen or bypass the
narrowed arteries.
All the registered antianginal drugs in HongKong areavailablein oral dosageforms e.g. tablets, capsules and
sublingual spray. Some of them are also availablein injectableforms and transdermal patches.Most oral products
are prescription-only medicines (except glyceryl trinitratetablets and sublingual spray which arepharmacy-only
medicines) and should be administered strictly under doctor’s instruction and recommendation. On the other
hand, glyceryl trinitratepatch is a pharmacy-only medicine,whileits injection is an over-the-counter medicine.
Classification of oral antianginal drugs
Antianginal drugs areused to provideimmediate relief from symptoms and prevent angina attacks.If your risk of
havinga heart attack or stroke is high,itshould be possibleto reduce the risk by usinga combination of
medication and lifestylechanges.Guidelines recommend initial treatment with one or two antianginal drugs,plus
aspirin,possibly an angiotensin-convertingenzyme inhibitor,and a statin for secondary prevention of
cardiovasculardisease.
The antianginal drugs recommended for initial treatment are β-blockers and calciumchannel blockers,which
reduce myocardial ischaemia by heartrate reduction and vasodilatory mechanisms respectively.Your doctor will
usually prescribeeither or both of these drug classes,together with a shortactingnitratefor prompt alleviation of
angina attacks.However, if these drugs arenot tolerated, arecontraindicated,or fail to correct symptoms,
alternativeantianginal drugs areavailable,such as oral long-actingnitrates and newer antianginal drugs.
Immediate relief from symptoms
Short-actingnitrates: often used to treat angina.Nitrates relax and widen your blood vessels,allowingmoreblood
to flowto your heart muscle.The most common nitrate used to treat angina is glyceryl trinitrate(GTN) tablets (to
be put under your tongue).
Preventing angina attacks
1) β-blockers: make the heart beat slower with less force. That means the heart needs less blood and
oxygen after exercise, which can either prevent angina or reduce the frequency of attack. Examples
are propranolol,atenolol,metoprolol,carvedilol,etc.
2) Calcium channel blockers: relax the muscles that make up the walls of your arteries,increasingthe
blood supply to the heart. Examples are amlodipine,diltiazem,felodipine,nifedipine,verapamil,etc.

3. 3) Long-acting nitrates: action similarto GTN. Designed for the long-term prevention of symptoms.
Examples are extended releaseisosorbidedinitrateand isosorbidemononitrate.
4) Ivabradine: selectivesinus nodeIf inhibitor,with effect similarto β-blocker – slows down the speed
of your heart beat. Often used in patients unableto take β-blockers for medical reasons.
5) Trimetazidine: metabolic agent which maintains proper energy metabolismduringischaemia.
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