Saturday, February 21, 2009

Angina Pectoris

Definition
Angina pektoris is a clinical condition marked by malaise or
pain in the chest due to heart muscle iskemia network.
The clinical form of angina divided in two forms, namely stable angina and
not stable. Angina is an unstable form of a more serious that can be
become and / or is a form of early infark miokard so
people need to be examined further and observasi in the hospital.
Causes
Iskemia this happens because the oxygen supply brought about by coronary blood flow
inadequate oxygen miokardium needs. This occurs when the demand
oxygen miokardium increased (eg because of physical, emotional, tirotoksikosis,
hypertension), or when the coronary blood flow is reduced (for example, or on spasme
trombus coronary) or when both occur.
Clinical picture
- People complain of chest pain and various forms of location.
- Started as a painful feeling , feeling squeezed or feel the burn
spread to the inside of the left arm and sometimes up to the neck, shoulder
neck and left, even to the left pinkie.
- The can also spread to the shoulders, throat, jaw and teeth
also have to submit the right arm.
- Men do not feel can be felt also in the epigastrium, but rarely felt in the region
apeks kordis.
- Pain may be accompanied by pain or some of the following symptoms: sweating
cold, nausea, and vomiting, feeling faint, feeling the pulse and fainting (fainting).
- Angina usually arise when performing physical activity (stable angina).
- This attack will be lost when people stop physical activity is
and rest.
- The attack lasted only a few minutes (1 - 5 minutes) but can be up to
more than 20 minutes.
- Angina pain is constant. When changes occur, for example long
attacks increased, more intense pain, the incidence of threshold

- Decreased or when the attack came up to bed, then the interference is necessary to
a. This change attention may be a sign prainfark (angina not
stable).
- A form of change (variant) angina called Prinzmetal usually arise
when people are resting.
- Angina said gain weight when the attack occurred after the next
physical work that is lighter, for example, after eating. This is also classified
unstable angina.
- Check out the physical attack does not generally show a deviation
means. At the time of attacks, increased heart rate, blood pressure
increased in the region and the heart feels prekordium hard bop.
- On auskultasi, sound heart sounds far away, heard the loud sistolik
mid or late sistol and heard the sound of the fourth.
- Usually found risk factors: hypertension, diabetes or melitus Obesity.
Diagnosis
- Retrosternal chest pain
- Checking EKG
Treatment
- Deviation preference angina pektoris be searched, then
reduced or treated. Factors that make such as smoking, body weight
excessive, and coffee drinking habits should be avoided.
- High blood pressure treated.
- Stress is
- Angina unstable should be treated in the hospital.
1. Treatment of acute
- Acute attacks with the rest in order to overcome the heart activity is reduced.
Vasodilator work to improve the provision of oxygen and reduce
oxygen consumption of the heart.
- Sublingual nitroglycerine 0.15 - 0.6 mg is very effective. Tablet can be
used several times each day without side effects except headaches.
When the tablet 1 may be repeated not help, but when repeated after 3
times symptoms do not diminish the possibility has occurred infark.
- Isosorbid dinitrat (ISDN) sublingual 2.5 - 5 mg can also be repeated
oral tablet or 5 - 30 mg.

2. Prevention of attacks
- Propranolol for angina pektoris effective because it can reduce the work
heart muscle so that the heart needs oxygen. Effect clinic
propranolol achieved when the heart rate in the rest 60 - 70
times / minute.
Initial dose: 20 mg 2 x day.
Maximum dose: 120 mg a day.
This medicine should not be used in angina Prinzmetal.
- Nitrate of old: ISDN oral tablet 10 - 20 mg 2 x day.
- Nifedipin 10 - 20 mg 4 x day,
diltiazem or 30 - 60mg x 3 a day,
verapamil or 40 - 80mg x 3 a day.
- Angina unstable: need special care.
- Angina variants: strong dilator: nitrate, calcium antagonis, prazosin 0.5 - 1mg
3 x per day with titrasi.