Unstable angina, its management by lifestyle changes and angioplasty
Unstable angina (also referred to as Acute Coronary Syndrome) is a condition in which there is unexpected chest pain usually occurring at rest or minimal exertion. It usually lasts for more than 20 minutes unless treated with nitrotroglcerine. It also occurs in a crescendo pattern, more severe, prolonged or frequent than previously. It is mostly caused by reduced blood flow to the heart muscle because coronary arteries are narrowed by fatty build-up (atherosclerosis).
Unstable angina is actually caused by the rupture of the plaque of the coronary artery. The ruptured plaque causes partial blockage of the artery, which may take a stuttering pattern producing angina in an unpredictable fashion as the blood clot grows and shrinks. Unstable angina may lead to a heart attack and therefore it should be treated as an emergency.
Unlike typical angina, Prinzmetal angina, which is caused by a spasm of the coronary arteries, always occurs at rest usually between midnight and early morning. These attacks are very painful.
Unstable angina is suspected if one or more of the following is present.
1. Angina at rest especially lasting more than 20 minutes at a time
2. New onset angina which limits the ability of physical activity of the person
3. If there is an increase in episodes of previous stable angina, which are more frequent, longer lasting or occurring with lesser exertion.
On suspecting unstable angina, the person should contact urgently the doctor for confirmation of the diagnosis because of the seriousness of the condition.
Once the diagnosis of unstable angina is confirmed, it should be managed by life-style changes, drugs and surgery.
Management by life-style changes-
Since the underlying cause of unstable angina is heart disease, the efforts should be made to reduce the risk factors of the heart disease.
- Smoking- Quit smoking
- Lack of physical activity- Start a safe exercise plan with the help of your doctor. Walking is a safe exercise. Since angina is brought on by exertion, take breaks often while exercising.
- Diet- Take a healthy diet with plenty of vegetables, fruits and whole grains and limit the amount of saturated fats.
- Excess weight- Reduce the excess weight.
- Reduce stress- Reduce it by stress reduction techniques.
- Underlying diseases- Treat diseases like diabetes, high blood pressure or high cholesterol if present.
Angioplasty in unstable angina-
In cases of unstable angina, angioplasty may have to be performed to get the blood back to the heart. It is also called percutaneous coronary intervention (PTI) or percutaneous transluminal coronary angioplasty (PTCA). Angioplasty is done by using a thin soft catheter which is inserted into a blood vessel in the wrist or groin. The catheter is guided through the blood vessel until it reaches coronary arteries in the heart. To visualize the blockages in the coronary arteries, an iodine containing dye is injected which makes the arteries visible on the digital x-ray screen. This test is called coronary angiogram.
If there is a blockage, the catheter is moved to the narrowed part of the artery. A tiny balloon is moved through the catheter to open the artery. The balloon is inflated for a short time and then deflated and removed. This makes room for the blood to flow. The balloon is also used to place a stent in the artery to keep it open.
All stents carry a risk to form scar tissue which may narrow the artery again. To prevent this repeat blockage, drug-eluting stents are used which are coated with drugs that prevent the scar tissue from growing in the artery. Therefore, the drug eluting stents lower the chance of second angioplasty to open the artery again.
The coronary angioplasty for unstable angina can be performed with a high initial success rate and the prognosis is favorable after initial successful coronary angioplasty.