Angina
Angina or chest pain is a typical symptom associated with coronary artery disease. Angina is a sign that the heart is not getting sufficient blood flow. This is usually due to narrowing of the arteries (atherosclerosis. It can also be the result of extreme hypertension, hypertrophic cardiomyopathy or valvular heart disease. Stable angina ia a pain that occurs when there is extra load on the heart and occurs in a regular pattern. This type of angina pain can be tackled with medication and rest. On the other hand, unstable angina can be dangerous as it may the precursor to a heart attack. The pain in such a case is more prolonged and severe. Prinzmetal's angina or variant angina pectoris occurs due to transient spasm of the coronary artery. This does not get trigerred due to physical exertion.
The pain associated with angina is uncomfortable pressure and squeezing on the chest. There is pain or discomfort in the neck, shoulder and arms. But not all chest pains are signs of angina. ECG (electrocardiograph) helps in tracing heart activity. Exercise-ECG assesses your heart condition when you are on a treadmill. Beta-blocker drugs help prevent angina pain. Potassium channel blockers and calcium channel blockers aid in improving blood flow to the coronary arteries. Glyceryl Trinitrate or GTN tablets work instantaneously by relaxing blood vessels and easening the blood flow to the heart muscles. Aspirin is prescribed to reduce the probability of blood clots and reducing blood viscocity. Statin medicines are prescribed to reduce cholesterol levels. Angioplasty involves passing a tiny balloon into a large artery and then blowing it up inside to widen the artery. Bypass surgery is done to bypass the narrowed section of arteries and provide the heart with blood vessels that are not obstructed. Angina can be controlled with medication and lifestyle changes in diet and exercise.
- Quit smoking
- Control cholesterol levels
- Control blood pressure levels
- Regular exercise regimen
- Nutritious diet - low in fat, high in fibers, rich in fruits, vegetables and oily fish
- Maintain healthy body weight
Cardiac Catheterization
Cardiac catheterization is a test which is performed to obtain certain diagnostic information about the heart. Patients may require this medical therapy rather than undergo angioplasty or bypass surgery when they suffer from rare or easily controlled episodes of angina. Alternatively, cardiac catheterization is not performed in patients who have infrequent episodes of angina and in whom angina can be easily controlled. When a patient has heart failure due to suspected coronary artery disease or there is suspected coronary artery disease, cardiac catheterization is conducted. Cardiac catheterization can help:
- Measure blood pressure within heart.
- Know the amount of oxygen in the blood.
- Check the pumping ability of the heart muscle.
- Check blood flow through the heart after surgery.
- Collect blood samples from the heart.
- Inject dye into the coronary arteries.
- To provide treatment in certain types of heart conditions like congenital heart defects and how severe it is.
- To find out a coronary artery disease and if found to pinpoint the size and location of fat and calcium deposits that have built up in coronary artery from atherosclerosis.
- To determine whether the patient needs bypass surgery or angioplasty.
- Examine the arteries of the heart with an x-ray technique called fluoroscopy.
The patient is asked not to drink or eat anything, except a small amount of water, for atleast 6 to 12 hours before the test. The patient is tested for allergy to iodine or other medications. Patients suffering from kidney disease or diabetes or bleeding disorders must keep the cardiologist informed. The cardiac catheterization test is performed in a cath lab by a cardiologist. The actual catheterization procedure takes about 15 - 30 minutes. The patient's electrocardiogram that continuously records the electrical activity of the heart is taken.
A pulse oximeter device that measures the oxygen levels of the patients' blood is monitored. An intravenous needle is inserted into the patients' vein to give fluids or medicine during the catheterization procedure. A sedative is also given through this IV line which helps the patient to relax.
Cardiac catheterization procedure involves passing a catheter, a thin flexible tube, into the right or left side of the heart. The doctor inserts this thin plastic tube into the groin - femoral artery. Other places where in the catheter may be inserted are the elbow- brachial artery or the wrist - radial artery. From there it is slowly advanced into the chambers of the heart or into the coronary arteries. The doctor watches the progress of the catheter into the heart's vessels and chambers on the imaging screen. Pressures within the heart chambers are measured and the blood and tissue samples are also removed through the catheter. A small amount of dye is also injected through the catheter into the heart chamber or into one of the coronary arteries.
Therapeutic catheterization: Certain types of heart defects can be repaired using catheterization. For instance, if the coronary arteries are blocked, the cardiologist can use a catheter, guide wire and balloon to open and improve blood flow to the heart. This is termed as percutaneous coronary intervention (PCI).
Normal result indicate that there is no significant narrowing or blockage in the coronary arteries. Abnormal results may suggest that the heart does not pump blood normally or the valves in the heart may be weak. There may be leakage between heart chambers. There is a possibility of aortic aneurysm. Some complications with cardiac catheterization include heart attack or stroke, hematoma, puncture of the heart or arrhthmias.
Sumatriptan
Sumatriptan, part of the family of drugs called as triptans is prescribed for the treatment of Migraine and cluster headaches. Migraine headaches are thought to be the result of dilation of blood vessels in the head. Sumatriptan causes constriction of the blood vessels thus relieving Migraine. Triptans are technically abortive migraine medications. However, Sumatriptan does not prevent or reduce the number of migraine attacks. There is another 'triptan' drug which has slightly less side effects than Sumatriptan - Rizatriptan.
Dosage and Administration: Starting dosage may be 25 mg or at the discretion of the physician. However, the Physician might want the patient to take the first dosage at his office to monitor any adverse heart events. Normal dosage is 25 mg to 100 mg or as prescribed by the Physician. Maximum dose in any 24 hours should not exceed 300 mg orally. Do not use Sumatriptan concomitantly with Ergotamine containing preparations.
Safety and efficacy has not been proved for patients over 65 years or for children.
Contraindications: The use of Sumatriptan is contraindicated in hypersensitivity, ischemic heart disease or previous myocardial infraction, Prinzmetal's angina, coronary vasospasm and controlled hyper tension. Sumatriptan should not be used unless there is a clear diagnosis of Migraine. Before use, exclude underlying cardiac disease especially in patients with risk factors. Chest symptoms may occur which mimic angina but are rarely found to be the result of vasospasm. Vasospasm may result in arrhythmia, ischemia or myocardial infarction. This drug is to be avoided for patients with impaired renal or hepatic functions.
Sumatriptan should not be administered along with ergot type migraine medications, or with MAO inhibitors. Sumatriptan and Ergotamine together can cause prolonged spasm of the blood vessels. It is essential that the use of these two medications should be separated by at least 24 hours.
Side Effects of Sumatriptan: Pain, tingling sensation, heaviness or pressure in the chest region which may be transient. Rarely severe flushing, dizziness, paresthesia, weakness, fatigue, drowsiness may occur. Transient rise in blood pressure may occur.
Bibliography / Reference
| 