Aching hearts – anginas

Dear Dr. Mo: I’ve recently been diagnosed with a Prinz-Metal angina and I’ve been told this type is somewhat unusual – what does it mean? And what exactly is angina?

Dear reader: Angina is a clinical syndrome resulting from a transient reversible cardiac ischemia – this means that blood flow through the coronary artery to one part of the heart, carrying all important oxygen, temporarily and reversibly becomes dangerously low leaving that part of the heart undernourished and basically starving – we call that segment of the heart a vulnerable myocardium (myocardium means a heart muscle). Coronary arteries are the ones responsible for feeding the heart.

Clinical presentation of angina is a central chest discomfort or pain – less like a pain, much more like a weight or pressure at times also described as a burning sensation. This intense discomfort and/or pain may radiate to one or both arms, neck, jaw, epigastrium (upper part of the stomach), may not radiate at all or may be felt only in the area of radiation.

This anginal sensation occurs when current oxygen supply to the heart is less than the demand for it and the suffering undernourished (ischemic) heart muscle cries, which causes symptoms felt in angina.

When hearts cry – it’s angina

We say that a tissue is ischemic when the blood supply to it drops below a minimum required level to provide oxygen and other nutrients necessary for normal function. If ischemia is prolonged, and depending on the type of tissue and its oxygen demand, cells die and in some tissues like in the heart or the brain, these cells cannot be replaced.

Duration of each episode of discomfort and/or pain typically shouldn’t last for longer than maximum 20 minutes and it usually spans from anywhere between 15 seconds to 15 minutes.
I am saying that 20 minutes of duration is maximum time within which we are talking about angina because longer ischemia causes myocardial infarction (death of heart cells which is irreversible as these cells are lost).  Continue reading