Question

Why does angina occur and how can it be treated?

Answer

Angina occurs when the demands of the heart muscle for oxygen and other nutrients is greater than its blood supply can provide. The most common cause in an older person would be some atherosclerosis and therefore narrowing of the cardiac arteries. Excessive demand on the heart such as high blood pressure, a rapid pulse or valvular disease can also give rise to angina. Treatment depends firstly on lifestyle changes such as ceasing to smoke and control of weight. Regular daily exercise within the angina threshold is encouraged. Alcohol can be continued in moderation, but should not exceed more than 2 or 3 units per day.

There are many different drug treatments for angina, including the beta blockers (such as metoprolol). They are so good at treating angina because they reduce the heart rate and the force of contraction of the heart, both of which determine myocardial oxygen consumption, and they may also have other beneficial effects. However, all drug therapy has negative as well as positive effects. The main negative effect of beta blockade is that it can provoke left ventricular failure in a small group of people (the ventricle is a chamber of the heart). It may also precipitate asthmatic attacks in those who have a history of the condition, and it may worsen other problems such as intermittent claudication, which is pain in the legs when somebody walks.

Surgical treatment of narrowed arteries of the heart is extremely successful, but this decision requires very careful consideration of each person individually.

Links

• What is Angina and Coronary Artery Disease?