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Angina pectoris (Heart Chest Pain) in the Elderly

Angina pectoris (Heart Chest Pain) in the ElderlyThe heart is a muscular pump that never stops beating. It needs a constant supply of blood rich in oxygen and nutrients to continue functioning. When the blood flow to the heart is insufficient for its workload, the muscle is injured. It causes a type of crushing chest pain that comes with activity and eases with rest. This condition is known as angina pectoris. Usually there is no permanent damage to the heart muscle in angina pectoris. It is a prelude to a heart attack and can exist for months or years. When the blood supply to heart is compromised for long enough or to a severe degree then a portion of the heart muscle dies. This is known as a heart attack (myocardial infarction).

Causes of Angina Pectoris

Angina pectoris is a symptom of coronary artery disease (CAD). The coronary arteries carry blood to the heart muscle. It can become blocked mainly with the build up of fatty plaques in its wall (atherosclerosis). The blood flow is restricted but is sufficient to supply the heart with the oxygen it needs for normal daily activity. However, when a person undertakes strenuous physical activity the heart needs more blood. The partially obstructed arteries hampers the increased demand for blood, the heart muscle undergoes injury due to insufficient oxygen (ischemia) and results in pain.

There are three types of angina :

  1. Stable angina when the chest pain comes about with physical activity, stress, cold temperatures and overeating.
  2. Unstable angina where a blood clot suddenly blocks an already narrowed coronary artery.
  3. Variant angina where the muscles in the coronary artery walls go into spasm suddenly narrowing the artery.

Angina pectoris occurs for many of the same causes of a heart attack.

Signs and Symptoms

Angina pectoris is one of the common causes of chest pain in the elderly. In fact along with a heart attack, it should be suspected and first excluded when a senior presents with chest pain. The presentation of angina pectoris is almost the same as that of a heart attack with the main difference being that the pain eases with rest. This does not happen in a heart attack.

Apart from chest pain that may radiate down the arm, to the neck or jaw, shoulder or back, the other symptoms include :

  • Shortness of breath
  • Dizziness
  • Sweating
  • Nausea
  • Anxiety

The pain is also mistaken for heartburn which is due to acid reflux. This can be differentiated with the use of antacids that will relieve heartburn but not angina. Similarly a type of medication known as nitrates will relieve the angina but not heartburn.

Treatment of Angina Pectoris

Mild angina may not require the use of medication. It can be managed with lifestyle changes such as :

  • Stopping cigarette smoking.
  • Losing weight.
  • Switching to a low fat diet.
  • Reducing psychological and physical stress.
  • Moderating alcohol intake.

More severe cases needs to be managed with medication.

  • Nitrates widen the arteries thereby allowing for more blood to flow through.
  • Aspirin helps to prevent the formation of a blood clot that can totally occlude the artery.
  • Anti-hypertensives help return blood pressure and heart activity to a normal state.
  • Cholesterol-lowering drugs to prevent the formation of fatty plaques in the artery wall.

Surgical procedures can also help with angina in the following ways :

  • Angioplasty and stenting is where a thin tube is inserted into the coronary artery and a balloon is inflated to widen the artery. A small wire coil is inserted to keep the artery opened.
  • Bypass surgery where an alternative blood flow is established by grafting a new artery to bypass the obstructed artery.

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