Angina – Medical Disorders

Medical Disorders

Angina

How often do you experience symptoms of angina?

When did you have your last angina attack?
Has there been a change in the frequency of attacks?
How is the angina pain relieved?
To what extent does the angina restrict your activities?
Do you have spontaneous at rest chest pain?
What medications are you taking?

These questions will determine if the patient has stable angina or unstable angina. The patient’s overall medical stability greatly differs between these two conditions; therefore, a determination must be made as to which condition is present.

Angina can be classified according to Canadian Cardiovascular Society and the Braunwald Classification of Unstable Angina.

Effects of medications may include increased bleeding tendencies and gingival overgrowth.

Stable Angina

A type of ischemic artery disease that is characterized by episodes of chest pain that result from predictable amounts of exertion and stress, respond to rest within 10 minutes or to treatment with nitroglycerin, and have not recently (within 60 days) changed characteristics.

Stable angina follows a pattern that has been consistent for at least 2 months. That means the following factors have not changed:

Discomfort that feels like gas or indigestion.
Pain during physical exertion or mental stress.
Pain that spreads from your breastbone to your arms or back.
Pain that is relieved by medicines.
Pattern of symptoms that has not changed in the last 2 months.
Symptoms that go away within 5 minutes.

Unstable Angina

A type of ischemic artery disease that is characterized by episodes of chest pain that result from variable amounts of exertion and stress, do not always respond to rest within 10 minutes or to treatment with nitroglycerin, and have recently (within 60 days) changed characteristics (progressive severity and duration or new onset angina).

Unstable angina does not follow a pattern. It may be new or occur more often and be more severe than stable angina. Unstable angina can also occur with or without physical exertion. Rest or medicine may not relieve the pain.

Changes in your stable angina symptoms.
Pain that grows worse.
Pain that is not relieved by rest or medicines.
Pain that lasts longer than 20 minutes or goes away and then comes back.
Pain while you are resting or sleeping.
Severe pain.
Shortness of breath.

Unstable angina is a medical emergency, since it can progress to a heart attack. Medical attention may be needed right away to restore blood flow to the heart muscle.

⚠️ Unstable angina is a predictor for developing a heart attack. Do not provide elective dental care.

Microvascular angina

Microvascular angina is a sign of ischemic heart disease affecting the tiny arteries of the heart. Microvascular angina events can be stable or unstable. They can be more painful and last longer than other types of angina, and symptoms can occur during exercise or at rest. Medicine may not relieve symptoms of this type of angina.

Pain after physical or emotional stress
Pain that is not immediately relieved by medicines
Pain that lasts a long time
Pain that you feel while doing regular daily activities
Severe pain
Shortness of breath

Variant angina

Variant angina, also known as Prinzmetal’s angina, is rare. It occurs when a spasm—a sudden tightening of the muscles within the arteries of your heart—causes the angina rather than a blockage. This type of angina usually occurs while you are at rest, and the pain can be severe. It usually happens between midnight and early morning and in a pattern. Medicine can ease symptoms of variant angina.

Cold sweats
Fainting
Numbness or weakness of the left shoulder and upper arm
Pain that is relieved by medicines
Pain that occurs during rest or while sleeping
Pain that starts in the early morning hours
Severe pain
Vague pain with a feeling of pressure in the lower chest, perhaps spreading to the neck, jaw, or left shoulder

Complications associated with angina

Medical Disorders
Oral Health Care Considerations
- Angina
Classifications and Definitions
- Angina
- Coronary Artery Calcium (CAC) Score