Cardiac Electrophysiology Consultants of South Texas, P.A.

Medical Center Tower I
7950 Floyd Curl Drive
Suite 803
San Antonio, TX 78229
tel: 210-615-9500
fax: 210-615-9600
email: office at
Specializing in the compassionate care of people who suffer from abnormalities of the electrical system of the heart Current Insurance Plans: We accept most major commercial insurance plans. Please call for details.
Medicare: We have opted out of Medicare, and are happy to care for Medicare beneficiaries on an affordable cash basis. Note: Federal law prohibits signing the Federally-mandated opt-out contract with a Medicare beneficiary who is in an emergency situation.
No insurance? No problem! Consider our affordable Fee for service (direct pay).
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General information about the heart for patients, their family members, and concerned laymen

  Angina Section Contents
Angina Pectoris
     The term "Angina pectoris" means "pain in the chest". It is actually not a good term for this condition because many patients with angina pectoris do not have pain. They often have a sensation of pressure, heaviness, burning, "gas", or squeezing in the chest area. Sometimes, the discomfort is not in the chest: it can be in the neck, the jaw on either or both sides, either shoulder, either arm, and/or either hand. When the discomfort is in the hands, it is often felt as a numbness. In all cases, however, angina pectoris results either from decreased blood supply to the heart, or an increase in blood demand by the heart that exceeds the supply available to it.

Angina pectoris, in its early stages, begins with exertion or strong emotion and ends when the exertion or strong emotion cease. It can also be relieved by nitroglycerin tablets or other medications that can improve blood supply to the heart. A curious phenomenon called "walk-through" angina can also occur. In this phenomenon, the anginal discomfort disappears even though the exercise or emotion continue.

The key points in dealing with angina pectoris are (1) to recognize that it is occuring (as opposed, for example, to acid indigestion, muscle strain, or arthritis in the chest wall), and (2) to evaluate whether it is "stable" or "unstable". Unstable angina is a medical emergency.

Unstable Angina
     "Angina" is a symptom that results from insufficient blood supply to the heart muscle. In the United States and in western Europe, this situation is often caused by blockages in the arteries that feed the heart muscle with blood (coronary artery stenoses due to atherosclerosis). Usually the blockages, or stenoses, develop slowly. For reasons that are unclear in 1996, however, they can become much more severe very quickly, creating "unstable" angina pectoris.

There are two basic ways that this happens. The first is that an atherosclerotic plaque (the material that blocks blood flow in the artery) suddenly becomes much larger because it "ruptures", or develops a crack in it that lets blood rush inside and expand its size. The second is that the clotting system becomes more active (again, for poorly understood reasons), and a blood clot forms on a previously existing tight stenosis. In either case, the blood flow through the affected artery is reduced suddenly.

If the reduction is complete (no blood gets through), heart muscle dies. This condition is called a "heart attack," or myocardial infarction (see below).

If the reduction is incomplete (some blood gets through), the patient develops angina that is unstable. New-onset angina is unstable when it occurs in patients who have never had anginal symptoms before. In patients who have had stable angina, the discomfort is more intense, more frequent, brought on by less effort, or different in character from the previously stable angina. Unstable angina is a medical emergency. About one of ten people with it go on to develop acute myocardial infarction. The adjective acute applies to situations that have just started and are at the most unstable stage. Acute myocardial infarction can cause lethal arrhythmias (sudden death) that, if treated promptly in a hospital, usually do not cause permanent harm. So, patients with unstable angina should be admitted promptly to the cardiology service in a hospital until it is clear whether or not their condition will progress to acute myocardial infarction.

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