CBSE AFFILIATION NO: 1930859

SCHOOL CODE: 55771 SUBJECT CODE: 044

ANGINA PECTORIS
BIOLOGY INVESTIGATORY PROJECT

ACADEMIC SESSION 2024 – 2025

SUBMITTED BY

_______________________________________________

REGISTER NUMBER:______________________

SUBMITTED TO

MRS. I. KANITHA CHRISTY

(BIOLOGY FACULTY)

SRI CHAITANYA TECHNO SCHOOL

SALEM - 636004

TAMIL NADU
 CERTIFICATE

This is to certify that ______________________________________________

Reg No: __________________ student of class 12 (Science) has

successfully completed his/her project work under the guidance of

subject teacher Mrs.KANITHA CHRISTY.I during the year 2024-2025

from SRI CHAITANYA TECHNO SCHOOL in partial fulfillment of

BIOLOGY practical examination conducted by CBSE.

INTERNAL EXAMINER EXTERNAL EXAMINER

PRINCIPAL
 ACKNOWLEDGEMENT
I am overwhelmed in all humbleness and gratefulness to

acknowledge my indebtedness to my family and friends who helped me put

these ideas together.

Our esteemed Principal Dr. S. Dhanasekaran, for fostering an

environment of learning and creativity within our school.

I would like to convey my heartfelt gratitude to

Mrs. Kanitha Christy for her tremendous support and assistance in the

completion of my project.

To my parents, their constant encouragement, patience, and

understanding have been the pillars of my success.

I am grateful to my friends who contributed ideas and perspectives

that enriched the project. Thank you everyone for shaping this project and

enhancing my learning experience.

 ABSTRACT
 MAIN SYMPTOMS
 THE MAJOR TYPES
 MAJOR RISK FACTORS
 CONDITIONS THAT EXACERBATE OR PROVOKE ANGINA
 OTHER MEDICAL PROBLEMS
 A MAJOR CAUSE: CORONARY ARTERY DISEASE
 WHY IS IT IMPORTANT TO ESTABLISH DIAGNOSIS?
 DIAGNOSIS
 TREATMENT
 CONCLUSION
 REFERENCE
 ANGINA PECTORIS

Abstract
Angina pectoris, commonly known as angina, is chest pain due to ischemia
(a lack of blood, thus a lack of oxygen supply and waste removal) of the heart
muscle, generally due to obstruction or spasm of the coronary arteries (the
heart's blood vessels). Coronary artery disease, the main cause of angina, is due
to atherosclerosis of the coronary arteries There is a weak relationship between
severity of pain and degree of oxygen deprivation in the heart muscle (i.e., there
can be severe pain with little or no risk of a heart attack, and a heart attack can
occur without pain). Worsening angina attacks, sudden-onset angina at rest, and
angina lasting more than 15 minutes are symptoms of unstable angina (usually
grouped with similar conditions as the acute coronary syndrome). As these may
herald myocardial infarction (a heart attack), they require urgent medical
attention and are generally treated as a presumed heart attack.
Main Symptoms
Angina is chest discomfort that occurs when there is decreased blood
oxygen supply to an area of the heart muscle. In most cases, the lack of blood
supply is due to a narrowing of the coronary arteries as a result of
arteriosclerosis.
Angina is usually felt as:
 pressure,
 heaviness,
 tightening,
 squeezing,
 Aching across the chest, particularly behind the breastbone.
This pain often radiates to the neck, jaw, arms, back, or even the teeth.
Patients may also suffer:
 indigestion,
 heartburn,
 weakness,
 sweating,
 nausea,
 cramping, and
 Shortness of breath.

Angina usually occurs during exertion, severe emotional stress, or after a

heavy meal, when the heart muscle demands more blood oxygen than the
narrowed coronary arteries can deliver. Angina typically lasts from 1 to 15
minutes and is relieved by rest or by placing a nitroglycerin tablet under the
tongue, which relaxes the blood vessels and lowers blood pressure. Both rest and
nitroglycerin decrease the heart muscles demand for oxygen, relieving angina
THE MAJOR TYPES:
1. Stable angina
2. Unstable angina
3. Microvascular angina
1. Stable Angina:
Stable angina is the most common type of angina, and what most people
mean when they refer to angina. People with stable angina have angina
symptoms on a regular basis and the symptoms are somewhat predictable (for
example, walking up a flight of steps causes’ chest pain). For most patients,
symptoms occur during exertion and commonly last less than five minutes. They
are relieved by rest or medication, such as nitroglycerin under the tongue. Stable
angina is one of many causes of chronic chest pain.
2. Unstable Angina:
Unstable angina is less common but more serious. The symptoms are more
severe and less predictable than the pattern of stable angina. Pain is more
frequent, lasts longer, occurs at rest, and is not relieved by nitroglycerin under
the tongue (or the patient needs to use more nitroglycerin than usual). Unstable
angina is not the same as a heart attack, but warrants an immediate visit to your
physician or hospital emergency department as further cardiac testing is urgently
needed. Unstable angina is often a precursor to a heart attack.
3. Microvascular Angina:
Microvascular Angina or Angina Syndrome X is characterized by angina-like
chest pain, but has different causes. The cause of Microvascular Angina is
unknown, but it appears to be the result of poor function in the tiny blood
vessels of the heart, arms and legs. Since Microvascular angina isn't
characterized by arterial blockages, it's harder to recognize and diagnose, but its
prognosis is excellent.
MAJOR RISK FACTORS:
 Age (≥ 55 years for men, ≥ 65 for women)
 Cigarette smoking
 Diabetes mellitus (DM)
 Dyslipidemia
 Family History of premature Cardiovascular Disease (men <55 years, female
<65 years old)
 Hypertension (HTN)
 Kidney disease (microalbuminuria or GFR<60 mL/min)
 Obesity (BMI ≥ 30 kg/m2)
 Physical inactivity
CONDITIONS THAT EXACERBATE OR PROVOKE ANGINA
 Medications
 Vasodilators
 Excessive thyroid replacement
 Vasoconstrictors
 Polycythemia which thickens the blood causing it to slow its flow through the
heart muscle
One study found that smokers with coronary artery disease had a
significantly increased level of sympathetic nerve activity when compared to those
without. This is in addition to increases in blood pressure, heart rate and
peripheral vascular resistance associated with nicotine which may lead to
recurrent angina attacks. Additionally, CDC reports that the risk of CHD
(Coronary heart disease), stroke, and PVD (Peripheral vascular disease) is
reduced within 1–2 years of smoking cessation. In another study, it was found
that after one year, the prevalence of angina in smoking men under 60 after an
initial attack was 40% less in those who had quit smoking compared to those
who continued. Studies have found that there are short term and long term
benefits to smoking cessation.
OTHER MEDICAL PROBLEMS
 profound anemia
 uncontrolled HTN
 hyperthyroidism
 hypoxemia
Other cardiac problems
 tachyarrhythmia
 bradyarrhythmia
 valvular heart disease
 hypertrophic cardiomyopathy
A MAJOR CAUSE: CORONARY ARTERY DISEASE
Coronary arteries supply oxygenated blood to the heart muscle. Coronary
artery disease develops as cholesterol is deposited in the artery wall, causing the
formation of a hard, thick substance called cholesterol plaque. The accumulation
of cholesterol plaque over time causes narrowing of the coronary arteries, a
process called arteriosclerosis. Arteriosclerosis can be accelerated by smoking,
high blood pressure, elevated cholesterol, and diabetes. When coronary arteries
become narrowed by more than 50% to 70%, they may no longer be able to meet
the increased blood oxygen demand by the heart muscle during exercise or stress.
Lack of oxygen to the heart muscle causes chest pain (angina).

WHY IS IT IMPORTANT TO ESTABLISH DIAGNOSIS?

Angina is usually a warning sign of the presence of significant coronary
artery disease. Patients with angina are at risk of developing a heart attack
(myocardial infarction). A heart attack is the death of heart muscle precipitated
by the complete blockage of a diseased coronary artery by a blood clot.
During angina, the lack of oxygen (ischemia) to the heart muscle is temporary
and reversible. The lack of oxygen to the heart muscle resolves and the chest
pain disappears when the patient rests or takes nitroglycerin. In contrast, the
muscle damage in a heart attack may be permanent, if there is a delay in
obtaining emergency treatment. The dead muscle turns into scar tissue when
healed. A scarred heart that results from a heart attack cannot pump blood as
efficiently as a normal heart, and can lead to heart failure. Many patients with
significant coronary artery disease have no symptoms at all, even though they
clearly lack adequate blood and oxygen supply to the heart muscle. These
patients have "silent" angina. They have the same risk of heart attack as those
with symptoms of angina.
DIAGNOSIS
The electrocardiogram (EKG or ECG) is a recording of the electrical activity
of the heart muscle, and can detect heart muscle which is in need of oxygen. The
EKG is useful in showing changes caused by inadequate oxygenation of the heart
muscle or a heart attack.
1. Exercise stress test
In patients with a normal resting EKG, exercise treadmill or bicycle testing
can be useful screening tools for coronary artery disease. During an exercise
stress test (also referred to as stress test, exercise electrocardiogram, graded
exercise treadmill test, or stress ECG), EKG recordings of the heart are performed
continuously as the patient walks on a treadmill or pedals on a stationary bike at
increasing levels of difficulty. The occurrence of chest pain during exercise can be
correlated with changes on the EKG, which demonstrates the lack of oxygen to
the heart muscle.
When the patient rests, the angina and the changes on the EKG which
indicate lack of oxygen to the heart can both disappear. The accuracy of exercise
stress tests in the diagnosis of significant coronary artery disease is 60% to 70%.
If the exercise stress test does not show signs of coronary artery disease, a
nuclear agent (thallium or cardiolyte) can be given intravenously during the test.
The addition of thallium or cardiolyte allows nuclear imaging of blood flow to
different regions of the heart, using an external camera. A reduced blood flow in
an area of the heart during exercise, with normal blood flow to the area at rest,
signifies significant artery narrowing in that region of the heart.
2. Stress echocardiography
Stress echocardiography combines echocardiography (ultrasound imaging
of the heart muscle) with exercise stress testing. Like the exercise thallium test,
stress echocardiography is more accurate than an exercise stress test in
detecting coronary artery disease. When a coronary artery is significantly
narrowed, the heart muscle supplied by this artery does not contract as well as
the rest of the heart muscle during exercise. Abnormalities in muscle contraction
can be detected by echocardiography. Stress echocardiography and thallium
stress tests are both about 85% to 90% accurate in detecting significant coronary
artery disease. When a patient cannot undergo exercise stress test because of
neurological or orthopedic difficulties, medications can be injected intravenously
to simulate the stress on the heart normally brought on by exercise. Heart
imaging can be performed with a nuclear camera or echocardiography.
3. Cardiac catheterization
Cardiac catheterization with angiography (coronary arteriography) is a
technique that allows X-ray pictures to be taken of the coronary arteries. It is the
most accurate test to detect coronary artery narrowing. Small hollow plastic
tubes (catheters) are advanced under X-ray guidance to the openings of the
coronary arteries. Iodine contrast "dye" is injected into the arteries while an X-ray
video is recorded. Coronary arteriography gives the doctor a picture of the
location and severity of coronary artery disease. This information can be
important in helping doctors’ select treatment options.
4. CT coronary angiogram
CT coronary angiography is procedure that uses an intravenous dye that
contains iodine, and CT scanning to image the coronary arteries. While the use of
catheters is not necessary (this procedure is considered "noninvasive"), there are
still some risks involved, including: patients allergic to iodine; patients with
abnormal kidney function; and Radiation exposure which is similar to, or greater
than, that received with a conventional coronary angiogram.
TREATMENT
The most specific medicine to treat angina is nitroglycerin. It is a potent
vasodilator that makes more oxygen available to the heart muscle. Beta-blockers
and calcium channel blockers act to decrease the heart's workload, and thus its
requirement for oxygen. Nitroglycerin should not be given if certain inhibitors
such as Sildenafil (Viagra), Tadalafil (Cialis), or Vardenafil (Levitra) have been
taken within the previous 12 hours as the combination of the two could cause a
serious drop in blood pressure. Treatments are balloon angioplasty, in which the
balloon is inserted at the end of a catheter and inflated to widen the arterial
lumen. Stents to maintain the arterial widening are often used at the same time.
Surgery involves bypassing constricted arteries with venous grafts. This is much
more invasive than angioplasty.
 The main goals of treatment in angina pectoris are relief of symptoms,
slowing progression of the disease, and reduction of future events, especially
heart attacks and, of course, death. Beta blockers (e.g., carvedilol, propranolol,
atenolol) have a large body of evidence in morbidity and mortality benefits (fewer
symptoms, less disability and longer life) and short-acting nitroglycerin
medications have been used since 1879 for symptomatic relief of angina. Calcium
channel blockers (such as nifedipine (Adalat) and amlodipine), isosorbide
mononitrate and nicorandil are vasodilators commonly used in chronic stable
angina. A new therapeutic class, called if inhibitor, has recently been made
available: ivabradine provides pure heart rate reduction leading to major anti-
ischemic and antianginal efficacy.
Low-dose aspirin decreases the risk of heart attack in patients with chronic
stable angina, and was previously part of standard treatment; however, it has
since been discovered that the increase in haemorrhagic stroke and
gastrointestinal bleeding offsets this gain so they are no longer advised unless
the risk of myocardial infarction is very high. Exercise is also a very good long
term treatment for the angina (but only particular regimens - gentle and
sustained exercise rather than intense short bursts), probably working by
complex mechanisms such as improving blood pressure and promoting coronary
artery collateralisation.
CONCLUSION:
Angina pectoris is a chest pain caused by decrease oxygen supply to the
heart muscle .ECG ,stress test and blood test are important in the diagnosis of
angina .It is managed with rest, medication and surgery.

REFERENCE
 www.wikipedia.com
 www.medscape.com
 www.emedicinehealth.com
 www.medicinenet.com
 Angina pectoris by Alice Gallo, Margaret L. Jones