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Vasodilan (Isoxsuprine Hydrochloride)

After the long latent period that we mentioned earlier, coronary disease shows itself in three main ways: angina pectoris, heart attack, and sudden death.
The patient with angina pectoris has brief attacks of pain in the chest, arms or lower jaw. The pain tends to come on during exercise and relief comes rapidly when he or she rests. It may be brought on by other stresses such as anger, tension or exposure to cold. It is also more likely to occur after a heavy meal, and can be mistaken for indigestion.
All these situations which can bring on an anginal attack have one thing in common: they increase the work done by the heart. For the heart is a highly organized muscle which acts as a pump to circulate the blood; and whenever the amount of blood pumped by the heart increases, the heart muscle needs a greater supply of oxygen.
The heart muscle is nourished chiefly by blood reaching it through the two coronary arteries. These arteries carry blood to the walls of the heart. The blood itself carries oxygen and the main fuels, which are glucose and fatty acids. As this private supply of blood leaves the heart again, it carries away waste products such as carbon dioxide; at rest these are removed as fast as they are formed.
Healthy coronary arteries carry enough blood to meet the needs of the heart at rest and even during strenuous exercise. Even when heavy demands are made upon the heart, the flow of blood through the coronary arteries is sufficient to provide enough oxygen, glucose etc., and to remove the waste products formed by the heart muscle.
If the coronary arteries are narrowed by disease, there may still be sufficient flow of blood to nourish the heart during rest. But when the work of the heart is increased, as by exercise, the supply of blood through the damaged arteries is no longer sufficient to meet the greater needs of the heart muscle. In the part of the heart supplied by the narrowed coronary artery, lack of oxygen develops and waste products accumulate. This lack of blood supply is known as ischemia. When the heart muscle becomes ischemic its nerve endings are stimulated and pain signals are transmitted to the brain.
As soon as the patient rests, the work of the heart decreases and the flow of blood through the narrowed coronary artery becomes sufficient to meet its needs again. The heart muscle is no longer ischemic, and the pain stops.
What causes this narrowing of the coronary arteries? Several diseases can do this, but by far the commonest at present is the condition known as atherosclerosis (other terms are ‘arteriosclerosis’, ‘atheroma’ and ‘hardening of the arteries’). Less commonly, coronary arteries can go into spasm. This spasm can happen in apparently normal arteries, or in atherosclerotic ones, or those which have become narrowed by inflammation. And angina can be simulated by other conditions, such as irritation of the gullet (oesophagus), or pain in the muscles of the chest wall; so the diagnosis has to be confirmed by special tests.

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