by P. Bobby

Created on: February 04, 2009

Claudication is to PAD what angina is to Coronary Artery Disease.

How then does angina relate to coronary artery disease (CAD) - both clinically and pathologically?

Arteriosclerosis, hardening and narrowing of arteries, is the pre-eminent human disease of our time; narrowed vessels unable to allow the requisite blood flow - be it at rest or during exertion - of vital nutrients to organs. In oxygen-poor environs, our cells produce lactic acid, by a process of anaerobic (meaning no oxygen) metabolism. We feel this build up of lactic acid as a burning pain in our muscles when we over-exert. In the case of heart muscle starved of oxygen, this central chest pain usually felt as crushing', is angina. Angina is the cardinal symptom that the heart muscle is pleading for more oxygen. If this detrimental situation persists for more than several minutes, some heart muscle cells die. This is a heart attack. The severity of the attack' depends on which cells and how many die. It can vary from very mild to fatal, and all because of narrowing or blockage of an artery.

People with typical' angina find a consistency and pattern to their symptoms, with long periods of little or no variation. For example, one person may find only get angina if they walk briskly for 100 meters or so. Time and again, this is the approximate distance they walk before their angina starts. If they stop to rest, the angina gradually subsides and goes away within a few minutes. Furthermore, if they start up again, sure enough after about 100 meters, the angina returns.

Why is there this pattern to angina?

The pathology helps explain the clinical picture. A mildly narrowed coronary artery is usually able to supply enough blood to an organ at rest. However, during exertion, the increased metabolism of the organs such as the heart muscle requires a requisite increase in oxygen and nutrient supply and hence blood flow. If the narrowing of an average artery is more than 30% its original diameter, then the blood it supplies may be inadequate during exertion, even if adequate during rest. This explains the regular onset of angina, its relief by rest, and its recurrence with exertion again.

What is PAD anyway?

Someone with a history of heart attack however, does not only have coronary artery disease, though this is usually the most critical arteries to be involved with atherosclerosis. Almost universally, people with CAD have generalized, or Peripheral' artery disease (PAD). This includes the arteries in the neck

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