Angina And The Throat

What Can Cause Throat Pain?

The throat can get infected by either bacteria, fungi or viruses, injured through physical trauma or eroded by gastric acid through reflux and therefore, can experience some kind of pain. A sore throat is the major source of throat pain.

Pharyngitis, which is the inflammation of the pharynx (wind pipe), that is caused by both virus and bacteria. Most of the time, throat pain and pharyngitis are not so distinguishable from each other as both present similar symptoms.

The majority of pharyngitis episodes are caused by viruses. [1] The viruses implicated include but are not limited to influenza virus, parainfluenza virus, rhinovirus, coronavirus, Epstein Barr virus (EBV), adenovirus, enterovirus and so on.

Streptococci species, Fusobacterium necrophorum, Arcanobacterium haemolyticum, Chlamydia, Gonococcal and so on are the bacterias implicated in sore throat.

Smoking of any type can also result in irritation of the throat. Accidental ingestion of very hot food or even bone from food can cause a trauma in the throat that would result in pain. An accurate diagnosis is often required to be able to initiate appropriate treatment which would address the underlying cause. 

What is Angina Pectoris?

Angina pectoris is the clinical manifestation of Ischemic Heart Disease. It is the discomfort that is experienced by the heart when the heart muscles are deprived of oxygen supply.[2]. This discomfort can manifest as pain in the chest, jaw, shoulder, back or arms and is usually increased by exertion i.e., moderate to increased physical activity on which level it is classified.

Angina that is precipitated by jogging, cycling, cutting woods and other strenuous activities is called class I angina. Class II angina is precipitated by climbing a few stairs rapidly, taking a few jobs after meals and other little activities. Class III angina comes from the inability to perform little  physical activity while Class IV angina is the one that does not allow you to carry out any physical activity without discomfort.[2]. When the blood and oxygen supply to the heart is shortened, it results in ischemic heart disease (IHD). As the heart is continually deprived of blood supply, the oxygen supply to the heart is reduced as well since the blood transports oxygen in the system. When this happens, the heart muscle cells begin to die as a result of inadequate supply of these essential nutrients. When they die, it results in Myocardial infarction.

Inadequate blood and oxygen supply to the heart muscles can result from the narrowing of the blood vessels or total blockage of the blood vessels by plagues which is medically referred to as  Atherosclerosis.

Angina pectoris are usually seen in patients with coronary heart disease (CHD), hypertrophic Cardiomyopathy and uncontrolled hypertension.

Signs and Symptoms

Fatigue

Feeling of tiredness always is a symptom of angina. Since the oxygen supply to the heart muscle cells are deprived, the cells suffocate and become weak. This makes the person feel tired.

Aching

Sharp pain in the chest, shoulder, arm, backbone or even jaw are classified under the discomfort that comes with angina pectoris.

Burning

Burning sensation is one of the feelings gotten during angina

Dizziness

The person might be having the feeling of fainting

Feeling of fullness

The stomach tends to be full and distended. 

Discomfort

General body discomfort and irritation is part of the clinical manifestations of angina.

Difficulty swallowing

The angina pain and discomfort is increased when one tries to swallow.

e.g. Difficulty Swallowing

Causes and Risk Factors

As earlier stated, angina is caused by ischemic heart disease which results from decreased oxygen supply to the heart. Stable angina is triggered by physical activity and stress which goes away when one rests. It lasts for a few minutes and can be alleviated with sublingual nitroglycerin.

Unstable angina comes when you are at rest or not engaged in any physical activity. It lasts for a longer time and the pain comes again and again.

The risk factors of angina include but are not limited to the following; Coronary heart disease, hypertension, diet, lifestyle like smoking and alcohol, hypertrophic cardiomyopathy, and so on.

What is Viral Angina?

Viral angina is caused by viral infection. It results in the inflammation of the tonsils called tonsillitis. Unlike the usual sore throat, the pain is more intense. 

Signs and Symptoms

The symptoms include; severe pain when swallowing, difficulty in swallowing, frequent salivation, weakness, headache, joint pain, and fever. Viral angina or viral pharyngitis starts with body weakness, muscle and joint pain, and irritation of the throat which would lead to incessant scratching and consequent soreness in the throat.

Treatment of viral angina is mostly supportive as the viral incubation period is short and mostly self-limiting. Home remedies like drinking hot water, and honey are good to alleviate the symptoms.

Causes and Risk Factors

The risk factors of viral angina are mainly being immunocompromised. This can result from taking immunosuppressive agents, chronic diseases like HIV, diabetes or even patients that underwent organ transplant. Children are also at a high risk of getting this disease since they have developing immune systems and are always in close contact with each other in school. The virus may be transmitted from breath, sharing of feeding materials, and handshake.

What is Bacterial Angina?

Bacterial angina is caused by bacteria infection of the pharynges. This results in severe sore throat and formation of pus. It hinders swallowing of hard foods.  

Signs and Symptoms

The symptoms of bacterial angina are rapid with severe inflammation of the pharynges. The fever is severe. Unlike viral angina, there is no runny nose or cough. 

Causes and Risk Factors

Mostly caused by streptococcus pyogenes and other bacterias. When left untreated, it can result in complications like purulent inflammation, otitis media, abscess, paranasal sinuses and immunological complications.

Diagnosis

Diagnosis of both viral and bacterial angina is based on the combination of the clinical manifestations presented by both and laboratory investigation of nasal or throat swabs to distinguish the viral from the bacterial. Laryngoscopy and full blood test can also be carried out. Physical examination of the throat, mouth and lymph nodes is also carried out.

Management and Treatment

Treatment of bacterial angina is usually with appropriate antibiotics following culture and sensitivity tests. Painkillers like ibuprofen and diclofenac are also used to alleviate pain. The fever is controlled using antipyretics like paracetamol. Home remedies like drinking of hot water, honey and eating of watery food is also recommended  for quick recovery. Lozenges are also used to alleviate symptoms. Improvement of the immune system using supplements rich in zinc, selenium, vitamin C and other essential components is another method to prevent viral and bacterial angina. 

Prevention

Oral hygiene should be maintained. Improve physical exercise as well.

Healthy nutrition consisting of vitamins and micronutrients would help boost the immune system. There should be immediate elimination of the oropharyngeal infection like sinusitis, cavities and otitis to prevent the spread and consequent migration to bacterial angina. Keep a long distance from an infected family or friend. Maintain  proper hygiene by washing your hands regularly.

When to See a Doctor

Viral angina should self-limit. After all the home remedies of drinking hot water, honey, improved diet, but symptoms persist, you should see a doctor. Do not self-medicate with. Antibiotics  must be taken from a doctor's prescription.

Summary

Angina is caused by a number of factors. Apart from the ischemic origin that results in angina pectoris, there is also angina  of infectious origin which can be caused by either virus or bacteria. The clinical manifestations of the angina of different origins differ, but the discomfort in the arm, joint, shoulder and back seems general. The angina that results from ischemia or CHD is divided into stable and unstable depending on the trigger and duration of discomfort. It could be alleviated with rest or sublingual nitroglycerin. In severe cases, treating the underlying causes would go a long way in alleviating the condition. Angina that is of infectious origin results in a sore throat which brings pain and discomfort. There is a great need to maintain good oral hygiene to prevent this. Home remedies should be initiated first when the symptoms are noticed. If symptoms persist after the application of the home remedies, you should see a doctor. Do not take antibiotics without a doctor's prescription.

References

  1. Tanz RR. Sore Throat. Nelson Pediatric Symptom-Based Diagnosis. 2018;1-14.e2.
  2. Ford TJ, Berry C. Angina: contemporary diagnosis and management. Heart. 2020 Mar 1;106(5):387–98.

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Valentine Okoye Chimezie

  1. This is an interesting and very resourceful article, I like the simplicity and the comprehensiveness. Thank you to the author Pharm. Okoye and thank you Klarity... Anticipate seeing more from this author

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