What is Angina Pectoris?

Angina pectoris is a clinical manifestation of ischemic heart disease (ischemic heart disease), characterized by chest pain or discomfort, which occurs when a part of the heart muscle (myocardium) does not receive enough oxygen. This imbalance between myocardial oxygen supply and demand is most often caused by narrowing or partial blockage of the coronary arteries (the blood vessels that supply the heart), a condition called coronary atherosclerosis.

Causes and Risk Factors

The main cause of angina pectoris is coronary atherosclerosis, but there may also be other rarer causes, such as coronary spasm (Prinzmetal's angina), microvascular dysfunction or severe valvular disease.

Risk factors include:

• Hypertension
• Diabetes mellitus
• Dyslipidemia (high cholesterol)
• Smoking
• Obesity
• Sedentarism
• Family history of cardiovascular disease
• Old age

Types of Angina Pectoris

• Stable angina: predictable pain, triggered by physical exertion or emotional distress and relieved by rest or nitroglycerin.
• Unstable angina: new, more frequent, more intense or resting pain, indicating worsening disease and an increased risk of myocardial infarction. It is a medical emergency.
• Prinzmetal's angina (vasospastic): pain caused by a temporary spasm of the coronary arteries, often occurs at rest and is usually relieved by nitroglycerin.

Symptom

Angina pain is typically described as a feeling of pressure, tightness, burning or heaviness in the chest, most often behind the breastbone. It can radiate to:

• Left arm (or both arms)
• Neck
• Mandible
• Shoulders
• Back
• Epigastrium (upper abdomen)

Other associated symptoms may include dyspnea (difficulty breathing), cold sweats, nausea, palpitations, dizziness or fatigue. The pain usually lasts for a few minutes (less than 20 minutes).

Diagnostics

The diagnosis of angina pectoris is based on:

• Anamnesis and physical examination
• Resting and/or exercise electrocardiogram (EKG)
• Stress test (stress ultrasound, stress myocardial scintigraphy)
• Blood tests (cardiac markers, lipid profile)
• Coronary angiography: the most accurate method to assess the degree of coronary artery stenosis.

Treatment

The goals of treatment are to relieve symptoms, prevent disease progression and reduce the risk of major cardiac events (heart attack, death). Treatment options include:

• Lifestyle changes: smoking cessation, healthy diet, regular exercise, maintaining an optimal weight.
• Medication: nitrates (to relieve acute symptoms), beta-blockers, calcium channel blockers, aspirin, statins (for risk factor control and prevention).
• Revascularization procedures:
  • Coronary angioplasty with stent (percutaneous, minimally invasive surgery).
  • Aorto-coronary bypass (open-heart surgery).