Angina Pectoris

Angina pectoris, commonly known as angina, is a medical condition characterized by chest pain or discomfort due to transient myocardial ischemia (reduced blood flow to the heart muscle). It is a symptom of coronary artery disease (CAD) and occurs when the heart muscle does not receive enough oxygen-rich blood.

Causes

The primary cause of angina pectoris is atherosclerosis, which is the buildup of plaque in the coronary arteries. This buildup narrows the arteries, reducing blood flow to the heart muscle and leading to ischemia. Other factors that can contribute to angina include:

• High blood pressure
• High cholesterol
• Smoking
• Diabetes
• Obesity
• Physical inactivity
• Family history of heart disease

Symptoms

The symptoms of angina pectoris can vary, but common characteristics include:

• Chest pain or discomfort (dull, squeezing, or pressure-like sensation)
• Pain or discomfort in the arms, back, neck, jaw, or stomach
• Shortness of breath
• Fatigue
• Lightheadedness or dizziness
• Sweating or nausea

Angina symptoms are often triggered by physical activity, emotional stress, or other factors that increase oxygen demand on the heart.

Types of Angina

There are several types of angina, including:

• Stable angina: The most common type, characterized by predictable and recurring episodes of chest pain or discomfort.
• Unstable angina: A more severe form, where the frequency, duration, or intensity of symptoms increases over time.
• Variant angina (Prinzmetal's angina): A rare type caused by coronary artery spasm, often occurring at rest and accompanied by ST-segment elevation on an electrocardiogram (ECG).
• Microvascular angina: A condition where the small blood vessels in the heart become narrowed or blocked, leading to chest pain.

Diagnosis

Diagnosing angina pectoris involves a combination of:

• Medical history: Assessing symptoms, risk factors, and family history.
• Physical examination: Checking blood pressure, heart rate, and listening to the heartbeat.
• Electrocardiogram (ECG): Recording the electrical activity of the heart to detect signs of ischemia or previous heart attacks.
• Stress test (exercise or pharmacological): Monitoring the heart's response to physical activity or medication-induced stress.
• Imaging tests: Such as echocardiography, cardiac catheterization, or coronary angiography to visualize the coronary arteries and assess blood flow.
• Blood tests: Measuring biomarkers like troponin or creatine kinase to detect heart damage.

Treatment

Treatment for angina pectoris focuses on reducing symptoms, slowing disease progression, and preventing complications. This may include:

• Lifestyle modifications: Quitting smoking, exercising regularly, maintaining a healthy weight, and managing stress.
• Medications: Nitrates (e.g., nitroglycerin), beta blockers, calcium channel blockers, antiplatelet agents (e.g., aspirin), and statins to lower cholesterol levels.
• Revascularization procedures: Such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) to restore blood flow to the heart muscle.
• Cardiac rehabilitation: A supervised program to improve cardiovascular health and reduce risk factors.

Complications and Prognosis

If left untreated or poorly managed, angina pectoris can lead to:

• Myocardial infarction (heart attack): Permanent damage to the heart muscle due to prolonged ischemia.
• Heart failure: The heart's inability to pump enough blood to meet the body's needs.
• Arrhythmias: Abnormal heart rhythms that can be life-threatening.
• Sudden cardiac death: Unexpected death due to a cardiac event.

The prognosis for angina pectoris varies depending on the severity of symptoms, underlying coronary artery disease, and response to treatment. With proper management and lifestyle modifications, many people with angina can lead active lives and reduce their risk of complications.