Angina Pectoris

Definition

• Angina Pectoris: Chest pain or discomfort due to reduced blood flow to the heart, known as myocardial ischemia.
• Described as squeezing pain or heaviness, possibly spreading to neck, arms, shoulders, back, or stomach area.
• Women may experience burning or tenderness instead.
• Not the same as a heart attack, but increases risk.

Causes

• Mainly caused by narrowing of coronary arteries (cholesterol plaques or vessel spasms).
• Can also be caused by anemia (inadequate red blood cells to carry oxygen).

Types of Angina

Stable Angina

• Most common form.
• Caused by fixed obstruction (plaques).
• Predictable pain pattern, typically triggered by physical exertion.
• Offsets by factors like stress, cold, heavy meals, and subsides with rest/medication.

Unstable Angina

• Occurs unexpectedly, even at rest.
• More severe, lasts longer, unresponsive to rest/medication.
• Indicates plaque rupture or clot formation.
• Medical emergency; often precedes heart attack.

Microvascular Angina (Cardiac syndrome X)

• Occurs with normal coronary arteries but issues in tiny branches.
• More common in women.

Variant Angina (Prinzmetal Angina)

• Caused by vascular spasms of coronary arteries.
• Occurs during rest, typically at night.
• Triggered by stress, smoking, cocaine.
• Detected by ST-segment elevation during attacks.

Diagnosis

• Electrocardiograms show ST-segment depression during attacks.
• Stress tests and angiography used; microvascular angina may not show in angiograms.

Treatment

Goals

• Relieve symptoms.
• Reduce frequency and risk of heart attacks.

Options

• Lifestyle changes to modify risk factors.
• Medications:
  • Nitroglycerin: Acute attack relief.
  • Long-lasting nitrates.
  • Antiplatelet drugs (e.g., aspirin).
  • Beta-blockers.
  • Calcium channel blockers.
• Surgical Procedures:
  • Coronary Angioplasty: Balloons/stents to widen arteries.
  • Coronary Bypass: Graft creates an alternate blood flow route.