Angina pectoris is chest pain or discomfort caused by reduced blood flow to the heart muscle, typically due to coronary artery disease. It’s often a symptom of an underlying heart condition where the heart doesn't get enough oxygen-rich blood, especially during physical exertion or stress.
### Key Points:
- **Types**:
- **Stable angina**:
Predictable, triggered by exertion or stress, relieved by rest or
nitroglycerin. Usually brief (a few minutes).
- **Unstable
angina**: Unpredictable, occurs at rest or with minimal activity,
longer-lasting, and may signal a heart attack risk. Requires urgent medical
attention.
- **Variant
(Prinzmetal’s) angina**: Caused by coronary artery spasm, often at rest, and
can occur in people with less severe artery narrowing.
- **Microvascular
angina**: Due to dysfunction in the heart’s smaller blood vessels, often harder
to diagnose.
- **Symptoms**:
- Chest pain,
pressure, tightness, or a squeezing sensation.
- May radiate to the
arms, neck, jaw, shoulder, or back.
- Other symptoms:
shortness of breath, nausea, sweating, or fatigue (especially in women).
- **Causes**:
- Most common:
Atherosclerosis (plaque buildup in coronary arteries).
- Other factors: Coronary
spasms, anemia, or microvascular dysfunction.
- Risk factors: High
cholesterol, hypertension, smoking, diabetes, obesity, sedentary lifestyle,
family history of heart disease.
- **Diagnosis**:
- Electrocardiogram
(ECG or EKG).
- Stress testing
(treadmill or chemical stress test).
- Coronary
angiography or CT angiogram to visualize artery blockages.
- Blood tests to
check for heart damage markers (e.g., troponin).
- **Treatment**:
- **Lifestyle
changes**: Heart-healthy diet, regular exercise, smoking cessation, stress
management.
- **Medications**:
Nitroglycerin (for symptom relief), beta-blockers, statins, antiplatelets
(e.g., aspirin), or calcium channel blockers.
- **Procedures**:
Angioplasty with stent placement or coronary artery bypass grafting (CABG) for
severe cases.
- **Management of
risk factors**: Control blood pressure, cholesterol, and diabetes.
- **When to Seek Help**:
- Immediate medical
attention is needed for new, worsening, or prolonged chest pain (lasting
>10-15 minutes), as it could indicate a heart attack.
- Call emergency
services if pain is accompanied by shortness of breath, sweating, or nausea.
- **Prevention**:
- Maintain a healthy
weight, exercise regularly (30 min/day most days), eat a balanced diet (low in
saturated fats, high in fruits/vegetables).
- Avoid smoking and
limit alcohol.
- Regular check-ups
to monitor heart health, especially if risk factors are present.
If you’re asking about angina for yourself or someone else,
consult a healthcare provider for personalized evaluation, especially if
symptoms are present.
### Key Points
- Angina pectoris is chest pain or discomfort due to reduced
blood flow to the heart, often from coronary artery disease.
- It seems likely that types include stable, unstable,
variant, and microvascular angina, each with different triggers and severity.
- Research suggests symptoms are chest pain, pressure, or
tightness, sometimes radiating to arms or neck, often relieved by rest.
- The evidence leans toward causes being atherosclerosis,
artery spasms, or microvascular issues, with risk factors like high
cholesterol.
- Diagnosis typically involves ECG, stress tests, and
angiography, with recent guidelines emphasizing risk models for accuracy.
- Treatment may include lifestyle changes, medications like
nitroglycerin, and procedures like angioplasty, tailored to the type and
severity.
- Prevention focuses on managing risk factors, such as
exercise, diet, and quitting smoking, to reduce heart strain.
### Overview
Angina pectoris is a condition where the heart doesn’t get
enough oxygen-rich blood, leading to chest pain or discomfort. It’s often a
sign of underlying heart issues, like coronary artery disease, and can vary in
severity and type. If you experience symptoms, it’s important to consult a healthcare
provider for personalized advice, especially if pain is new or worsening.
### Types and Symptoms
There are different types of angina, such as stable
(predictable, during exertion, relieved by rest) and unstable (unpredictable,
potentially serious). Symptoms usually include a squeezing sensation in the
chest, which may spread to the arms, neck, or back, and can be accompanied by
shortness of breath or sweating.
### Diagnosis and Treatment
Doctors diagnose angina using tests like ECGs and stress tests,
with recent guidelines suggesting a risk factor-weighted model to assess
likelihood of disease. Treatment can range from lifestyle changes (like a
heart-healthy diet) to medications (such as beta-blockers) or procedures (like
stents) for severe cases, depending on the diagnosis.
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### Survey Note: Comprehensive Overview of Angina Pectoris
Angina pectoris, a medical condition characterized by chest
pain or discomfort due to reduced blood flow to the heart muscle, is primarily
associated with coronary artery disease (CAD).the understanding and management
of this condition have evolved, incorporating recent guidelines and research
findings. This section provides a detailed exploration of angina pectoris,
covering its types, symptoms, causes, diagnosis, treatment, and prevention,
with an emphasis on the latest updates.
#### Types of Angina Pectoris
Angina pectoris is classified into several subtypes based on
its presentation and underlying mechanisms:
- **Stable Angina**: The most common form, characterized by
predictable chest pain triggered by physical exertion or emotional stress. It
is typically relieved by rest or nitroglycerin and lasts a few minutes.
- **Unstable Angina**: A more severe and unpredictable type,
which can occur at rest or with minimal activity. It is considered a medical
emergency as it may signal an imminent heart attack, lasting longer than stable
angina episodes.
- **Variant (Prinzmetal’s) Angina**: Caused by coronary
artery spasms, often occurring at rest, and typically affecting individuals
with less severe artery narrowing. It is less common and can be associated with
ST-segment elevation on ECG.
- **Microvascular Angina**: Results from dysfunction in the
heart’s smaller blood vessels (microvasculature), which may not show
significant blockages on traditional tests. This type is often harder to diagnose
and manage.
The 2024 European Society of Cardiology (ESC) Guidelines for
Chronic Coronary Syndromes (CCS) highlight an expanded focus on angina with no
or non-obstructive coronary artery disease, termed ANOCA-INOCA, which includes
microvascular angina. This reflects a growing recognition of non-obstructive
causes in clinical practice.
#### Symptoms
The hallmark symptom of angina pectoris is chest pain or
discomfort, often described as:
- Pressure, tightness, or a squeezing sensation in the chest.
- Pain that may radiate to the arms (usually the left), neck,
jaw, shoulder, or back.
- Accompanying symptoms such as shortness of breath, nausea,
sweating, or fatigue, particularly noted in women.
Symptoms typically subside with rest or after taking nitroglycerin,
but persistent or worsening symptoms, especially if lasting more than 10-15
minutes, require immediate medical attention, as they may indicate a heart
attack.
#### Causes
Angina is primarily caused by an imbalance between myocardial
blood supply and oxygen demand, often due to:
- **Atherosclerosis**: The buildup of plaque in the coronary
arteries, narrowing them and reducing blood flow, is the most common cause.
- **Coronary Artery Spasms**: Temporary narrowing of the
arteries due to muscle spasms, as seen in variant angina.
- **Microvascular Dysfunction**: Issues with the smaller
blood vessels supplying the heart, leading to microvascular angina, which is
increasingly recognized in recent guidelines.
- **Other Contributing Factors**: Conditions like anemia,
hypertension, or thyroid disorders can exacerbate angina by increasing the
heart’s oxygen demand or reducing oxygen supply.
Risk factors for angina include high cholesterol,
hypertension, smoking, diabetes, obesity, a sedentary lifestyle, and a family
history of heart disease. The 2024 ESC Guidelines emphasize a risk
factor-weighted clinical likelihood model to estimate the probability of
obstructive CAD, enhancing diagnostic accuracy.
#### Diagnosis
Diagnosing angina involves a combination of clinical
evaluation and diagnostic tests:
- **Electrocardiogram (ECG/EKG)**: Detects abnormal heart
rhythms or signs of ischemia, such as ST-segment changes. However, it may be
normal in up to 50% of patients with stable angina.
- **Stress Testing**: Includes treadmill tests or chemical
stress tests (e.g., using dobutamine) to assess heart function under exertion,
revealing ischemia not apparent at rest.
- **Coronary Angiography or CT Angiogram**: Visualizes
blockages in the coronary arteries, with CT angiography being less invasive and
increasingly used for initial assessment.
- **Blood Tests**: Checks for markers of heart damage (e.g.,
troponin) to rule out a heart attack, especially in unstable angina.
- **Advanced Tests for INOCA/ANOCA**: Includes functional
tests like coronary flow reserve measurement or acetylcholine provocation
testing to evaluate microvascular dysfunction, as highlighted in recent
guidelines.
The 2024 ESC Guidelines recommend using a risk
factor-weighted model, incorporating age, sex, symptoms, and risk factors, to
estimate the pre-test likelihood of obstructive CAD. This approach reclassifies
more individuals into very low and low likelihood categories, potentially
reducing unnecessary testing. For patients with moderate or high pre-test
likelihood, an updated diagnostic algorithm is provided, emphasizing
personalized testing strategies.
#### Treatment
Treatment for angina aims to relieve symptoms, reduce the
risk of heart attack, and improve quality of life. It is tailored based on the
type and severity of angina and includes:
- **Lifestyle Changes**:
- Adopting a
heart-healthy diet low in saturated fats and high in fruits, vegetables, and
whole grains.
- Regular exercise,
such as at least 30 minutes most days, tailored to the patient’s capacity and
guided by a healthcare provider.
- Smoking cessation
and limiting alcohol intake to reduce cardiovascular risk.
- Stress management techniques, such as
mindfulness or counseling, to lower emotional triggers.
- **Medications**:
- **Nitroglycerin**:
Provides immediate relief by dilating blood vessels, often used as a sublingual
spray or tablet.
- **Beta-Blockers**:
Reduce heart rate and blood pressure, decreasing the heart’s oxygen demand
(e.g., metoprolol, atenolol).
- **Statins**: Lower
cholesterol to slow plaque buildup and stabilize existing plaques (e.g.,
atorvastatin, simvastatin).
- **Antiplatelet
Drugs**: Such as aspirin, to prevent blood clots and reduce the risk of heart
attack.
- **Calcium Channel
Blockers**: Relax blood vessels and reduce heart workload, particularly useful
in variant angina (e.g., amlodipine, diltiazem).
- **Ranolazine**:
Reduces chest pain by improving blood flow to the heart muscle, often used as
an add-on therapy.
- **Nicorandil**: A
potassium channel activator with nitrate-like effects, noted in the 2025 bpacnz
update for caution with concurrent use of NSAIDs and aspirin due to potential
interactions.
- **Procedures**:
- **Angioplasty and
Stent Placement**: For patients with significant artery blockages, to restore
blood flow.
- **Coronary Artery
Bypass Grafting (CABG)**: For severe or extensive blockages, creating new
pathways for blood flow around blocked arteries.
- **Management of INOCA/ANOCA**:
- Focuses on
addressing microvascular dysfunction with medications like beta-blockers,
calcium channel blockers, or ranolazine.
- Lifestyle
modifications are particularly emphasized, given the lack of obstructive
disease.
The 2025 bpacnz article, incorporating updated international
guidelines, provides evidence comparing revascularization (e.g., angioplasty or
CABG) with pharmacological treatment. The choice depends on the severity of
CAD, the presence of obstructive disease, and patient preferences, with a shift
toward personalized treatment plans.
#### Prevention
Preventing angina involves managing risk factors and adopting
heart-healthy habits:
- Maintain a healthy weight through balanced diet and regular
physical activity.
- Exercise regularly, aiming for at least 30 minutes most
days, with activities like walking, swimming, or cycling, as tolerated.
- Eat a diet low in saturated fats and high in fruits,
vegetables, and whole grains, such as the Mediterranean diet, to support heart
health.
- Avoid smoking and limit alcohol consumption to reduce
cardiovascular strain.
- Control blood pressure, cholesterol, and diabetes through
regular check-ups and medication if necessary.
- Manage stress through relaxation techniques or counseling
to lower emotional triggers for angina.
#### Latest Updates (2025)
The management of
angina pectoris has seen several updates:
- **Guidelines**: The 2024 ESC Guidelines for Chronic
Coronary Syndromes provide the current standard of care, with a focus on risk
stratification, diagnosing INOCA/ANOCA, and managing recurrent or refractory
angina. These guidelines incorporate a risk factor-weighted model for
estimating CAD likelihood, which helps tailor diagnostic and treatment
strategies.
- **INOCA/ANOCA Focus**: There is increased attention on
patients with angina but no obstructive CAD, as these cases are often
underdiagnosed and undertreated.
- **Medication Updates**: The 2025 bpacnz update highlights
the need for caution when using Nicorandil with NSAIDs and aspirin, due to
potential interactions, which is a critical consideration for patients on
multiple medications.
- **Comparative Evidence**: Recent studies and guidelines
provide evidence comparing revascularization with pharmacological treatment,
helping clinicians make informed decisions based on individual patient needs,
as reflected in the bpacnz article’s revision of the 2011 version to include
new sections on diagnosis, monitoring, and INOCA.
