Angina, also known as angina pectoris, is a medical condition characterized by chest pain or discomfort that occurs when the heart muscle does not receive enough blood and oxygen. The pain or discomfort may also be felt in the shoulders, arms, neck, jaw, or back.

There are different types of angina, including stable angina, unstable angina, variant (Prinzmetal’s) angina, and microvascular angina. Stable angina is the most common type and typically occurs during physical exertion or emotional stress, while unstable angina occurs unpredictably and may be a sign of a more serious underlying heart condition.

Angina is often caused by the narrowing or blockage of the coronary arteries, which supply blood to the heart muscle. Risk factors for angina include high blood pressure, high cholesterol, smoking, diabetes, obesity, and a family history of heart disease. Treatment for angina may involve lifestyle changes, such as a healthy diet and regular exercise, as well as medication or medical procedures to improve blood flow to the heart.

Definition

Angina, also known as angina pectoris, is a medical condition characterized by chest pain, pressure, or discomfort that occurs when the heart muscle does not receive enough blood and oxygen. The pain or discomfort may also be felt in the shoulders, arms, neck, jaw, or back. Angina is typically caused by the narrowing or blockage of the coronary arteries, which supply blood to the heart muscle. It can be classified into several types, including stable angina, unstable angina, variant (Prinzmetal’s) angina, and microvascular angina, based on their underlying causes and symptoms.

Pathophysiology

Angina occurs when there is a mismatch between the oxygen supply and demand of the heart muscle. The heart requires a constant supply of oxygen and nutrients to function properly, which are delivered by the coronary arteries. If the coronary arteries become narrowed or blocked due to a buildup of fatty deposits called plaque, the blood flow to the heart muscle is reduced, leading to ischemia (a lack of oxygen).

Ischemia triggers a series of physiological changes in the heart muscle that result in the symptoms of angina. The heart responds to ischemia by releasing chemical signals that cause pain, pressure, or discomfort in the chest and other parts of the body. The pain is often described as a squeezing or tightness sensation that may radiate to the arms, neck, jaw, or back.

The severity and duration of angina symptoms depend on the degree of blockage or narrowing in the coronary arteries and the level of physical or emotional stress. Stable angina occurs when there is a predictable pattern of symptoms that occur during physical exertion or emotional stress and resolve with rest or medication. Unstable angina is more serious and occurs unpredictably, even at rest, and may be a sign of an impending heart attack.

Etiology

The etiology of angina can be attributed to various factors that affect the coronary arteries, which supply oxygen and nutrients to the heart. Causes and contributing factors of angina include:

  1. Coronary Artery Disease (CAD): The most common cause of angina is CAD, also known as atherosclerosis. CAD occurs when the coronary arteries become narrowed or blocked due to the buildup of fatty deposits called plaques. These plaques restrict blood flow to the heart, leading to reduced oxygen supply and resulting in angina symptoms.
  2. Arterial Spasm: Angina can also be caused by the temporary constriction or spasm of the coronary arteries, which reduces blood flow to the heart muscle. This condition, known as variant angina or Prinzmetal’s angina, is often unrelated to atherosclerosis and can occur even in people with normal coronary arteries.
  3. Coronary Microvascular Disease: In some cases, the small blood vessels (microvasculature) within the heart may be affected, leading to inadequate blood flow despite the absence of significant blockages in the main coronary arteries. This condition is called coronary microvascular disease or microvascular angina and is more common in women.
  4. Emotional Stress: Emotional stress and anxiety can trigger angina symptoms in susceptible individuals. Stress hormones released during these periods can cause the coronary arteries to constrict, reducing blood flow to the heart and leading to angina.
  5. Physical Exertion: Physical activity or exertion can also provoke angina symptoms, especially in individuals with underlying coronary artery disease. The increased demand for oxygen by the heart during exercise may surpass the blood supply available through narrowed or blocked arteries, resulting in angina.

Risk Factors

  1. Age: The risk of developing angina increases with age, particularly in individuals over the age of 45 for men and over 55 for women.
  2. Gender: Men are more likely than women to develop angina, although the risk for women increases after menopause.
  3. Family History: A family history of heart disease increases the risk of developing angina.
  4. Smoking: Cigarette smoking and exposure to secondhand smoke can damage the lining of the blood vessels and increase the risk of developing angina.
  5. High Blood Pressure (Hypertension): High blood pressure can damage the blood vessels and increase the risk of developing angina.
  6. High Cholesterol (Hyperlipidemia): High levels of cholesterol can contribute to the build-up of plaque in the coronary arteries, increasing the risk of angina.
  7. Diabetes Mellitus: Diabetes can damage the blood vessels and increase the risk of developing angina.
  8. Obesity: Being overweight or obese increases the risk of developing angina.
  9. Sedentary Lifestyle: Lack of exercise and physical activity can increase the risk of developing angina.
  10. Stress: Emotional and physical stress can trigger angina episodes in individuals with underlying heart disease.

Signs & Symptoms

  1. Chest Pain or Discomfort: This is the most common symptom of angina and is usually described as a pressure or squeezing sensation in the chest. The pain may also be described as a tightness, heaviness, or burning sensation.
  2. Pain in Other Areas of the Body: In addition to chest pain, angina may also cause pain or discomfort in the arms, neck, jaw, shoulder, or back.
  3. Shortness of Breath: Angina can cause shortness of breath, especially during physical activity or exertion.
  4. Fatigue: Angina may cause fatigue or weakness, especially during physical activity.
  5. Nausea: Angina may cause nausea or vomiting, especially in women.
  6. Sweating: Angina may cause sweating or clammy skin, especially in women.
  7. Dizziness: Angina may cause dizziness or lightheadedness.

Types

  1. Stable Angina: This is the most common type of angina and is typically triggered by physical exertion or emotional stress. The symptoms of stable angina are usually predictable and may be relieved by rest or medication.
  2. Unstable Angina: Unstable angina is a more serious type of angina and can occur unpredictably, even at rest. The symptoms may be more severe and last longer than stable angina, and can be a sign of an impending heart attack.
  3. Variant (Prinzmetal’s) Angina: Variant angina occurs when the coronary artery spasms and reduces blood flow to the heart muscle, leading to angina symptoms. This type of angina is rare and usually occurs at rest, often during the night.
  4. Microvascular Angina: Microvascular angina occurs when the small blood vessels in the heart are damaged, leading to reduced blood flow to the heart muscle and angina symptoms. This type of angina is more common in women and may occur even in the absence of significant coronary artery disease.
  5. Silent Angina: Silent angina is a type of angina that does not cause any noticeable symptoms. This type of angina is more common in people with diabetes or in those who have had a previous heart attack.
  6. Nocturnal Angina: Nocturnal angina occurs during the night and can be a sign of unstable angina or variant angina.
  7. Postprandial Angina: Postprandial angina occurs after a meal and is usually associated with reduced blood flow to the heart due to increased demand for blood in the digestive system.
  8. Decubitus Angina: Decubitus angina occurs when lying down and is usually associated with reduced blood flow to the heart due to changes in blood pressure.

Diagnosis

The diagnosis of angina typically involves a combination of a medical history, physical examination, and diagnostic tests.

  1. Electrocardiogram (ECG): This test measures the electrical activity of the heart and can help identify abnormalities in heart rhythm or blood flow.
  2. Stress Test: A stress test involves exercising on a treadmill or stationary bike while being monitored with an ECG. This test can help identify changes in heart rhythm or blood flow that may be indicative of angina.
  3. Cardiac Catheterization: This invasive procedure involves inserting a catheter into the heart to measure blood flow and pressure, and to identify blockages or other abnormalities.
  4. Echocardiogram: This test uses ultrasound to create images of the heart and can help identify structural abnormalities or problems with blood flow.
  5. CT or MRI Angiography: These tests use advanced imaging techniques to create detailed images of the heart and blood vessels, and can help identify blockages or other abnormalities.
  6. Blood Tests: Blood tests can be used to measure cholesterol levels, blood sugar levels, and other factors that may contribute to the development of angina.

Treatment

The treatment of angina typically involves a combination of lifestyle changes, medications, and sometimes medical procedures. The goals of treatment are to reduce symptoms, prevent complications, and improve quality of life.

  1. Lifestyle Changes: This includes quitting smoking, maintaining a healthy weight, eating a healthy diet, getting regular exercise, and managing stress.
  2. Medications: Several medications may be used to treat angina, including nitrates, beta blockers, calcium channel blockers, and antiplatelet medications. These medications can help improve blood flow to the heart, reduce blood pressure, and reduce the workload of the heart.
  3. Medical Procedures: In some cases, medical procedures such as angioplasty, stenting, or coronary artery bypass grafting (CABG) may be necessary to restore blood flow to the heart and reduce symptoms of angina.
  4. Cardiac Rehabilitation: This is a structured exercise and education program that can help improve cardiovascular health and reduce symptoms of angina.
  5. Psychological Counselling: Counseling or therapy may be helpful for managing stress and anxiety, which can contribute to the development of angina.

Complications

  1. Heart Attack: A heart attack occurs when a blockage in a coronary artery completely cuts off blood flow to the heart muscle. This can cause permanent damage to the heart muscle and can be life-threatening.
  2. Arrhythmias: Angina can cause abnormal heart rhythms, including atrial fibrillation, ventricular tachycardia, and ventricular fibrillation, which can be life-threatening.
  3. Heart Failure: Over time, angina can weaken the heart muscle and lead to heart failure, which occurs when the heart cannot pump enough blood to meet the body’s needs.
  4. Stroke: Angina can increase the risk of blood clots forming in the heart, which can then travel to the brain and cause a stroke.
  5. Peripheral Artery Disease (Pad): Angina can also lead to the development of PAD, which occurs when there is a blockage in the blood vessels that supply blood to the arms and legs.

Prevention

There are several steps that can be taken to prevent angina or reduce the risk of developing complications from angina.

  1. Quitting Smoking: Smoking is a major risk factor for angina and other cardiovascular diseases. Quitting smoking can reduce the risk of developing angina and improve overall cardiovascular health.
  2. Eating a Healthy Diet: A diet that is low in saturated and trans fats, cholesterol, and sodium and high in fruits, vegetables, whole grains, and lean proteins can help reduce the risk of developing angina and other cardiovascular diseases.
  3. Maintaining a Healthy Weight: Being overweight or obese can increase the risk of developing angina and other cardiovascular diseases. Maintaining a healthy weight through a healthy diet and regular exercise can help reduce this risk.
  4. Exercising Regularly: Regular exercise can help improve cardiovascular health, reduce the risk of developing angina and other cardiovascular diseases, and improve overall health and well-being.
  5. Managing Stress: Stress can contribute to the development of angina and other cardiovascular diseases. Managing stress through relaxation techniques, exercise, and counselling can help reduce this risk.
  6. Controlling Underlying Health Conditions: Underlying health conditions such as high blood pressure, high cholesterol, and diabetes can increase the risk of developing angina and other cardiovascular diseases. Controlling these conditions through medication and lifestyle changes can help reduce this risk.

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