Angina Pectoris
Overview of Angina Pectoris
Angina pectoris refers to a recurring chest pain or discomfort that happens as a result of myocardial (heart muscle) ischemia (
restriction in blood supply) caused by an imbalance between myocardial blood supply and oxygen demand. Angina is a symptom of coronary heart disease (CHD), which occurs when arteries (that carry blood to the heart) become narrowed and blocked due to atherosclerosis (deposition of fat along the walls of arteries).
The American Heart Association (AHA) had estimated (in a 2004 update) that 6.8 million Americans suffer from angina and about 400,000 new patients present with stable angina every year.1 Angina significantly affects more women than men, both in total numbers and as an age-adjusted percentage.1 The chest pain may be provoked by an activity or exercise or any other physical or mental stress, which increases the heart’s demand for blood. Diagnosis and assessment of angina involve clinical assessment, laboratory tests and specific cardiac investigations.
The treatment of angina and CHD has changed significantly over the past few years owing to improvements in surgical and medical modalities of improving blood flow to the myocardium. The optimal treatment plan involves a number of strategies and should be tailored according to patients’ age, presence of concomitant medical disorders, lifestyle, side-effects of the medication and the risks of procedures.2 With proper management, the symptoms can usually be controlled and the prognosis substantially improved.
Pathophysiology (How Angina Pectoris Developes )
Angina can result from the following:
- Decrease in myocardial blood supply due to increased coronary resistance in large and small coronary arteries as a consequence of the following:
- Presence of substantial atherosclerotic lesion in the large coronary arteries with at least a 50% reduction in arterial diameter.
- Coronary spasm (Prinzmetal’s angina).
- Abnormal constriction of vessels due to vascular disease.
- Systemic inflammatory or collagen vascular disease such as scleroderma, systemic lupus erythematous or polyarteritis nodosa.
- Reduction in the oxygen-carrying capacity of blood as in severe anemia (hemoglobin <8 g/dL).
- Congenital anomalies of the major epicardial coronary arteries.
- Structural abnormalities of the coronary arteries.
Risk Factors for Angina Pectoris
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Symptoms of Angina Pectoris
Symptoms of angina may or may not disappear when the patient is at rest. The patient may have the typical chest pain, which radiates to the left side of the shoulder, arm, jaw and back. This radiation of pain is because of the close
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Evaluation and Diagnosis of Angina Pectoris
Diagnosis and assessment of angina involve clinical assessment, laboratory tests and specific cardiac investigations. In the majority of cases, it is possible to make a sure diagnosis based on the history alone, although physical
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Management of Angina Pectoris
The management of angina requires a thorough approachto the patient and his/her family including attention to the emotional aspectsof the illness. Comprehensive risk stratification should be conducted with specific attention
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Written by: Healthplus24 team
Date last updated : February 09, 2010