Angina pectoris: Types, Causes, Symptoms, Treatment-NotesMed

What is angina pectoris?

Angina pectoris is a medical term in which a type of ischemic heart disease characterized by the sudden occurrence of intermittent chest pain beneath the sternum (for 15sec to 15 min) that often radiates towards the left arm, shoulder, or jaw. But, angina is not a disease but is a symptom of an underlying heart problem, usually coronary artery disease.

Types of angina pectoris

There are mainly divided into 4 types, they are

• Classical/ stable angina
• Prinzmetal angina (vasospastic angina or variant angina)
• Unstable angina
• Microvascular angina

Classical angina

It is also known as angina of effort or stable angina. In this case blockade of vessel up to 70%. Pain occurs only during exertion.

Prinzmental angina

It is also known as variant angina or vasospastic angina because pain occurs as a result of a spasm of a coronary artery.

Unstable angina

In this case, pain occurs during rest position too. This lies in between stable angina and myocardial infarction.

Etiopathogenesis of angina pectoris

Occur as a result of an imbalance between myocardial oxygen demand and supplement. Ischemia is the main factor that causes the damage of cardiac muscle cells and stimulates pain afferents so intense pain occurs.

_{Factors that decrease oxygen supplement}

• Atherosclerosis of coronary vessels.
• Spasm of the vessel due to agents like cocaine.
• Reduce oxygen availability due to hypoxia.

_{Factors that increase oxygen demand}

• Increase heart rate
• Increase cardiac wall thickness
• Increase contractility of the heart
• Increase workload on the heart due to increase blood volume or narrowing of outflow vessels.

Risk factors

• Old age (increases the risk for men more commonly after 45 years of age and for women after 55 years of age).
• Males> females
• Family history/ genetics
• Smoking
• Alcohol consumption
• Obesity
• Diabetes
• Hyperlipidemia etc.

Symptoms 

• Chest pain & radiates towards arms, etc.
• Shortness of breath or difficulty of breath
• Weakness
• Tiredness 
• feeling faint

Treatment of Angina Pectoris

All areas of chest pain should be checked by a doctor or consultant. If a doctor or consultant thinks that may have unstable angina or that angina is related to serious heart problems, they may recommend the following tests and procedures:

• Chest X-ray
• Electrocardiogram (EKG)
• Blood test
• Stress test
• Computed tomography angiography
• Coronary angiography

_{Treatment of angina includes}

• Lifestyle change
• Medicines use (only use after doctor prescription)
  • Nitrates e.g. Glyceryl trinitrate, isosorbide dinitrate, etc.
  • Calcium channel blockers like diltiazem, verapamil, amlodipine, etc.
  • Beta-blockers e.g.Propanolol, metoprolol, atenolol, timolol, etc.
  • Potassium channel openers: e.g. Nicorandil, etc.
  • Other drugs like Dipyridamole, Trimetazidine, etc.
• Cardiac exercise