Angina Pectoris

Overview
Tests
Treatment
Sources

What is it?
Angina Pectoris is a term for chest pain caused by an inadequate supply of blood and oxygen to the heart. More than 9 million people in the United States have angina. It is often associated with the narrowed arteries found in coronary artery disease (CAD). This narrowing is due to atherosclerosis. With angina, the affected patient’s heart may get sufficient blood for daily activities, but the arteries may not be able to respond appropriately to increased demands for oxygen during exercise, times of emotional or physical stress, and with extremes of temperature.

Symptoms of angina appear and then may or may not disappear when the patient is at rest. The patient may have chest pain, discomfort and/or pressure, or experience referred pain – pain that is felt in the left shoulder, arm, back, or jaw. Angina may be more difficult to identify in some elderly patients when they have symptoms such as abdominal pain after eating (due to increased blood demand for digestion) or have back or shoulder pain (which may be thought to be due to arthritis). The amount of activity that it takes to trigger an episode of angina and the symptoms involved vary from person to person and may also vary between episodes and over time. Since CAD tends to be progressive, angina may worsen over time – either with more severe symptoms, more frequent episodes, and/or less response to rest and treatment.

There are three main types of angina:

Stable angina is characterized by predictable patterns of symptoms and periods of discomfort that occur during exercise or periods of stress. This pain is usually relieved with rest and/or treatment with nitroglycerin or another appropriate medication. Many patients with this type of angina can live a relatively normal life for many years, but some patients will progress over time, or relatively rapidly, to unstable angina.
Unstable angina, one of the acute coronary syndromes that includes heart attack, is characterized by a change in the pattern of angina episodes, occurring more frequently, at rest, and/or not responding to treatment. It is usually a sign that the patient’s condition is worsening. The pain a patient experiences with unstable angina may be more severe and prolonged than that of stable angina. People with unstable angina are at increased risk of a heart attack, severe cardiac arrhythmia, and cardiac arrest. This is an acute emergency and should be evaluated and treated immediately. The first episode of angina that a patient ever experiences is also called unstable angina.
Variant angina (Prinzmetal’s angina) almost always occurs during periods of rest, usually at night. The cause is a spasm of a coronary artery. Many people who have this type also have severe atherosclerosis in at least one major vessel on the heart. It can also occur, although much less often, in people with heart valve disease or uncontrolled high blood pressure (hypertension), and may also be seen with the use of cocaine and methamphetamines.