Angina Pectoris: Types, Causes, Symptoms & Treatment
Angina Pectoris
Angina pectoris or angina is a health concern manifested by discomfort or pain in the chest, jaw, shoulder, back, or arm. It is caused by an imbalance between myocardial oxygen supply and myocardial oxygen demand resulting in reduced blood supply to the heart.
The risk of angina pectoris increases in people with high blood pressure and high blood cholesterol level. Lack of exercise, smoking, and stress also put you at higher risk for developing angina pectoris. Angina pectoris can affect people of all ages but the risk increases with increasing age.
Types Of Angina Pectoris
There are four main types of angina pectoris, stable angina, unstable angina, prinzmetal angina/variant or vasospastic angina, and microvascular angina.
The chest discomfort reported in stable angina is caused by transient myocardial ischemia. It is usually developed after some physical activity or stress and lasts within 5 minutes or less.
Unstable angina is caused by a decrease in blood flow resulting in insufficient oxygen supply to the heart muscles due to atherosclerosis. Unstable angina lasts for about more than 20 minutes.
Prinzmetal angina is caused by the coronary artery spasm. It causes the temporary narrowing of arteries which causes the reduced blood supply to the heart.
Microvascular angina is caused by the narrowing of small blood vessels of the heart and ultimately stops functioning normally.
Symptoms Of Angina Pectoris
Commonly reported symptoms of angina pectoris is chest pain & discomfort which is described as a heaviness, squeezing, pressure, burning, or choking sensation. You may also feel pain in the shoulders, arms, epigastrium, back, jaw, or neck.
Symptoms such as dizziness, shortness of breath, sweating, fatigue, and nausea may also be reported in rare cases.
Causes Of Angina Pectoris
Decreased blood supply to the heart muscle, generally because of blocked or restricted coronary veins, is the main cause of angina pectoris. The following are some typical causes of angina pectoris
1. Coronary Artery Diseases: The most common reason for angina is coronary artery disease (CAD), which happens when a development of plaque causes the coronary arteries that convey blood to the heart to limit or become stopped up. Angina symptoms are brought on by the restriction of blood flow to the heart muscle.
2. Atherosclerosis: Another risk factor for angina pectoris is atherosclerosis. Atherosclerosis decreases or blocks the blood supply to the heart due to the buildup or accumulation of fatty substances or cholesterol in the blood vessels. This plaque can restrict the arteries over time, decreasing blood flow and resulting in angina.
3. Coronary Artery Spasm: In different conditions, the coronary arteries may have spasms that briefly confine them.
4. Coronary Microvascular Disease: This condition influences the small arteries in the heart, weakening their capacity to grow and contract appropriately. It can cause angina-like symptoms, especially in ladies, despite the significant coronary supply routes may not have critical blockages.
5. Heart Valve Disease: Certain heart valve conditions, like aortic valve stenosis or mitral valve disgorging, can prompt expanded burden on the heart and decreased blood flow, bringing about angina symptoms.
6. Hypertrophic Cardiomyopathy: Angina symptoms can arise as a result of this genetic condition, which is characterized by thickening of the heart muscle.
7. Other Factors: High blood pressure (hypertension), smoking, diabetes, obesity, high cholesterol levels, a sedentary lifestyle, stress, and age are additional risk factors for angina.
It's essential to take note of that angina can be a side effect of a respiratory failure (myocardial infarction). If you experience serious or delayed chest pain, shortness of breath, or different side effects reminiscent of a heart failure, it is crucial to seek immediate medical attention.
Treatment Of Angina Pectoris
Commonly prescribed drugs for the treatment of angina pectoris are nitrates, calcium channel blockers, beta-blockers, sodium channel blockers, ACE inhibitors, and antiplatelet agents.
Nitrates are the first-line agents for the treatment of stable, unstable, and variant angina. They decrease the myocardial oxygen demand. There are two types of nitrates, short-acting and long-acting nitrates. Short-acting nitrates include nitroglycerine and long-acting nitrates include isosorbide dinitrate, isosorbide mononitrate, and long-acting nitroglycerine.
Calcium channel blockers exert their action by blocking the entry of calcium into cardiac and smooth muscles. CCBs are arteriolar vasodilators and cause a decrease in smooth muscle tone and peripheral vascular resistance. CCBs decrease myocardial oxygen demand, cardiac contractility, and wall pressure.
CCBs are prescribed for those patients in which beta-blockers are contraindicated. There are two main types of calcium channel blockers, dihydropyridines, and non-dihydropyridines. Dihydropyridine CCBs are felodipine, amlodipine, and Nifedipine while non-dihydropyridine CCBs are diltiazem and verapamil.
Beta-blockers decrease the myocardium's oxygen demand, heart rate, contractility, and cardiac output. Commonly used beta-blocker drugs are atenolol, bisoprolol, metoprolol, pindolol, and propranolol.
Sodium channel blockers are proven to be effective in the treatment of chronic angina. A commonly used drug is ranolazine. Their exact mechanism of action is still not known.
Antiplatelet agents are cardioprotective agents and are used in stable and unstable angina. A commonly used drug is aspirin. Angiotensin-converting enzyme (ACE) inhibitor medicines are captopril, fosinopril, and Ramipril.
Two commonly used surgical procedures for the treatment of angina pectoris are percutaneous coronary intervention (previously called Angioplasty/stenting) and CABG (Coronary Artery Bypass Graft Surgery).