Angina Pectoris

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1- Introduction

2- Anatomical Overview

3- Causes

4- Treatment 

Introduction

Angina pectoris, commonly known as angina, is chest pain or discomfort that occurs when your heart muscle doesn’t receive enough oxygen-rich blood. It’s often described as a squeezing or pressure sensation in the chest. Angina is usually a symptom of an underlying heart problem, such as coronary artery disease (CAD), which is caused by a buildup of plaque in the coronary arteries. Angina can be triggered by physical exertion, stress, or other factors that increase the heart’s workload.

Anatomical Overview

Pain that originates in the heart is called angina or angina pectoris (L. angina, strangling pain + L. pectoris, of the chest). Individuals with angina commonly describe the transient (15 seconds to 15 minutes) but moderately severe constricting pain as tightness in the thorax, deep to the sternum. The pain is the
result of ischemia of the myocardium that falls short of inducing the cellular necrosis that defines infarction. Most often, angina results from narrowed coronary arteries. The reduced blood flow results in less oxygen being delivered to the cardiac striated muscle cells. As a result of the limited anaerobic metabolism of the myocytes, lactic acid accumulates and the pH is reduced in affected areas of the heart. Pain receptors in muscle are stimulated by lactic acid.

Causes

Angina pectoris is primarily caused by reduced blood flow to the heart muscle. The most common cause of this reduced blood flow is coronary artery disease (CAD), which occurs when the coronary arteries that supply blood to the heart become narrowed or blocked by a buildup of plaque. This plaque is usually made up of cholesterol, fat, and other substances.

  • Coronary artery spasm: This is a temporary constriction of the coronary arteries that can reduce blood flow to the heart.

  • Coronary microvascular disease: This condition affects the walls and inner lining of the small coronary arteries, which can lead to reduced blood flow to the heart muscle.

  • Anemia: A decrease in the oxygen-carrying capacity of the blood can lead to inadequate oxygen delivery to the heart muscle.

  • Heart valve disease: Certain heart valve problems, such as aortic stenosis, can lead to increased workload on the heart and reduced blood flow to the coronary arteries.

  • Hypertrophic cardiomyopathy: This is a genetic condition where the heart muscle becomes abnormally thick, making it harder for the heart to pump blood effectively.

  • Risk factors: Factors such as smoking, high blood pressure, high cholesterol, diabetes, obesity, and a sedentary lifestyle can increase the risk of developing coronary artery disease and, consequently, angina pectoris.

Treatment

The treatment of angina pectoris aims to relieve symptoms, prevent future episodes, and reduce the risk of complications. Treatment options may include:

  1. Lifestyle changes: Adopting a healthy lifestyle can help manage angina. This includes eating a heart-healthy diet, exercising regularly, maintaining a healthy weight, quitting smoking, and managing stress.

  2. Medications: Several medications can be used to treat angina, including:

    • Nitroglycerin: to relieve acute episodes of angina
    • Beta-blockers: to reduce the heart’s workload and oxygen demand
    • Calcium channel blockers: to relax and widen the blood vessels, improving blood flow to the heart
    • ACE inhibitors or ARBs: to lower blood pressure and reduce the workload on the heart

  3. Nitroglycerin therapy: Nitroglycerin is a common medication used to relieve angina symptoms by relaxing the blood vessels, improving blood flow to the heart, and reducing the heart’s workload.

  4. Percutaneous coronary intervention (PCI): Also known as angioplasty, this procedure involves inserting a catheter with a balloon at its tip into a narrowed coronary artery. The balloon is inflated to compress the plaque, widening the artery and improving blood flow. A stent may also be placed to help keep the artery open.

  5. Coronary artery bypass grafting (CABG): In this surgical procedure, a healthy blood vessel is taken from another part of the body and used to bypass a blocked coronary artery, restoring blood flow to the heart.

  6. Cardiac rehabilitation: This program includes supervised exercise, education, and counseling to help improve cardiovascular health and reduce the risk of future heart problems.

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