Angina Pectoris: Causes, Symptoms, Diagnosis and Treatment

Angina pectoris is the pain that occurs in the chest in response to a shortage of oxygen to the heart. It is usually a sudden onset of severe pain, usually described as tightness, and is accompanied by a feeling of shortness of breath. Its duration is variable and is limited to a few minutes, with a slow disappearance of symptoms. It appears in response to intense physical activities or emotions, but it is also common not to identify a clear precipitant.

The heart receives the oxygen and nutrients it needs through the coronary arteries. This supply is not constant, but varies throughout the day in response to its needs, increasing in situations of greater requirement, such as climbing a hill, and decreasing in situations of rest.

Angina is the consequence of a transient imbalance between what the heart demands and what the coronary arteries supply. It is a serious disease, usually progressive, but there are many treatments available today to control its symptoms.

Causes of angina pectoris

Atherosclerosis or the formation of atheroma plaques inside the coronary arteries is the most frequent cause of angina pectoris. According to cardiology specialists, it is a consequence of the progressive deposit of fat and other substances, which slowly reduce the caliber of the vessel and compromise the blood supply.

Heart diseases such as aortic valve stenosis, heart failure, coronary hypertrophy or spasm and other conditions such as hypertension, hyperthyroidism, anemia or respiratory insufficiency may be the cause of angina and should be ruled out during its study.

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Symptoms of angina pectoris

Pain is the most constant symptom. It is usually oppressive, of sudden onset, located in the center of the chest and radiating to the arms, neck, back or jaw. At other times it is of lesser intensity and may not even appear.

The characteristics of the pain also vary, sometimes manifesting itself as a burning, stabbing or heavy sensation that can be confused with other pathologies such as hiatal hernia, anxiety or gas. Other symptoms and signs that may appear are sudden shortness of breath, sweating, pale skin and nausea. Women and diabetic patients are more prone to a less typical presentation of the disease.

Diagnosis

The description of the pain and the circumstances in which it has manifested itself can give us the first diagnostic suspicion. Family and personal history, with special attention to vascular risk factors (smoking, cholesterol, diabetes, hypertension) will tell us if we are dealing with a patient at high risk for coronary problems.

Physical examination in angina due to atherosclerosis is usually normal, and the electrocardiogram and echocardiography, once the pain has subsided, usually show no alterations. Measurement of cardiac enzymes in the blood (troponins and CPK) allows us to know if there has been damage to the cardiac muscle, but they are negative if the episode has been transient and the heart has returned to normal.

Ischemia tests are used to study patients who present with pain suggestive of angina pectoris but in whom the initial tests have been normal.

The most common and accessible is the ergometry or stress test, which can be performed on a treadmill or bicycle. It consists of performing progressive physical exercise, which increases the needs of the heart, and reveals situations in which it is not possible to increase the blood supply through the coronary arteries.

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Other tests such as dobutamine echocardiography, stress MRI or perfusion scintigraphy are also useful in identifying patients with coronary ischemia.

Coronary CT or cardiac catheterization allows us to directly visualize, by administering contrast, the coronary arteries and evaluate the presence of stenosis in their path, thus confirming the presence of atherosclerotic plaques.

What is the treatment?

Treatment should be aimed at reducing and facilitating the work of the heart, as well as improving perfusion through the coronary arteries and controlling vascular risk factors. This includes drugs that act in combination: beta-blockers, calcium antagonists and ivabradine reduce heart rate and contractility and allow better blood flow in each cardiac cycle; nitrates relax smooth muscle in arteries and veins increasing blood supply, and ranolazine acts at the cellular level; antiaggregants are key to prevent arterial thrombosis and the possibility of infarction; drugs that control hypertension, cholesterol or diabetes may even reduce the progression of atherosclerotic disease.

In cases of severe and uncontrolled disease, it may be necessary to intervene at the coronary artery level: stent implants and bypass surgery, in selected cases, can restore the flow of the heart muscle.

The diagnosis and treatment of angina pectoris is therefore complex. Therefore, it should be supervised and monitored by a cardiovascular disease specialist.