Angina pectoris is a common presentation of coronary artery disease. It is a clinical syndrome characterized by a series of symptoms including intense chest pain with a typical profile, generally oppressive, located in the precordium (anterior chest) and with variable irradiation (neck, jaw, back, shoulders and arms), onset with exercise and emotional stress, which subsides with nitroglycerin.
This is the definition given in the clinical practice guidelines of the European Society of Cardiology on the management of stable angina and has been in force for 2 decades.
Symptoms of angina pectoris
The duration of angina pectoris is usually less than 20 minutes and a series of symptoms called vegetative cortex (sweating, nausea, vomiting…) may appear, which are more frequent in infarction than in angina.
These symptoms become more atypical in special population groups such as women, the elderly and diabetics, and the characteristics of the pain may vary and may even be absent in the diabetic group, which poses a diagnostic challenge in these patients.
Causes of angina pectoris
It is mainly caused by a deficit in the blood supply to the myocardium due to a lesion in the coronary macro or microvasculature; depending on the degree of involvement, symptoms may occur at rest or on exertion.
Incidence of angina pectoris
The incidence in Spain is difficult to determine exactly because it is a clinical diagnosis, which confers a subjective character.
The results of some series show that it can be the initial presentation of coronary artery disease in almost half of men and slightly more than half of women. The prevalence of angina shows an increase with age in both sexes.
Treatment for angina pectoris
After an initial diagnostic approach and assessment of the underlying coronary artery disease, treatment is based on antianginal drugs (nitrates, calcium antagonists and beta-blockers as first line) and, if necessary, revascularization of the culprit coronary artery in case of no symptom control or significant coronary artery disease.
However, as always, the best approach is a good primary prevention strategy with control of cardiovascular risk factors (CVRF), such as hypertension, diabetes mellitus, dyslipidemia, smoking cessation, sedentary lifestyles and overweight (which is the scourge of the 21st century).
In summary, angina pectoris is a form of coronary artery disease that represents a medical emergency. We aim at its early differential diagnosis with the other entity, myocardial infarction, which entails different initial treatments and with different urgency.
The key lies in primary prevention.
Bibliography:
– Bonet Basiero, A., BardajĂ, A.Epidemiology of stable angina.Rev Esp Cardiol Supl. 2010;10(B):3-10 – Vol. 10 NĂşm.Supl.B.
– ESC 2013 clinical practice guideline on diagnosis and treatment of stable ischemic heart disease. European Society of Cardiology Working Group on diagnosis and treatment of stable ischemic heart disease.
– GarcĂa-BermĂşdez, M. , Gil Bonet, BardajĂ, A. Epidemiology of stable angina and comorbidity.
Rev Esp Cardiol Supl. 2012;12(D):3-8 – Vol. 12 Num.Supl.D DOI: 10.1016/S1131-3587(12)70066-3.
For more information consult your cardiologist.