Angina pectoris is a generally painful and/or oppressive discomfort, acute, gradual and usually appears in the center of the chest, although it can extend to the left arm, both arms, back or area below the sternum. Although it is a serious disease, with proper treatment and a heart-healthy lifestyle it can be controlled.
Ischemic heart disease is a heart disease that is due to the existence of ‘myocardial ischemia’, that is, insufficient or no oxygenated blood supply to an area of the heart muscle (myocardium).
Ischemic heart disease manifests itself in two forms: as angina pectoris or acute myocardial infarction. Its most frequent cause is coronary atherosclerosis, the appearance of cholesterol plaques and other substances (atherosclerosis plaques atheromas) on the inner wall, in the lumen of the coronary arteries.
The heart muscle (heart wall or myocardium) receives oxygenated blood through the coronary arteries and atheroma plaques, when they grow excessively, narrow the lumen of the artery, making it difficult for oxygenated blood to pass through and causing myocardial ischemia.
Myocardial ischemia causes pain or discomfort in the center of the chest. This pain is known as ‘angina pectoris’. It may be stable or unstable if there is an acute partial or total obstruction due to the sudden association of a clot in the atheromatous plaque. Acute myocardial infarction can occur if the clot obstruction is prolonged over time.
Among the risk factors that can trigger ischemic heart disease are tobacco addiction, arterial hypertension, diabetes, obesity, high cholesterol levels, lack of physical activity and family history.
Symptomatology of angina pectoris
The main symptom of stable angina pectoris is discomfort in the center of the chest, in the tie area, which may radiate to the throat, arms, back and jaw. The sensation is one of tightness, heaviness, tightness, burning or swelling. It lasts between five and twenty minutes and appears with physical exercise or strong emotions, subsiding with rest.
In unstable angina pectoris, the discomfort has the same characteristics, but appears when at rest and calm, lasts more than 20 minutes and the episodes are increasingly intense and frequent.
In acute myocardial infarction, the discomfort continues to have the same characteristics, but persists after half an hour and does not subside with sublingual nitroglycerin.
Causes and prevention of angina pectoris
Although some people have a genetic predisposition, it is people with multiple cardiovascular risk factors who tend to suffer from it. These are smoking, sedentary lifestyle, obesity, diabetes, hypertension and high cholesterol. Other factors that may favor angina pectoris are the stress to which the patient is subjected or states of depression.
If modifiable cardiovascular risk factors – hypertension, diabetes, etc. – are controlled by means of a healthy diet, physical exercise, medication and keeping stress at bay, the onset of the disease and its complications can be prevented or considerably delayed.
Treatment of angina pectoris
First of all, cardiovascular risk factors must be controlled and checked periodically.
All patients should take acetylsalicylic acid or another antiaggregant if they have hypersensitivity or intolerance, a statin (to lower cholesterol) and one or more medications to reduce angina episodes (beta-blocker, nitrate or other alternatives). Cholesterol and lipid metabolism and glucose metabolism should be monitored.
Always carry nitroglycerin tablets with you to chew and place one under the tongue in case of angina. In severe cases, the implantation of one or more coronary stents or coronary surgery (bypass) can be used.
Adequate exercise prescription for the patient is important, as well as adequate prevention. For more information on angina pectoris, consult a specialist in cardiology.