Angina Pectoris: Causes, Types, Symptoms, and Treatments

Angina pectoris also known as Ischemic Chest Pains is a clinical syndrome for severe chest pains due to the lack of blood flow to the heart. Not receiving enough blood is termed ischemia. Angina is a symptom of Coronary Artery Disease(CAD). This is an extremely common condition with an estimate of 10 million cases each year in India alone. Angina pectoris occurs when the cardiac workload of the coronary arteries exceeds the limit, resulting in the lack of supply of oxygenated blood to the heart muscles.

Key Terms: Angina Pectoris, CAD, Heart, Cardiac muscles, Chest, Ischemia, Coronary arteries

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Causes of Angina Pectoris

There are several causes of Angina Pectoris, as follows:

• Atherosclerosis, is a medical term for the build-up of cholesterol plaque in the arteries, resulting in the narrowing of the blood vessels. This ultimately decreases the blood supply to the cardiac muscles
• A blood clot can also cause obstruction to blood flow, decreasing the oxygenated blood supply to the heart muscles.
• Poor blood flow through a narrowed heart valve can also cause Angina Pectoris.
• Even lessened pumping of the heart muscle can be a cause for the development of Angina Pectoris.
• Coronary artery spasms can also be a cause of this condition.
• During periods of Emotional stress or Strenuous physical activities the heart requires a larger quantity of blood supply, and if this requirement is not met then this could also lead to the development of Angina.

Read more: Symptoms of heart attack in men and women       

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Types of Angina Pectoris

There are several types of Angina Pectoris. It includes Stable angina, Unstable angina, Atypical angina, Nocturnal angina, Angina decubitus, Silent ischemia, Variant angina, Microvascular angina, etc.

Out of which, the below four are the most prominent forms of angina.

• Stable angina
• Unstable angina
• Variant angina
• Microvascular angina

Stable angina

Stable angina is more common when compared to the other types. Symptoms such as breathlessness during physical activities become apparent and occur regularly. These patterns are usually predictable and are observed during the case of exertion.

Unstable angina

In the case of unstable angina, patterns are less or changes in frequency and are unpredictable. But the chest pain experienced is more severe and can last for a longer period of time. These symptoms occur during non-strenuous activities like resting too. This can also be a precursor to a cardiac arrest and hence, requires immediate testing and diagnosis.

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Variant angina

Vasospastic or variant angina also known as Prinzmetal’s angina or Angina inversa is the type of angina that occurs in younger patients that are already predisposed to heart conditions. This occurs to these individuals while resting, specifically during the night or early morning.

Microvascular angina

This type of angina affects the smaller coronary arteries of the Heart. This type is generally difficult to diagnose and is brought about by spasms within the blood vessels. The episodes of Chest pain last longer when compared to the other types, and are more severe.

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Symptoms of Angina Pectoris

The symptoms of Angina pectoris include

• Feeling of pressure/tightening/heaviness across the chest area.
• Shortness of breath especially during strenuous physical activities.
• Pain that spread to the arms, shoulder, neck, jaw, back, and occasionally down the right arm.
• Heartburn
• Lightheadedness/fainting
• Indigestion
• Nausea
• Sweating
• Cramping

Discomfort and pain of Angina Pectoris is said to be commonly felt below the sternum, although the location varies. It can also be felt in the upper abdomen. Angina can also further be aggravated by medications which include thyroid replacements, vasodilators, and polycythemia.

Read more: Blood circulatory system

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Diagnosis of Angina Pectoris

Diagnosis of angina pectoris is done through several methods

1. Typical symptoms can be a diagnosis of Angina
2. ECG- evaluates the heart rhythm and measures the electrical activity of the heart. Since angina resolves with rest, ECG can rarely be done during an episode except during stress testing
3. Stress testing- is essential to confirm the diagnosis of Angina and this test evaluates the severity of this condition. This includes both Exercise stress testing with ECG and Stress testing with myocardial imaging.

• Exercise Stress Test– includes bicycle testing or exercise treadmill for detecting coronary artery disease.
• Stress ECG– this includes a combination of exercise stress testing along with heart muscle ultrasound imaging. This test has been known for its higher accuracy.

4. Angiography – is a non-invasive test, which uses intravenous dye containing iodine along with CT scanning for imaging the arteries wherein, the blood vessels and the blood flow to the heart can be examined and mapped out.
5. Cardiac catheterisation– this particular X-ray test helps in identifying the narrowing of the artery.

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Treatments for Angina Pectoris

The main goal during treating Angina Pectoris is

1. Relieve acute symptoms
2. Prevent/reduce ischemia
3. Prevent future ischemic events

Hence the treatment of Angina Pectoris requires a significant change in the lifestyle. This is to reduce the risk factors which include making dietary changes and physical activity changes and also avoiding smoking, drinking, and consumption of lipid-heavy food.

To relieve symptoms during an episode, Nitroglycerin is given. Nitroglycerin is a smooth-muscle relaxant and vasodilator which helps in the greater flow of oxygenated blood to pass to the cardiac muscles. Patients are prescribed to carry these Nitroglycerin tablets or aerosol spray to use when there is an attack.

To prevent ischemia, several classes of drugs are recommended and used, which include the following

1. Antiplatelet drugs – these drugs are prescribed to patients who are subject to CAD, coronary artery disease. Clopidogrel, prasugrel, and ticagrelor reduce the risk of ischemic events and are most effective when given together.
2. Beta-blockers – these drugs limit symptoms and prevent infarction. Examples include diltiazem, verapamil, and bisoprolol.
3. Long-acting nitrates – are used if the symptoms persist even after the beta-blocker dose is maximised. Examples of long-acting nitrates include Nitroglycerin, Isosorbide etc
4. Calcium channel blockers – are administered when symptoms persist after administering nitrates. They shouldn’t be used alone to treat stable angina. These are particularly good to treat hypertension or coronary spasm.

Read more: Heart diseases

Revascularization with PCI or CABG is recommended if symptoms persist even after drug therapy and cause a disruption in the quality of living.

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Things to Remember

• Angina Pectoris is an indication of Coronary artery disease or an indication of a heart attack/stroke.
• Is mainly caused due to the lack of oxygenated blood supply to the cardiac muscles.
• The intensity of the chest pain and the time period and frequency of these chest pains are different for different types of Angina Pectoris
• It is not a life-threatening condition and with treatment and proper care, it can be managed.
• Nitroglycerin is most commonly used to treat Angina Pectoris

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Sample Questions

Ques. What is Angina Pectoris? (2 marks)

Ques. Do people die due to Angina Pectoris? (2 marks)

Ques. Name the four prominent types of Angina Pectoris. (2 marks)

Ques. The drug that is administered at the time of an Angina attack is (1 marks)
(a) Clopidogrel
(b) Aspirin
(c) Nitroglycerin
(d) Ticagrelor

Ques. Mention the general treatments for Angina Pectoris. (2 marks)

Ques. If a tissue is having an inadequate supply of oxygen, the condition is called (1 marks)
(a) Hypoxia
(b) Asphyxia
(c) Anoxia
(d) Pleurisy

Ques. Does exercise aggravate the condition of Angina Pectoris? (2 marks)

Ques. Name a few diagnostic methods for recognising Angina Pectoris.  (2 marks)

Ques. List the symptoms of Angina Pectoris.  (2 marks)

Ques. Which of the Following Procedures Indicate Movement of Blood in the Heart? (1 marks)
(a) Coronary artery bypass
(b) Stent
(c) Angioplasty
(d) Angiography

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