From the Guidelines
Angina pectoris is a clinical syndrome characterized by discomfort in the chest, jaw, shoulder, back, or arm, typically aggravated by exertion or emotional stress and relieved by nitroglycerin, and its management should prioritize lifestyle modifications, medications, and sometimes procedures like angioplasty with stenting or coronary artery bypass surgery to reduce symptoms and prevent complications. The diagnosis of angina pectoris involves a careful history, physical examination, ECG, stress tests, and sometimes coronary angiography 1. The characteristics of discomfort related to myocardial ischemia (angina pectoris) may be divided into four categories: location, character, duration, and relationship to exertion and other exacerbating or relieving factors 1. Some key points to consider in the management of angina pectoris include:
- Classification of chest pain as typical angina, atypical angina, and noncardiac chest pain 2, 3, 4
- Angina is further classified as stable or unstable, with unstable angina defined as angina that presents in one of three principal ways: rest angina, severe new-onset angina, or increasing angina 2, 3, 4
- The American College of Physicians (ACP) has developed evidence-based guidelines for the management of patients with chronic stable angina, which summarize the recommendations of the ACC/AHA updated guideline and underscore the recommendations most likely to be important to physicians seeing patients in the primary care setting 2, 3, 4
- The ACP bases guideline recommendations on the results of systematic reviews of high-quality evidence (multiple, well-designed randomized, controlled trials) and meta-analyses where appropriate 2, 3, 4
- The most recent and highest quality study, which is the 2013 ESC guidelines on the management of stable coronary artery disease, should be prioritized in the management of angina pectoris 1.
From the FDA Drug Label
Angina is a pain or discomfort that keeps coming back when part of your heart does not get enough blood. Angina feels like a pressing or squeezing pain, usually in your chest under the breastbone. Sometimes you can feel it in your shoulders, arms, neck, jaws, or back.
Overview of Angina Pectoris:
- Angina pectoris is a type of chest pain that occurs when the heart does not receive enough blood.
- It is characterized by a pressing or squeezing pain in the chest, usually under the breastbone.
- The pain can also be felt in the shoulders, arms, neck, jaws, or back.
- Angina is a recurring condition, with pain that keeps coming back over time 5, 6.
- Key Points: + Angina is caused by insufficient blood flow to the heart. + It is characterized by chest pain or discomfort. + The pain can radiate to other areas, such as the shoulders or arms.
From the Research
Definition and Prevalence of Angina Pectoris
- Angina pectoris is defined as substernal chest pain, pressure, or discomfort that is typically exacerbated by exertion and/or emotional stress, lasts greater than 30 to 60 seconds, and is relieved by rest and nitroglycerin 7.
- Approximately 10 million people in the United States have angina, and there are over 500 000 cases diagnosed per year 7.
Management and Treatment of Angina Pectoris
- Pharmacologic therapy for angina includes β-blockers, nitrates, calcium channel blockers, and the late sodium current blocker ranolazine 7.
- Revascularization is indicated in certain high-risk individuals and also has been shown to improve angina 7.
- Treatment for refractory angina not amenable to usual pharmacologic therapies or revascularization procedures, includes enhanced external counterpulsation, transmyocardial revascularization, and stem cell therapy 7.
- Ranolazine has been shown to be effective in reducing angina and improving exercise performance in patients with chronic angina 8.
Risk Factors and Complications of Angina Pectoris
- Angina pectoris is a predictor of major adverse cardiac events 7.
- Angina is a serious morbidity that impedes quality of life and should be treated 7.
- Nitroglycerin tolerance is a limitation of its use in treating angina, but coadministration of Alda-1, an activator of ALDH2, can prevent this tolerance 9.