What is angina pectoris?

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, due to reduced blood flow to the heart muscle, usually as a result of coronary artery disease. 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. The discomfort caused by myocardial ischemia is usually located in the chest, near the sternum, but may be felt anywhere from the epigastrium to the lower jaw or teeth, between the shoulder blades or in either arm to the wrist and fingers.

Key Features of Angina Pectoris

• The discomfort is often described as pressure, tightness, or heaviness; sometimes strangling, constricting, or burning 1.
• Shortness of breath may accompany angina, and chest discomfort may also be accompanied by less-specific symptoms such as fatigue or faintness, nausea, burning, restlessness, or a sense of impending doom.
• The duration of the discomfort is brief—no more than 10 minutes in the majority of cases and more commonly even minutes or less—but chest pain lasting for seconds is unlikely to be due to angina.
• An important characteristic is the relationship to exercise, specific activities, or emotional stress, with symptoms classically appearing or becoming more severe with increased levels of exertion and rapidly disappearing within a few minutes when these causal factors abate 1.

Diagnosis and Management

The diagnosis of angina pectoris is primarily based on a careful history and physical examination, with further assessment using non-invasive strategies such as exercise ECG, stress echo, or myocardial perfusion scintigraphy to confirm the diagnosis and plan management 1. Treatment aims to reduce the frequency and severity of angina episodes, improve quality of life, and decrease the risk of cardiovascular events. This includes lifestyle modifications, medications such as nitroglycerin, beta-blockers, calcium channel blockers, and statins, and sometimes procedures like angioplasty or bypass surgery 1.

Importance of Early Recognition and Management

Early recognition and appropriate management of angina pectoris are crucial to prevent progression to more severe coronary artery disease, myocardial infarction, or death. General practitioners play a significant role in the initial assessment and management of patients with suspected angina, including triage, initial treatment, and referral to specialists when necessary 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.

Angina pectoris is a type of chest pain that occurs when part of the heart does not receive enough blood, characterized by a pressing or squeezing pain, usually in the chest under the breastbone, and sometimes in the shoulders, arms, neck, jaws, or back 2.

From the Research

Definition and Overview of Angina Pectoris

• Angina pectoris, commonly known as angina, is a condition characterized by chest pain or discomfort due to transient myocardial ischemia [(3,4,5,6,7)].
• It is a symptom of an underlying heart condition, such as coronary artery disease, where the heart muscle does not receive enough oxygen-rich blood [(3,4,5,6,7)].

Types of Angina

• Stable angina: This is the most common type, where the chest pain occurs with physical activity or stress and is relieved by rest or medication [(3,6)].
• Unstable angina: This type of angina is more severe and can occur at any time, even at rest 3.
• Microvascular angina: This type is caused by spasms in the small blood vessels of the heart 5.

Symptoms and Diagnosis

• The main symptom of angina is chest pain or discomfort, which may feel like pressure, tightness, or heaviness in the chest [(3,4,5,6,7)].
• Other symptoms may include shortness of breath, dizziness, or nausea [(3,4,5,6,7)].
• Diagnosis is typically made using a combination of medical history, physical examination, electrocardiogram (ECG), and imaging tests such as stress echocardiography or cardiac magnetic resonance [(3,4,5)].

Treatment and Management

• Treatment for angina typically involves a combination of lifestyle changes, medications, and procedures [(3,4,5,6,7)].
• Medications may include nitrates, beta blockers, calcium channel blockers, and ranolazine [(3,4,5,6,7)].
• Procedures may include percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABGS) [(3,4)].