Angina: Everything You Need to Know, From Symptoms and Causes to Diagnosis and Treatment

Our heart is an engine that works uninterruptedly, day and night, to keep our body moving and alive. However, the heart can also encounter difficulties if it is not properly cared for. One of the most common problems that can endanger our health is angina pectoris – an alarm signal that the heart is not receiving enough oxygen.

Only by understanding the mechanism of occurrence, the types of angina pectoris, and the methods of diagnosis and prevention can this condition be effectively managed. Find out more about angina pectoris and the signals our body sends us to warn us about our health.

Angina Pectoris: Definition, Symptoms, and Causes

Angina pectoris is most often the result of the narrowing or blockage of coronary arteries. How does this happen and what are the first signs of the condition?

Angina Pectoris – What is it and How Does it Occur?

Angina pectoris is one of the most common clinical manifestations of coronary heart disease. It is characterized by chest pain or discomfort caused by temporary myocardial ischemia. Angina pectoris reflects an imbalance between the oxygen demand of the heart muscle and its actual supply.

How Does Angina Pectoris Occur?

The heart muscle (myocardium) requires a constant flow of oxygen and nutrients to function optimally. These nutrients are supplied through the coronary arteries. When the coronary arteries are narrowed or blocked due to atherosclerosis – a buildup of cholesterol plaques and other substances on the artery walls – blood flow to the heart muscle is limited. This limitation leads to myocardial ischemia, meaning a reduction in the amount of oxygen reaching the heart muscle.

Furthermore, myocardial ischemia causes the symptoms of angina pectoris to appear. Essentially, pain and discomfort occur when the myocardium is temporarily deprived of oxygen. This deprivation happens especially during moments when its metabolic needs are increased, such as during physical exercise or emotional stress.

Pain in Angina Pectoris: Normal or Unusual?

Painful angina pectoris is not a distinct form of the condition, but a normal state. The main symptom of angina pectoris is chest pain or discomfort.

This pain has a set of distinctive characteristics:

• it is often described as a feeling of pressure, tightness, burning, or heaviness in the chest area;
• it can be diffuse and not always localized to a specific point;
• it frequently radiates to other parts of the body, such as the neck, shoulder, arm (especially the left one), or jaw;
• its duration can vary, from a few seconds to a few minutes.

Typical angina pectoris lasts a maximum of 10-15 minutes after stopping the triggering factor. If the pain persists or becomes progressive, it may indicate an unstable form of angina or an evolving myocardial infarction, which requires immediate medical intervention. Pay attention to the symptoms you experience and do not hesitate to consult a doctor whenever you suspect something is wrong.

Symptoms of Angina Pectoris and Other Clues to Recognize It

The typical symptoms of angina, including pain, are well-known. However, there are also subtle clues that may suggest the presence of this condition, especially in atypical forms of angina.

Thus, besides classic chest pain, angina can also manifest with other symptoms:

• discomfort in other body regions: pain in the jaw or neck, easily confused with dental or sinus problems, or upper abdominal discomfort, which can be mistaken for gastrointestinal symptoms like acid reflux or indigestion;

• feeling of suffocation or heaviness in the chest;
• difficulty breathing (dyspnea);
• feeling of extreme exhaustion after light physical activities;
• dizziness or fainting spells;
• heavy sweating (diaphoresis).

Angina Pectoris – Atypical or Subtle Signs and Symptoms

Especially in women, the elderly, and people with diabetes, angina pectoris symptoms can be atypical or more difficult to detect. Among these are:

• generalized discomfort, with chest pain being less common;
• burning sensation in the stomach or nausea;
• extreme fatigue or difficulty breathing, without chest pain.

Recognizing the symptoms of angina pectoris is essential for preventing its complications, such as myocardial infarction. Chest pain, discomfort in other body areas, a feeling of suffocation, fatigue, and difficulty breathing are important signs that should prompt patients to seek immediate medical help.

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Angina Pectoris: Causes and Triggers

The causes of angina pectoris are closely related to the flow of oxygenated blood to the heart muscle. If the oxygen supply is insufficient, myocardial ischemia occurs. Therefore, the main causes of angina pectoris are:

1. Coronary Artery Disease (Atherosclerosis). Fat deposits on the artery walls narrow them and reduce oxygen flow to the heart.
2. Coronary Thrombosis. Thrombi (blood clots) can form on the surface of an atheroma plaque that has ruptured inside a coronary artery. These clots can partially or completely obstruct blood flow, triggering unstable angina or even a myocardial infarction.
3. Microvascular Angina. This occurs when the small blood vessels in the heart do not function correctly, meaning they do not dilate sufficiently to ensure proper blood flow. Although the main coronary arteries may be normal, the problem lies with the small vessels.
4. Severe Anemia, when a reduced number of red blood cells or a low hemoglobin level causes the blood to carry less oxygen.
5. High Blood Pressure increases the heart’s oxygen demand, as the heart has to pump harder to cope with the increased pressure. If the coronary arteries are narrowed, this extra effort can trigger an angina episode.
6. Emotional Stress causes an increase in blood pressure and heart rate. These reactions increase the heart’s oxygen demand, and if the coronary arteries are affected by atherosclerosis, blood flow is insufficient to meet the myocardium’s needs.
7. Aortic Stenosis involves the narrowing of the aortic valve, which controls the flow of blood from the heart to the aorta and the rest of the body.

In all these situations, as the pressure on the heart increases, the oxygen demand also increases, thus triggering ischemia.

About Angina Pectoris: What are its Triggers?

Since angina pectoris is particularly associated with activities that increase the heart’s oxygen demand, its symptoms are mainly triggered by:

• physical exertion: demanding activities such as climbing stairs, running, or carrying heavy objects;
• emotional stress: situations of anxiety, anger, or intense psychological stress, which increase heart rate and blood pressure;
• exposure to cold: this can constrict arteries, reducing blood flow to the heart;
• heavy meals: excessively large or fatty meals can increase blood flow needed for digestion, which overworks the heart;
• smoking: nicotine causes vasoconstriction, triggering typical angina symptoms.

Angina pectoris has multiple causes, most related to a reduced blood flow through the coronary arteries. Identifying the specific cause is essential for effectively managing the condition and preventing complications such as myocardial infarction.

At the same time, modifiable risk factors, such as smoking, hypertension, and emotional stress, play a significant role and must be addressed carefully to prevent angina episodes.

Blood Pressure in Angina Pectoris and Other Relevant Parameters

In angina pectoris, blood pressure can provide important clues about cardiovascular status and the factors contributing to the onset of symptoms.

• High Blood Pressure (elevated blood pressure) is a major risk factor for angina pectoris. When blood pressure is high, the heart has to work harder to pump blood, which increases the oxygen demand of the heart muscle.
• Low Blood Pressure (hypotension), although less commonly associated with angina, can occur in certain cases, especially as a reaction to medications used to treat angina, such as nitrates. Blood pressure that is too low can reduce coronary perfusion and worsen ischemia.

In addition to blood pressure, other physiological parameters influence or are influenced by angina pectoris:

• Heart rate is another important parameter that influences the onset and severity of angina pectoris. Tachycardia (increased heart rate) can worsen angina because the heart requires more oxygen when it beats faster.
• During an angina episode, oxygen saturation may remain normal because the problem is not related to the lungs’ ability to oxygenate the blood. A decrease in oxygen saturation may indicate an associated respiratory problem or a more severe complication, such as heart failure, which can worsen angina symptoms.
• During a stable angina episode, cardiac enzyme levels remain normal because ischemia is temporary and does not cause permanent damage to the heart muscle. However, in cases of unstable angina or myocardial infarction, cardiac enzyme levels may increase, indicating myocardial damage.
• Cardiac output and ejection fraction are parameters that reflect the efficiency with which the heart pumps blood. In patients with severe angina or advanced coronary artery disease, these parameters may be affected.

These relevant parameters can be measured during an angina episode or during routine clinical assessments. Monitoring blood pressure, heart rate, and other physiological parameters is essential in the evaluation and management of angina pectoris. As they provide important clues about the severity of ischemia and the risk of cardiovascular complications, they contribute to better disease management and prevention of myocardial infarction.

Angina Pectoris of Effort, Unstable, or Chronic: Types of Angina Pectoris

There are several types of angina, each with different causes, symptoms, and risks. All these types vary in how they are triggered, their duration, and the severity of symptoms. Knowing them is essential for a prompt response.

Unstable and Stable Angina Pectoris

Stable Angina Pectoris

• also known as angina of effort, it occurs predictably during physical exertion or emotional stress (angina pectoris of emotion), and is the most common form. An important indicator of stable angina is that the symptoms tend to disappear with rest or after administering nitroglycerin.

Nitroglycerin dilates the coronary arteries, allowing better blood flow to the heart and relieving pain. Thus, in the case of stable angina, the pain usually improves after 5-15 minutes of rest or after administering nitroglycerin.

Angina of effort is considered stable because the symptoms appear predictably and can be managed. However, it requires careful monitoring to prevent progression to a more severe form, such as unstable angina or myocardial infarction.

Unstable Angina Pectoris

• can occur suddenly, even at rest, and indicates an increased risk of heart attack. It is a more serious form of angina pectoris and is considered a medical emergency because it indicates a rapid deterioration of blood flow through the coronary arteries.

The symptoms of unstable angina pectoris are mainly intense chest pain, accompanied by sweating, nausea, difficulty breathing (dyspnea), and even a feeling of impending death.

Without prompt treatment, there is a high probability of progression to a heart attack, meaning irreversible damage to the heart muscle. Therefore, immediate hospitalization for evaluation and treatment is vital.

About Angina of Rest

Angina of rest is a form of angina in which chest pain occurs in the absence of physical activity or obvious exertion, i.e., during periods of rest or even during sleep. This type of angina is more serious than angina of effort and may indicate an increased risk of complications, including myocardial infarction. Angina of rest is often classified as a subcategory of unstable angina, but the two are not identical. The distinction is important for appropriate treatment and can only be made by a specialist physician.

Acute or Chronic Angina Pectoris and Anginal Attack

Chronic Angina

• is a general term used to describe angina pectoris that occurs regularly and persists for a long time. It usually refers to long-term stable angina, which is well-managed with treatment but requires constant monitoring.

Chronic angina is triggered by the same activities or conditions as stable angina (physical exertion, stress, cold, heavy meals), but the symptoms are better controlled due to treatment and lifestyle adjustments. With proper treatment, patients with chronic angina can lead a relatively normal life, with symptom relief through rest and medication (nitroglycerin, beta-blockers, calcium channel blockers, etc.).

Acute Anginal Attack

• represents an episode of chest pain that occurs suddenly and usually signals a worsening of coronary heart disease. This form of angina is usually unstable and requires hospitalization and urgent evaluation to rule out a myocardial infarction. Initial treatment includes oxygen administration, nitroglycerin, aspirin, and anticoagulants to prevent clot formation. In severe cases, coronary angioplasty or coronary bypass surgery may be necessary to restore blood flow to the heart.

Both forms of angina require appropriate evaluation and treatment to reduce the risk of heart attack and improve patients’ quality of life.

Angina Pectoris: Diagnosis and Treatment. How Can It Be Prevented?

Preventing angina pectoris involves both managing known risk factors and preventing the progression of coronary artery disease. Here’s what you can do for your body:

1. Quit smoking. This harmful habit narrows arteries and increases the risk of myocardial infarction.
2. Maintain a healthy diet. A diet low in saturated fats, cholesterol, and salt, and rich in fiber, antioxidants, omega-3 fatty acids, and healthy fats can reduce the risk of atherosclerosis – the main cause of angina pectoris.
3. Monitor your blood pressure. If necessary, and only on your doctor’s recommendation, make sure to take your antihypertensive medications regularly.
4. If you have diabetes, make sure to keep it under control through diet, exercise, and medication.
5. Stress management is also important. Chronic stress can worsen angina and increase the risk of cardiovascular disease.
6. Exercise. Physical activity improves cardiovascular function and reduces the risk of angina. A minimum of 30 minutes of moderate exercise at least 5 times a week is recommended.

If, however, you develop angina pectoris, its manifestations can significantly affect your life. A correct diagnosis and appropriate treatment are essential to regain your normal lifestyle.

Diagnosing Angina Pectoris

The diagnosis of angina pectoris involves both a clinical evaluation and laboratory and imaging tests to confirm the presence of myocardial ischemia and rule out other causes of chest pain.

Electrocardiogram (ECG)

• is the most relevant test. During an angina episode, a resting ECG may show typical changes of ischemia, such as ST segment depression or inverted T waves. However, there is also an exercise ECG. It is performed during physical exercise (on a treadmill or stationary bike) to evaluate how the heart responds to stress. In cases of ischemia, ECG changes may be revealed that are not present at rest.

Blood Tests

• may include tests for cardiac enzymes (troponin and CK-MB), which are elevated in cases of myocardial infarction, but may be normal in stable angina. Blood sugar and cholesterol are also investigated to identify risk factors.

Stress Echocardiography

• is a test that uses ultrasound to visualize the heart muscle during exercise or after the administration of a heart-stimulating medication. This investigation can detect areas of the heart that are not receiving enough blood.

Coronary Angiography (Coronarography)

• is the most complex investigation for evaluating coronary arteries. This invasive procedure involves inserting a catheter into the coronary arteries and injecting a contrast agent, allowing doctors to visualize any narrowing or blockages.

All these analyses and tests are necessary to assess the severity of the disease and rule out other possible causes of symptoms. Based on them, your doctor will prescribe a treatment appropriate for your health condition.

Thus, although it may seem like a simple chest pain, angina pectoris shows us that lifestyle, stress, or lack of attention to our health can have serious consequences. Through a careful and balanced approach, with preventive measures and essential changes in daily habits, we can protect our heart and prevent serious complications.

References:

https://www.hopkinsmedicine.org/health/conditions-and-diseases/angina-pectoris

https://www.mayoclinic.org/diseases-conditions/angina/symptoms-causes/syc-20369373

https://www.nhs.uk/conditions/angina/

https://www.msdmanuals.com/professional/cardiovascular-disorders/coronary-artery-disease/angina-pectoris#Symptoms-and-Signs_v934109

https://www.webmd.com/heart-disease/heart-disease-angina

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