Angina or angina pectoris is cardiac chest pain that occurs as the result of myocardial ischemia.
Angina is classically described as substernal chest discomfort that is of a typical quality and duration (heavy, tight, ‘bandlike’ pain that lasts for minutes at a time). Angina is generally provoked by exertion or emotional stress and rapidly relieved by rest and/or nitrates (within minutes).
Two main types of angina are recognized:
- stable angina: chest pain only occurs with exertion or emotional stress
- unstable angina
- chest pain can occur at any time, including at rest
- this falls under the spectrum of acute coronary syndromes and is therefore generally treated as such
Examination will often be unremarkable. There may be evidence of hypertension or hypercholesterolemia. Angina is generally the result of coronary artery atherosclerosis but remember angina may occur in the context of other cardiac disease, for instance with severe aortic stenosis; these patients will generally have a systolic murmur.
Cardiac biomarkers (such as high-sensitivity troponin) would be expected to be normal (or at least normal for the patient). New elevation of biomarkers would by definition be myocardial infarction rather than angina.
Between attacks, the ECG may be normal. During an attack, ST depression or T-wave inversion may be seen.
Plain radiograph of the chest will usually be normal unless there is another co-existing pathology (such as cardiac failure).
Computed tomography of the chest may be normal, or may demonstrate features of co-existing pathologies (as with plain radiography). Calcification of the coronary arteries or heart valves may also be demonstrated on CT.
Treatment and prognosis
Treatment is generally with anti-anginal medications to reduce cardiac preload/afterload (including beta-blockers, calcium channel blockers and nitrates).
Patients that are deemed higher risk or who have troubling symptoms may undergo coronary angiography, possibly with angioplasty/stenting of narrowed arteries.
As angina usually is representative of coronary artery atherosclerosis, affected patients will be more at risk of myocardial infarction (which is usually the result of plaque rupture).