What is angina pectoris?

In angina pectoris, also known as angina, a person experiences a strange, oppressive, and heavy pain in the chest area, as if the chest were constricting. This is caused when blood flow to the heart is reduced due to coronary disease.

Angina pectoris is a relatively common condition, and the painful sensation is often described as a feeling of a heavy object on the chest.

Generally, angina pectoris is a consequence of coronary artery disease, where blood flow is reduced due to atherosclerosis, this is a condition where fatty plaques build up on the artery walls, narrowing the passages and causing less blood and oxygen to reach the heart muscle.

Angina pectoris is classified into:

• Stable: This is the most common type and usually only appears during physical activity. It lasts for two to five minutes.
• Unstable: This can also occur at rest, presenting with intense and prolonged pain (lasting 15 to 30 minutes or more). This is a medical emergency, as if the heart does not receive enough blood and oxygen, it can lead to a life-threatening heart attack.
• Prinzmetal’s: This type of angina is not caused by coronary artery disease but by an arterial spasm episode that reduces blood flow. It appears in cycles and responds to medication.
• Refractory: These are recurrent attacks that do not respond to drug treatment or lifestyle changes, and the patient is not considered a candidate for surgery.

Angina pectoris is a clinical manifestation of an insufficient oxygen supply to the heart muscle, which is usually caused by a partial obstruction in the coronary arteries.

Beyond the characteristic chest pain, it can be accompanied by other symptoms, which vary in intensity and form depending on the patient.

The main symptoms may include:

• Oppressive chest pain.
• A burning sensation in the center of the chest that can radiate to other areas.
• Inflammation in the wall of the coronary arteries.
• A feeling of pressure in the chest.
• Pain in the arms, neck, jaw, back, or shoulders.
• Dizziness.
• Fatigue.
• Nausea.
• Shortness of breath.
• Sweating.

The diagnosis of angina pectoris begins with a detailed clinical evaluation, where the doctor asks the patient about the characteristics of their chest pain—its location, duration, triggering factors, and what relieves it.

It’s also important to consider a history of cardiovascular diseases and risk factors like diabetes or hypertension.

During the physical exam, results may be normal, especially if the angina is stable or if there is no active ischemia at that precise moment. Nevertheless, the doctor will look for any suggestive findings, such as abnormal heart sounds or signs of heart failure.

An electrocardiogram (ECG) is a key tool to confirm the diagnosis and assess the severity of ischemia, especially if it is performed during an episode of pain.

Stress tests may also be required to evaluate the heart’s response to exercise, as well as imaging studies like a coronary CT scan or an echocardiogram.

In specific cases, a coronary angiography may be needed to directly visualize the coronary arteries and confirm the presence of obstructions.

The main goal of angina pectoris treatment is to relieve symptoms, improve the patient’s quality of life, and reduce the risk of major cardiovascular events, such as an acute myocardial infarction.

To achieve this, lifestyle changes must be implemented, including quitting smoking, managing weight, eating a healthy diet, and exercising regularly.

Additionally, pharmacological treatment may be required to help reduce the heart’s oxygen demand or improve coronary flow. Other medications can help modify the course of the disease, such as those that inhibit platelet aggregation or reduce cholesterol.

For patients with persistent angina or significant coronary obstructions, there is the option of surgical treatment, such as coronary angioplasty with stent placement or coronary bypass surgery.

The choice of the right treatment will depend on various factors, including the severity of the disease, the response to medical management, and the patient’s clinical profile.

At the Heart Failure Clinic of Centro Médico ABC, we can provide you with specialized care. Contact us!