Angina pectoris is a condition associated with a chest pain of cardiac etiology. Heart muscle is supplied by two major coronary arteries withdrawing from the aorta. The problem called angina pectoris occurs when a part of these vessels starts narrowing.
The major risk factor of coronary arteries disease is a chronic process known as atherosclerosis. In a very simplified way it means a chronic deposition of fat in the walls of blood arteries that causes their narrowing. You can find more information in corresponding article.
The classic symptom is recurring chest pain by physical exertion (burning, pressure, retrosternal pain) that forces to terminate physical activity and rest. During resting or only a mild physical activity there are no problems because myocardial oxygen demand is secured even with narrowed arteries. When exertion of a certain degree occurs, the oxygen requirements increase to such extent that the narrowed vessel are unable to fulfill. This lack of heart oxygen (heart ischemia) manifests like chest pain. This angina pain typically disappears within a few minutes after the physical activity stopped. It is one of the differences from pain by an acute myocardial infarction, because it lasts regardless of the physical activity. If the artery narrowing continues, the exercise tolerance keeps declining.
Scheme of the problem in angina pectoris -displayed narrowed artery and dotted areas with the lack of oxygen
Angina alone restricts patient's activity and quality of life but despite that it is not the main problem. The real problem is a rupture in atherosclerotic narrowing that is followed by a clot formation. This clot can suddenly and completely obstruct the vessel and cause a myocardial infarction with all its consequences. It is also significant to know that heart cells often troubled by lack of oxygen during angina periods are prone to trigger severe disturbances in heart rhythm (heart arrhythmias), sometimes with sudden fatal consequences. That means that treatment of angina pectoris is very important and should not be underestimated.
Treatment and prevention
Angina pectoris must be prevented through its underlying cause, the atherosclerosis. Essential prevention measures should be a regular physical activity and health eating (fruit, vegetables, reduction of fat intake etc). As a second line of defense there are many drugs designed to lower blood levels of cholesterol and fats to stop or even reverse the process of atherosclerosis. Statins are the most common ones. In addition anti-clotting drugs are administered, especially drugs containing acetylsalicylic acid or a substance called clopidogrel.
To prevent an attack of angina pain we use nitrates, often in form of tablets with long-lasting effect. Nitrates cause widening of narrowed coronary arteries and improve the blood supply to heart muscles. Other possibilities present drugs improving heart muscle metabolism such as substance called molsidomin or trimetazidin.
During an angina attack that has already started the best solution is to use nitrates with quick effect. They are produced in forms of sublingual tablets or sprays.
Where necessary (worsening of symptoms, insufficient effect of pharmacotherapy) therapeutic endovascular coronary catheterization should be considered. During such examination a coronary angioplasty and stent implantation may be performed. When such endovascular therapy is impossible, there still exists a possibility of cardio surgery (coronary artery bypass creation).