Angina

Definition:

• A clinical syndrome characterised by discomfort or pain in the chest, usually due to myocardial ischaemia (reduced blood supply to the heart muscle).

Etiology:

• Coronary artery disease (CAD): Atherosclerosis of the coronary arteries is the most common cause.
• Coronary artery spasm (Prinzmetal’s angina).
• Cardiac syndrome X: Angina with normal coronary arteries on angiography.

Types:

• Stable angina: Triggered by exertion, resolves with rest.
• Unstable angina: Occurs unpredictably and can persist at rest. Higher risk of progression to myocardial infarction.
• Prinzmetal’s angina: Due to coronary artery spasm, can occur at rest and is often cyclic.

Clinical Presentation:

• Typically described as a heavy, squeezing or tight chest pain.
• May radiate to the left arm, neck, jaw, or back.
• Associated symptoms: Dyspnoea, nausea, sweating.
• Duration: Usually < 20 minutes.

Investigations:

• ECG: ST-segment depression or T-wave inversion during pain. Normal between episodes.
• Exercise stress test.
• Coronary angiography: Gold standard for diagnosing CAD.
• Blood tests: Troponin, cholesterol, glucose.

Management:

• Pharmacological:
  • Nitrates: Short-acting (GTN) for immediate relief; long-acting for prophylaxis.
  • β-blockers: Reduce myocardial oxygen demand.
  • Calcium channel blockers: Especially in Prinzmetal’s.
  • Aspirin and statins: For secondary prevention in CAD.
• Interventional:
  • Percutaneous coronary intervention (PCI) with stent placement.
  • Coronary artery bypass grafting (CABG).

Prognosis:

• With treatment, many individuals can have good symptom control and reduced risk of myocardial infarction.
• Regular follow-ups are essential to monitor for disease progression and response to treatment.

Complications:

• Myocardial infarction.
• Heart failure.
• Arrhythmias.