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.

What different types of angina are there?

  • 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.
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.
    • Ī²-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.
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