Angina pectoris definition
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Understanding Angina Pectoris: Definition and Key Insights
Definition of Angina Pectoris
Angina pectoris is a clinical syndrome characterized by episodes of chest pain or discomfort due to myocardial ischemia, which is an imbalance between the heart's oxygen supply and demand. This condition is typically triggered by physical exertion or emotional stress and is relieved by rest or nitroglycerin . The pain is often described as a pressure or choking sensation in the chest, but it can also radiate to adjacent areas such as the shoulders, arms, neck, or jaw .
Pathogenesis and Mechanism
The underlying cause of angina pectoris is usually the narrowing of coronary arteries due to atherosclerosis, which limits blood flow to the myocardium. This reduction in blood flow leads to myocardial ischemia, especially during increased physical or emotional stress when the heart's oxygen demand rises . The exact sequence of events during an anginal attack remains a subject of ongoing research, with multiple theories proposed to explain the pathophysiology.
Types of Angina Pectoris
Stable Angina
Stable angina is the most common form and is characterized by predictable chest pain that occurs with exertion or stress and is relieved by rest or nitroglycerin. It is associated with a fixed atherosclerotic plaque in the coronary arteries .
Variant Angina
Variant angina, also known as Prinzmetal's angina, occurs at rest and is not typically triggered by physical exertion or stress. It is caused by transient coronary artery spasms, which temporarily reduce blood flow to the myocardium. This type of angina is often more severe and can be cyclic, occurring at the same time each day.
Mixed Angina
Mixed angina involves features of both stable and variant angina. Patients may experience predictable chest pain with exertion as well as unpredictable pain at rest due to transient impairments in coronary blood flow.
Clinical Significance and Management
Angina pectoris is a significant predictor of major adverse cardiac events and can severely impact the quality of life. Management strategies include lifestyle modifications, pharmacologic therapy, and in some cases, revascularization procedures . Common medications used to manage angina include beta-blockers, nitrates, calcium channel blockers, and newer agents like ranolazine . In refractory cases, advanced treatments such as enhanced external counterpulsation, transmyocardial revascularization, and stem cell therapy are being explored .
Conclusion
Angina pectoris is a complex and multifaceted condition primarily caused by myocardial ischemia due to coronary artery disease. Understanding its various forms and underlying mechanisms is crucial for effective management and improving patient outcomes. Ongoing research continues to refine our knowledge and treatment approaches, offering hope for better therapeutic options in the future.
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