Angina types and symptoms
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Types of Angina: Typical, Atypical, and Special Forms
Angina is chest discomfort caused by reduced blood flow to the heart. The main types are typical angina, atypical angina, and special forms like microvascular and vasospastic angina. Typical angina is most strongly linked to obstructive coronary artery disease (CAD) and is characterized by chest pain or discomfort that is triggered by exertion or stress and relieved by rest or nitroglycerin. Atypical angina includes symptoms that do not fit the classic pattern, such as pain in the neck, jaw, or back, or symptoms like shortness of breath and fatigue. These atypical symptoms are more common in women and are less predictive of obstructive CAD than typical angina symptoms 2456.
Special forms of angina include:
- Microvascular angina (coronary microvascular dysfunction, CMD): Often presents with chest pain but normal coronary arteries on angiography.
- Vasospastic angina (VSA): Caused by spasms in the coronary arteries, leading to chest pain, often at rest.
- Angina with nonobstructive coronary arteries (ANOCA/INOCA): Patients have angina symptoms but no significant blockages in the main coronary arteries 13.
Common Angina Symptoms and Their Variations
The most common symptom of angina is chest pain, reported by nearly 90% of patients. Other frequent symptoms include chest tightness, chest pressure, shortness of breath, and fatigue. Over half of patients may experience symptoms at rest, not just during physical activity. Triggers for angina symptoms include exertion (most common), emotional stress, and rest .
Women are more likely than men to report pain in the arm, neck, back, or jaw, as well as symptoms like shortness of breath, weakness, nausea, and loss of appetite. Women also tend to describe their pain as stabbing or knifelike and are more likely to experience depression alongside angina 145.
Angina Symptom Patterns and Diagnostic Value
Typical angina symptoms (chest pain with exertion, relieved by rest) are the strongest predictors of obstructive CAD. Patients with these symptoms are more likely to have significant blockages in their coronary arteries. In contrast, atypical symptoms or non-chest pain symptoms are less predictive of CAD and may reflect different underlying causes or referral patterns 26.
In patients with angina but no obstructive coronary disease (ANOCA/INOCA), the type of angina can help suggest the underlying problem:
- Angina at rest is highly specific for coronary artery spasm (vasospastic angina).
- Exertional angina is more likely linked to microvascular dysfunction (CMD) .
Gender Differences in Angina Symptoms
While there is significant overlap in symptoms between men and women, women are more likely to experience and report non-chest pain symptoms, such as shortness of breath, weakness, and pain in areas other than the chest. This can lead to under-recognition or misclassification of angina in women if only typical symptoms are considered. The concept of a "gender continuum" in angina symptoms highlights that both men and women can experience a wide range of symptoms, and the distinction between "typical" and "atypical" angina may not always be helpful 145.
Angina Severity Classifications
Angina severity is often classified using standardized systems:
- The Canadian Cardiovascular Society (CCS) Angina Classification grades stable angina from I (mild) to IV (severe).
- The Braunwald Angina Classification is used for unstable angina, with classes I to III based on severity and context .
Conclusion
Angina presents in several forms, with typical angina being the most predictive of obstructive coronary artery disease. Symptoms can vary widely, especially between men and women, and may include chest pain, pressure, tightness, shortness of breath, and pain in other areas. Recognizing the full spectrum of angina symptoms, including those seen in special forms like microvascular and vasospastic angina, is important for accurate diagnosis and management. Understanding these differences helps ensure that all patients, regardless of gender or symptom type, receive appropriate evaluation and care 123456.
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