Define angina
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Understanding Angina: Definition, Symptoms, and Mechanisms
Definition of Angina
Angina pectoris, commonly referred to as angina, is a clinical syndrome characterized by chest discomfort due to myocardial ischemia, which is a mismatch between the oxygen supply and demand of the heart muscle . The term "angina" is derived from the Latin word "angere," meaning "to strangle," reflecting the sensation of chest tightness or pressure experienced by patients.
Symptoms and Presentation
Typical Angina Symptoms
Typical angina is described as substernal chest pain or discomfort that is often triggered by physical exertion or emotional stress and is relieved by rest or nitroglycerin . The pain may radiate to the arms, jaw, or upper back, indicating that the heart is not receiving enough oxygen. This type of angina is commonly associated with coronary artery disease (CAD) and is a significant predictor of major adverse cardiac events.
Atypical Angina Symptoms
Atypical angina, more frequently observed in women and elderly patients, may present with symptoms that are not as clearly related to physical exertion or stress and can occur even at rest. These patients often have nonobstructive CAD, making diagnosis and management more challenging .
Mechanisms of Angina
Myocardial Ischemia
The primary mechanism behind angina is myocardial ischemia, which occurs when there is an imbalance between the heart's oxygen supply and demand. This can be due to atherosclerotic plaque in the coronary arteries, leading to reduced blood flow .
Other Contributing Factors
Angina can also occur in the absence of significant coronary artery obstruction. Factors such as endothelial dysfunction, coronary artery spasm, and microvascular impairment can contribute to the development of angina symptoms . Additionally, conditions like valvular heart disease, hypertrophic cardiomyopathy, and uncontrolled hypertension can also lead to angina.
Conclusion
Angina is a complex and multifaceted condition primarily characterized by chest discomfort due to myocardial ischemia. It can present in typical forms, often related to physical exertion or stress, and atypical forms, which are more common in women and the elderly. Understanding the underlying mechanisms, including coronary artery disease and other contributing factors, is crucial for effective diagnosis and management.
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