Angina Pectoris: Understanding Treatment and Prevention Strategies

They sprint to the bus, climbing several floors by stairs or unusually strenuous physical activity – and suddenly the upper body becomes tight, breathing difficult, and it hurts behind the breastbone. This is known as angina pectoris – a clear warning signal that must be taken seriously because, in many cases, there is a circulatory disorder in the heart muscle behind it.

Development of angina pectoris

The arterial blood supply to the heart muscle occurs via the coronary arteries, originating in the aorta and fan out like a treetop outside the heart.

If there is an imbalance between the oxygen demand of the heart muscle and the oxygen supply via the coronary vascular system, circulatory disorders can occur in the heart muscle. This causes pain and a feeling of tightness – angina pectoris (AP).

 

Causes of angina pectoris

The most common cause of circulatory disorders is hardening of the arteries (atherosclerosis), which has progressed over the years. The resulting constrictions mean that the coronary arteries are initially unable to ensure adequate blood flow, especially when the heart muscle needs more oxygen, such as during physical exertion, later even at rest.

This is also known as coronary artery disease (CHD) – angina pectoris is, therefore, its main symptom.

Rarer causes of angina pectoris can be vasospasms, i.e. the spasmodic constriction of the coronary vessels (Prinzmetal’s angina), as well as heart muscle or heart valve diseases, all of which can also lead to an increased oxygen requirement of the heart muscle.

Features, diagnostics, course

Depending on whether angina pectoris occurs during physical exertion or at rest, one speaks of stress angina or rest angina:

• Stress angina characteristically occurs when the coronary arteries can still ensure adequate blood flow despite existing constrictions under resting conditions. However, when there is an increased need for oxygen, for example, during sporting activity, the lack of blood circulation becomes clear. The symptoms go away at rest (or after the administration of nitroglycerin ).
• Resting angina:  In the case of severe constriction of the coronary arteries, circulatory disorders of the heart muscle can occur even under resting conditions. Suppose an exercise-dependent angina pectoris changes to angina at rest over time. In that case, this is often a sign of an increase in the constriction of the coronary arteries and is a critical alarm symptom.

 

Stable and unstable Angina pectoris

Professionals also distinguish between stable angina and unstable angina – with exertional angina almost always being a stable form unless it is very severe for the first time or progressively worsening during an attack. Angina at rest, on the other hand, is permanently assigned to the unstable form since it can be the immediate precursor or the first symptom of a heart attack.

To differentiate between an angina at rest reliably and an acute myocardial infarction, it is necessary even for a doctor to write an electrocardiogram (ECG) and determine laboratory values.

If angina pectoris symptoms occur, a doctor should be consulted as early as possible.

heart attack as a complication

In most cases, angina pectoris is the warning sign of coronary artery disease. The most severe complication can be a heart attack, which can lead directly to death or significantly reduce life expectancy due to side effects such as cardiac arrhythmia or cardiac muscle weakness.

But even without an acute myocardial infarction, the person affected is at risk of cardiac arrhythmias occurring or the strength of the heart muscle decreasing simply because of the chronic circulatory disorders.