Angina

Angina, or angina pectoris, is chest pain or discomfort caused by transient myocardial ischemia, typically arising when the heart muscle does not receive enough blood flow through the coronary arteries. It most often reflects underlying coronary artery disease and a mismatch between oxygen supply and demand.

There are several types. Stable angina results from fixed atherosclerotic narrowing and usually occurs with exertion or emotional stress, improving with rest or nitroglycerin. Unstable angina is new or changing chest pain that can occur at rest and signals a high risk of heart attack. Variant (Prinzmetal) angina is due to a temporary coronary vasospasm and may occur unpredictably, sometimes with ST-segment elevation on ECG.

Symptoms commonly include a pressure, squeezing, tightness, or burning sensation in the chest, which may radiate to the left arm, neck, jaw, or back. Other signs can include shortness of breath, sweating, nausea, or dizziness. Women, older adults, and people with diabetes may have atypical presentations.

Causes and risk factors center on coronary artery disease, though other conditions can contribute. Atherosclerosis is the principal mechanism reducing blood flow. Risk factors include age, male sex, smoking, hypertension, high cholesterol, diabetes, obesity, physical inactivity, and a family history of heart disease.

Diagnosis relies on clinical history, resting ECG, and tests during symptoms or rest, such as stress testing, imaging, or blood biomarkers to exclude myocardial infarction. Coronary angiography may reveal the degree of artery narrowing.

Treatment aims to relieve symptoms, improve prognosis, and prevent heart attack. Acute treatment uses nitroglycerin; long-term therapy includes beta-blockers, calcium channel blockers, long-acting nitrates, antiplatelet therapy (aspirin, P2Y12 inhibitors), statins, and risk-factor modification. Revascularization by PCI or CABG may be considered for certain patients.