Stenokardia

Stenokardia, also called angina pectoris, is chest discomfort caused by myocardial ischemia due to inadequate blood flow to the heart muscle. It arises from an imbalance between myocardial oxygen demand and supply, most commonly secondary to atherosclerotic coronary artery disease. The pain is typically a pressure, squeezing, or heaviness in the chest that may radiate to the left arm, neck, jaw, or back. It is usually provoked by physical exertion or emotional stress and relieved by rest or nitroglycerin. Some individuals, especially women, the elderly, and those with diabetes, may present with atypical symptoms.

There are several forms of stenokardia. Stable angina has a predictable pattern related to exertion and responds to rest or medication. Unstable angina is new or worsening and can occur at rest, indicating higher risk for myocardial infarction. Variant (Prinzmetal) angina results from episodic coronary vasospasm. Microvascular angina can occur with non-obstructive coronary arteries and is related to dysfunction of small vessels.

Diagnosis relies on clinical history and changes observed on the electrocardiogram during episodes, with cardiac biomarkers typically normal unless a myocardial infarction occurs. Noninvasive evaluation includes stress testing and imaging; coronary angiography identifies the location and severity of obstructions.

Management focuses on risk factor modification and relief of symptoms. Antiplatelet therapy (often low-dose aspirin), statins, and blood pressure control are common. Antianginal drugs include short-acting nitrates for immediate relief and longer-acting agents such as beta-blockers or calcium channel blockers; ranolazine may be used for refractory cases. Revascularization through percutaneous coronary intervention or coronary artery bypass grafting is considered for patients with high-risk anatomy or persistent symptoms despite medical therapy. Prognosis improves with effective treatment and risk factor management.