Angina pectoris: symptoms and causes

By Cristiano Antonino On Dec 14, 2022

What is angina pectoris? The term angina denotes a manifestation of Myocardial Ischemia of which it is a member, predominantly a consequence of atherosclerosis, characterized by the formation of atheromatous plaques that result in narrowing (stenosis) of varying degrees along the arteries

This results in reduced blood, and therefore oxygen, and nutrient supply to the areas irrigated by the diseased branch.

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Signs and symptoms of angina pectoris

Angina pectoris represents the most frequent symptom of coronary atherosclerosis and is manifested by intense, transient pain with regression at rest, lasting from 5 to 15 minutes, located in the center of the chest, often radiating down the left arm but also to the right or both arms.

Less frequently, it may radiate to the neck, jaw, epigastric region, and scapulae.

Those affected describe the pain as a sense of constriction, weight, compression, less frequently burning.

In most patients, angina occurs sporadically, usually related to exertion, and is therefore termed stable angina pectoris.

A second form of angina, termed unstable angina, straddles the line between stable angina and true infarction and includes various clinical pictures:

new-onset angina (within the last two months), in which there are episodes of pain, from mild physical exertion and/or normal daily tasks, that are more protracted than in stable angina;
aggravating angina (within the last two months), in which there is aggravation of a preexisting stable angina with the occurrence of more intense, lower threshold and/or resting episodes of pain, protracted in time and more frequent;
early post-infarct angina, if it occurs less than 30 days after acute myocardial infarction, usually within 2 weeks, with sudden increase in severity of pre-existing stenosis. It indicates coronary artery disease in still active phase, characterized by high incidence of reinfarction and high mortality.

Angina pectoris, while less severe than infarction, is characterized by the unpredictability and instability of the clinical picture, hence the term ‘unstable’

It is, in fact, an expression of an unstable state of the disease that, in the absence of appropriate therapies to be carried out in the hospital, can lead to the onset of infarction.

To date, it is one of the major causes of mortality in Western countries.

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Causes of angina pectoris

Unlike infarction, in angina pectoris there is temporary myocardial ischemia (decreased nutritional supply to the myocardium) due to temporary narrowing of a coronary artery, resulting from spasm and/or an initial, reversible thrombotic process.

Infarction, on the other hand, occurs when the occlusion lasts for more than 30 minutes, resulting in the death of some cardiac cells

Coronary syndromes can, moreover, have a variable prognosis: in other words, some patients have a low probability of events such as infarction, persistent angina, and death (1-2% in the three months after the onset of symptoms).

Other patients have a 20-30% risk of events; and it is in these cases that treatment is most effective.

Consequently, it is very important at an early stage to identify individuals with severe angina and with extracardiac disease and associated cardiovascular risk factors.

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