Angina

Question 1

Definition

Answer 1

Chest pain caused by restricted blood flow to the heart muscles

Question 2

Cause

Answer 2

Usually caused by atherosclerotic changes within the arteries supplying blood to the heart (coronary arteries) meaning they become narrowed and allow less blood flow. This is called coronary artery disease.

Things that can increase the risk of atherosclerosis:
– an unhealthy diet
– a lack of exercise
– smoking
– increased age
– a family history of atherosclerosis or heart problems

Question 3

Epidemiology

Answer 3

Incidence increases with age in both sexes

Women are more likely between the ages of 45-64 (5.7%)

Men are more likely between the ages of 65-84 (12-14%)

Mortality rate per year ranges from 1.2% to 2.4%

Question 4

Risk factors

Answer 4

Hypertension

Hyperlipidaemia

Diabetes mellitus

Sedentary lifestyle

Obesity

Smoking

Family history

Question 5

Clinical presentation

Answer 5

Classically felt as an ache or discomfort in the centre of the chest

Substernal pressure 2-3 mins

Patients may describe a tight or crushing sensation

May be associated with pain or parasthesia in 1 or both arms

May radiate to jaw and face pain

Lasts for up to 10 minutes

Other symptoms:
– fatigue
– dizziness
– shortness of breath
– feeling sick

On physical examination:
– can be hypertension, tachycardia, systolic murmur

Triggers:
– exertion
– emotion
– cold windy weather
– unaffected by twisting, inspiration or turning

Question 6

Different types of angina

Answer 6

Classical angina:
– chest pain that’s ‘heavy’, ‘tight’ and ‘gripping’
– typically pain is central and may radiate to the jaw or arms
– the pain tends to occur with exercise or emotional stress, or when walking up slopes in cold weather, and eases rapidly with rest

Stable angina (more common):
– attacks have a trigger (such as stress or exercise) and stops within a few minutes of rest

Unstable angina (more serious):
– attacks are more unpredictable (they may not have a trigger) and can continue despite resting
—- some people develop unstable angina after having stable angina

Refractory angina:
– patients with severe coronary disease in whom revascularization is not possible and angina is not controlled by medical therapy

Vasospastic or variant angina (prinzmetals):
– angina that occurs without provocation, usually at rest, as a result of coronary artery spasm. Occurs more frequently in women

Microvascular angina:
– patients have exercise-induced angina but normal or unobstructed coronary arteries.