Angina pectoris is a clinical syndrome characterized by chest discomfort or pain resulting from myocardial ischemia, which occurs when the heart muscle does not receive sufficient oxygenated blood.

This condition is a critical indicator of underlying cardiovascular disease, particularly coronary artery disease, and requires careful evaluation and management.

<h3>Understanding Angina Pectoris</h3>

Angina pectoris literally means "chest pain" and represents a manifestation of myocardial ischemia due to an imbalance between the oxygen demand of the heart and the oxygen supply delivered by coronary circulation.

This ischemic mismatch can arise from various pathological processes that reduce coronary blood flow or increase myocardial oxygen consumption. Unlike a heart attack, angina does not typically cause permanent myocardial damage but signals that the heart muscle is under distress.

<h3>Etiology and Pathophysiology</h3>

The most common cause of angina is atherosclerotic coronary artery disease (CAD), where progressive plaque accumulation narrows the epicardial coronary arteries, restricting blood flow especially during increased cardiac workload. The arterial narrowing effectively limits oxygen delivery, causing ischemia during exertion or stress when myocardial demand escalates.

Other less common but significant causes include coronary artery spasm, which temporarily constricts coronary vessels causing variant or Prinzmetal angina. This form presents with chest pain predominantly at rest and without significant coronary artery obstruction.

Microvascular angina arises from dysfunction of the small coronary arteries and capillaries, frequently discussed as Syndrome X, which disproportionately affects women and presents diagnostic challenges due to the absence of large vessel disease.

External factors such as severe anemia, aortic stenosis, and hypertrophic cardiomyopathy may also contribute by either reducing oxygen carrying capacity or increasing myocardial oxygen consumption. Moreover, vasculitis and congenital anomalies can impair coronary perfusion, resulting in ischemic episodes.

<h3>Clinical Presentation</h3>

Classically, angina presents as a pressing, squeezing, or constrictive chest pain localized behind the sternum, often described as a heavy weight or tightening sensation. This pain may radiate to the jaw, neck, shoulders, arms, or back. Symptoms typically arise during physical exertion, emotional stress, or exposure to cold and usually resolve with rest or nitroglycerin administration within minutes.

Stable angina refers to predictable chest pain triggered by activities that increase oxygen demand and relieved by rest. Unstable angina is characterized by new onset, worsening intensity, or pain occurring at rest, representing a medical emergency due to elevated risk for myocardial infarction. Variant angina presents with cyclical chest pain caused by transient coronary spasms, often occurring nocturnally.

Additional symptoms accompanying angina may include dyspnea, diaphoresis, fatigue, dizziness, and nausea. Importantly, atypical presentations, especially in women, diabetics, and the elderly, may manifest as epigastric discomfort, fatigue, or jaw pain without classic chest symptoms, necessitating a high index of clinical suspicion.

<h3>Diagnostic Evaluation</h3>

The diagnosis of angina pectoris is primarily clinical, supported by detailed history taking and physical examination. Electrocardiogram (ECG) during episodes may reveal transient ST-segment depression or elevation, but a normal ECG does not exclude ischemia. Stress testing using exercise or pharmacological agents assesses inducible ischemia by monitoring ECG changes, symptoms, and hemodynamic response.

Imaging modalities such as echocardiography evaluate ventricular function and wall motion abnormalities, while coronary angiography provides definitive visualization of the coronary anatomy and extent of obstructive disease. Emerging non-invasive imaging like coronary computed tomography angiography (CCTA) aids in anatomical assessment, and cardiac magnetic resonance imaging (MRI) can evaluate myocardial perfusion and viability.

<h3>Treatment Strategies</h3>

Treatment of angina pectoris aims to alleviate symptoms, improve quality of life, reduce myocardial ischemia, and prevent cardiovascular events. Initial management includes lifestyle modifications such as diet optimization, regular physical activity, and control of comorbidities like hypertension and diabetes.

Pharmacological therapy encompasses anti-anginal agents including nitrates (which dilate coronary vessels and reduce preload), beta-blockers (which decrease heart rate and myocardial oxygen demand), and calcium channel blockers (which reduce coronary spasm and afterload). Antiplatelet therapies such as aspirin reduce thrombotic risk, while statins target atherosclerotic progression.

For patients with refractory or high-risk angina, revascularization procedures such as percutaneous coronary intervention (PCI) with stenting or coronary artery bypass grafting (CABG) may be necessary to restore adequate coronary blood flow. Continuous follow-up and risk factor optimization remain pivotal to manage progression and improve outcomes.

Dr. Nicholas (Nick) West, a highly credible expert in the field of interventional cardiology and cardiovascular medicine, states "The wide range of clinical data we are generating reflects our persistent focus on addressing unmet patient needs in cardiovascular medicine."

Angina pectoris is a complex clinical syndrome arising from myocardial ischemia due to an imbalance between oxygen supply and demand, most commonly resulting from coronary artery disease. It presents with characteristic chest discomfort but requires careful evaluation given the potential variability in symptoms.

A multidisciplinary approach combining lifestyle changes, medical therapy, and interventional procedures offers the best outcome for affected individuals.