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AnginaPectoris

Whatisanginapectoris?
Anginapectorisisthemedicaltermforchestpainordiscomfortduetocoronaryheart
disease. Anginaisasymptomofaconditioncalledmyocardialischemia. Itoccurs
whentheheartmuscle(myocardium)doesn'tgetasmuchblood(henceasmuch
oxygen)asitneeds.Thisusuallyhappensbecauseoneormoreoftheheart'sarteries
(bloodvesselsthatsupplybloodtotheheartmuscle)isnarrowedorblocked.
Insufficientbloodsupplyiscalledischemia.
Anginaalsocanoccurinpeoplewithvalvularheartdisease,hypertrophic
cardiomyopathy(thisisanenlargedheartduetodisease)oruncontrolledhighblood
pressure. Thesecasesarerare,though.
Typicalanginaisuncomfortablepressure,fullness,squeezingorpaininthecenterof
thechest. Thediscomfortalsomaybefeltintheneck,jaw,shoulder,backorarm.
Manytypesofchestdiscomfortaren'trelatedtoangina. Acidreflux(heartburn)and
lunginfectionorinflammationareexamples.
Whendoesanginapectorisoccur?
Anginaoftenoccurswhentheheartneedsmoreblood. Forexample,runningtocatcha
buscouldtriggeranattackofanginawhilewalkingmightnot. Anginamayhappen
duringexercise,strongemotionsorextremetemperatures.Somepeople,suchasthose
withacoronaryarteryspasm,mayhaveanginawhenthey'reresting.(Seebelow,
unstableangina,Prinzmetal'sorvariantanginapectoris.)
Anginaisasignthatsomeoneisatincreasedriskofheartattack,cardiacarrest
andsuddencardiacdeath.SeetherelatedentriesinthisEncyclopedia,listedbelow.
Alsosee"RiskFactorsandCoronaryHeartDisease,""HeartAttackSymptoms/
WarningSigns"and"AnginaPectorisTreatments."
Whatisstableangina?
Peoplewithstableangina(orchronicstableangina)haveepisodesofchestdiscomfort
thatareusuallypredictable. Theyoccuronexertion(suchasrunningtocatchabus)or
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undermentaloremotionalstress.Normallythechestdiscomfortisrelievedwith
rest,nitroglycerinorboth.
Peoplewithepisodesofchestdiscomfortshouldseetheirphysicianforanevaluation.
Thedoctorwillevaluatetheperson'smedicalhistoryandriskfactors,conductaphysical
exam,orderachestXrayandtakeanelectrocardiogram(ECG). Somepeoplewillalso
needanexerciseECG(stresstest),anechocardiogram orotherteststocompletethe
diagnosis.
Whatisunstableangina?
Inpeoplewithunstableangina,thechestpainisunexpectedandusuallyoccurswhileat
rest. Thediscomfortmaybemoresevereandprolongedthantypicalanginaorbethe
firsttimeapersonhasangina. Themostcommoncauseisreducedbloodflowtothe
heartmusclebecausethecoronaryarteriesarenarrowedbyfattybuildups
(atherosclerosis). Anarterymaybeabnormallyconstrictedorpartiallyblockedbya
bloodclot.Inflammation,infectionandsecondarycausesalsocanleadtounstable
angina. InaformofunstableanginacalledvariantorPrinzmetal'sangina,thecauseis
coronaryarteryspasm.
Unstableanginaisanacutecoronarysyndromeandshouldbetreatedasan
emergency. Peoplewithnew,worseningorpersistentchestdiscomfortshouldbe
evaluatedinahospitalemergencydepartmentor"chestpainunit"andmonitored
carefully. They'reatincreasedriskfor
acutemyocardialinfarction(heartattack).
severecardiacarrhythmias.Thesemayincludeventriculartachycardiaand
fibrillation.
cardiacarrestleadingtosuddendeath.
Whatisvariantanginapectoris(Prinzmetal'sangina)?
VariantanginapectorisisalsocalledPrinzmetal'sangina.Itusuallyoccurs
spontaneously,andunliketypicalangina,itnearlyalwaysoccurswhenapersonisat
rest. Itdoesn'tfollowphysicalexertionoremotionalstress,either. Attackscanbevery
painfulandusuallyoccurbetweenmidnightand8a.m.
Variantanginaisduetotransientcoronaryarteryspasm. Abouttwothirdsofpeople
withithaveseverecoronaryatherosclerosisinatleastonemajorvessel.Thespasm
usuallyoccursveryclosetotheblockage.