Angina pectoris - causes, Symptoms, Treatment

What is Angina Pectoris?

Angina pectoris is the medical term for pain or discomfort in the chest due to an inadequate supply of oxygen-rich blood to the heart. It is often described as a pressure, squeezing, or aching sensation in the chest which can then radiate to the back, neck, arms, shoulders, teeth, or jaw. Angina is not a disease in itself but a symptom related to an underlying problem of the heart, which is usually coronary artery disease.

Why Does Angina Pain Radiate to the Arm, Neck & Jaw?

Angina pectoris begins whenever the load on the heart becomes more in relation to the available coronary blood flow. This pain is usually felt beneath the upper sternum over the heart. In addition, it is often referred to distant surface areas of the body, most commonly the left arm, left shoulder, neck and even to the side of the face.

The reason for this distribution of pain is that the heart originates during embryonic life in the neck, as do the arms. Therefore, both the heart and these surface areas of the body receive pain nerve fibers from the same spinal cord segments.

Types of Angina Pectoris

Understanding the different types of angina pectoris is important for the identification of its symptoms and timely treatment.

Stable Angina

It is controlled with the help of lifestyle measures and medication, and therefore, control of the amount of physical activity and managing stress are necessary for the patient.

Unstable Angina

It is an acute condition that requires immediate treatment in order to prevent damage to the heart.

Variant (Prinzmetal) Angina

Responsive to vasodilators, such as nitrate or calcium channel blockers.

Microvascular Angina

It can be trickier to diagnose because of the location of the problem in the smaller blood vessels, and the assessment must cover the entire complexity of symptoms and medical history.

Risk Factors of Angina Pectoris

Several risk factors cause angina pectoris, that are:

• Coronary Artery Disease: This is the most common cause of angina, generally where the arteries become narrowed or blocked.

• Hypertension: Over time, high blood pressure can damage the arteries, thereby increasing the risk of angina.

• High Cholesterol: It prevents proper blood flow in the arteries due to plaque build-up.

• Smoking: Smoking causes harm to the blood vessels and reduces the oxygen delivery to the heart.

• Diabetes: The risk of developing the disease of coronary artery increases.

• Sedentary Lifestyle: Laziness at work causes no exercise, and subsequently obesity and heart disease

• Obesity: Increased body weight is a strain on the heart.

Symptoms of Angina Pectoris

Recognition of symptoms of angina pectoris is an important step to ensure medical intervention at the right time. Some common symptoms include:

• Chest Pain or Discomfort: It is usually felt to squeeze or pressure.

• Diffuse Pain: Pain may spread to the shoulders, neck, arms, back, teeth, or jaw.

• Shortness of breath: This can be an isolated finding or be present in conjunction with chest pain.

• Nausea: Some people can experience nausea and abdominal pain.

• Fatigue: Some individuals, especially females, may experience unusual levels of tiredness that may indicate angina.

Diagnosis of Angina Pectoris

Diagnosis of angina pectoris includes the following;

Medical History

It provides an overall appreciation of signs and symptoms and risk factors

Electrocardiogram (ECG)

ECG measures activities of the heart .It detects anomalies and monitors heart performance.

Stress Testing

This tests how the heart performs under physical stress

Imaging (Echo / Angiography)

Echocardiograms, or coronary angiography, to check blood flow through the coronary arteries.

Treatment for Angina Pectoris

Angina pectoris treatment is directed towards the relief of symptoms and improvement in heart function. General treatment options are:

Lifestyle Modifications

Lifestyle changes like diet, exercise, and weight loss counseling to promote a healthy lifestyle.

Medications

Nitrates, beta-blockers, calcium channel blockers, and antiplatelet medications to improve blood flow and also reduce chest pain.

Surgical Interventions

Angioplasty, CABG, or other interventions are required in more severe cases to open blood vessels.

Angina Pectoris NEET MCQs (With Answers & Explanations)

Important questions asked in NEET from this topic are:

• Types of Angina pectoris

• Symptoms, diagnosis & treatment of angina pectoris

Practice Questions for NEET

Q1. Heaviness with severe chest pain which may disappear with rest indicates

1. Angina pectoris

2. Atherosclerosis

3. Arteriosclerosis

4. Hyperthyroidism

Correct answer: 1) Angina pectoris

Explanation:

Angina pectoris, a condition frequently known as angina, is a manifestation of cardiac distress that arises when the myocardium is deprived of an adequate supply of oxygenated blood. Typically, this condition is indicative of a more profound issue, namely coronary artery disease (CAD).

Causes:
The primary etiological factor for angina pectoris is the diminished perfusion of the heart muscle secondary to atherosclerosis, a condition characterized by the gradual buildup of plaque within the coronary arteries, leading to their narrowing.
Another significant cause is an augmentation in the heart's oxygen requirements, which may surpass the limited supply provided under the constraints of impaired blood flow. This increased demand is often triggered by activities such as exercise or exposure to stressful situations.

Hence, the correct answer is option 1) Angina pectoris

Q2. Blood pressure in the pulmonary artery is:

1. same as that in the aorta.

2. more than that in the carotid.

3. more than that in the pulmonary vein.

4. less than that in the venae cavae.

Correct answer: 3) more than that in the pulmonary vein.

Explanation:

The openings of the right and the left ventricles into the pulmonary artery and the aorta respectively are provided with the semilunar valves.

The valves in the heart allow the flow of blood only in one direction, i.e., from the atria to the ventricles and from the ventricles to the pulmonary artery or aorta. These valves prevent any backward flow.

Hence, the correct answer is Option (3) more than that in the pulmonary vein.

Q3. Most probable cause of heart attack is

1. Vasomotion

2. Systolic pressure 120 mmHg

3. Arteriosclerosis

4. High level of HDL

Correct answer: 3) Arteriosclerosis

Explanation:

Myocardial infarction is also referred to as a heart attack It results from the expiration of a part of the heart muscle following the stopping of blood supply. The symptoms of myocardial infarction include chest pain or discomfort (angina), shortness of breath, nausea, sweating, and pain radiating to the arm, jaw, or back. If left undiagnosed, can lead to major complications like heart failure and even death.

Hence, the correct answer is option 3) Arteriosclerosis.

Also Read:

• MCQ Practice on Disorders of the Circulatory System

• Components of Blood

• Disorders of the Circulatory System

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