This is a clinical syndrome of episodic chest discomfort due to transient myocardial ischemia. In most cases, angina is just a symptom of many other diseases such as aortic valvular disease and obstructive hypertrophic cardiomyopathy. It is more common in males in the range of 40-60 years. The pain of angina is triggered by exertion and relieved by rest or sublingual nitrate. Angina is of two types- stable and unstable.

CAUSES:

Coronary atherosclerosis is the main cause of it. It occurs due to the narrowing of the coronary artery due to intramural plaques as a result of atherosclerosis and causes ischemia due to the reduced blood supply and result in pain.

SYMPTOMS:

• Left-sided pain in the chest discomfort triggered by exertion and relieved by rest.
• Heaviness, squeezing, choking pain.
• Discomfort is represented by closing a hand around the throat by putting the fist on the sternum.
• Pain radiating to neck, jaw and in arms, the left arm, wrists, and hands.
• Pain during initial periods of walking is a feature of start-up angina.
• Angina occurring on lying down flat in the recumbent position is a feature of angina decubitus
• Angina occurring at night is a feature of nocturnal angina.

PRECIPITATING FACTORS FOR A PAIN:

• Anemia
• Obesity
• Thyrotoxicosis
• Pregnancy
• Aortic valve disease

DIAGNOSIS:

• Physical examination
• Resting ECG
• Exercise ECG
• Echocardiography
• Isotope scanning
• Coronary angiography

TREATMENT:

• REASSURANCE: the patient should be made comfortable and explain the nature of the disease and explaining the useful life even with angina pectoris.
• REMOVAL OF RISK FACTORS: by reducing habits such as smoking, physical exercise, cold weather, heavy meals and by including habits such as maintaining ideal body weight, using sublingual nitrate before exertion, change in lifestyle.
• DRUG THERAPY: includes aspirin, lipid-lowering agents, nitrates, sub-lingual tri-nitrite, beta-adrenoreceptor blocker, calcium channel blockers, combination therapy, potassium channel activators, cytoprotective agents.
• SURGERY: includes coronary angioplasty used in cases of unstable angina to provide complete revascularization in patients with single or two vessel disease and coronary artery bypass grafting is used in patients with left main coronary artery stenosis and triple vessel cases by using a reversed saphenous vein.