Overview
Definition
Predictable chest pain or discomfort caused by transient myocardial ischemia, typically occurring with exertion or emotional stress and relieved by rest or nitroglycerin.
Epidemiology
Affects millions of adults; a primary manifestation of stable ischemic heart disease (SIHD).
Etiology & Risk Factors
- Atherosclerotic narrowing of one or more epicardial coronary arteries (typically >70% stenosis)
- Coronary vasospasm (Prinzmetal angina)
Clinical Symptoms
- Substernal chest pressure/heaviness
- Radiation to left arm, neck, or jaw
- Triggered by physical exertion
- Relieved completely by rest within 5-10 minutes
Clinical Approach
Diagnosis
- Clinical history is paramount
- ECG (usually normal at rest; ST depression during pain)
- Stress Testing (Exercise ECG, Stress Echo, or Nuclear Perfusion scan)
- Coronary CT Angiography (CCTA)
Management
- Risk factor modification (Statins, Aspirin, strict BP control, smoking cessation)
- Antianginal therapy: Beta-blockers (first-line), Calcium Channel Blockers, Long-acting Nitrates, Ranolazine
- Sublingual nitroglycerin for acute episodes
Complications
- Progression to Acute Coronary Syndrome (Unstable Angina / MI)
- Ischemic cardiomyopathy
- Sudden cardiac death