Angina pectoris is one of the most common symptoms in the field of cardiology. The term "angina pectoris" comes from Latin and means "tightness in the chest". Thus, angina pectoris is characterized by pain with a feeling of tightness in the chest. In many patients, the cause is coronary heart disease.
Below you will find further information and selected angina pectoris specialists.
Angina pectoris (chest tightness) causes pain in the chest area. It can be traced back to an insufficient supply of oxygen-rich blood to the heart muscle.
Those affected often describe this pain as
The pain of angina pectoris can radiate into the arms, lower jaw or upper abdomen.
Depending on the severity of the symptoms
can trigger angina pectoris. The pain disappears completely when the patient is at rest or relaxed.
In women, atypical symptoms (abdominal pain) occur more frequently.
If the symptoms recur after a short period of improvement, this is referred to as"walking-through angina".
In many cases, the cause of angina pectoris is coronary heart disease. Arteriosclerotic deposits cause narrowing of the coronary arteries. As a result, the heart muscle no longer receives enough blood or oxygen. This impairs heart function.
Other triggers of angina pectoris can be:
However, pain in the chest area can also be triggered by numerous other diseases, for example in the area of
Chest wall syndrome, for example, is the cause of chest pain in 43 to 47 percent of cases. Chest wall syndrome is usually caused by tension in the chest muscles.
Chronic coronary heart disease, on the other hand, is only responsible for around ten percent of cases. The doctor will take these differential diagnoses into account when making a diagnosis.
Mental illnesses can also lead to angina pectoris.
Angina pectoris can be classified according to
into a stable and an unstable form.
The term "stable" means that the symptoms always manifest themselves under the same circumstances. The course of the disease is therefore constant.
The severity of angina pectoris is not determined by the intensity of the pain, but by the way in which the pain is triggered.
Angina pectoris, the symptoms of which only become noticeable during severe physical exertion, is therefore a milder form of the disease. In contrast, angina pectoris that occurs at rest or during light exertion is one of the more severe forms.
The chest pain usually lasts between a few to about 15 minutes.
According to the Canadian Heart Society (CSS), stable angina pectoris is divided into four degrees of severity:
The term "unstable" indicates that the extent of the symptoms has changed from its usual character.
If the disease-related symptoms initially only occur during heavy exertion and now become noticeable during light exertion or even at rest, this change is referred to as unstable angina.
The diagnosis can only be made by a doctor, usually a specialist in cardiology. They will first ask about the patient's symptoms and when they typically occur. This may already reveal a trigger for the occurrence of the symptoms.
The doctor also needs to know whether the administration of nitrous spray improves the symptoms. This enables him to recognize whether the symptoms described by the patient are actually related to a heart-related illness.
As part of the physical examination, the doctor will listen to the patient's heart. A blood pressure measurement is also recommended in this case in order to be able to diagnose any high blood pressure. This increases the risk of arteriosclerosis and damages the vessel wall from the inside.
An electrocardiogram (ECG) at rest and under stress allows the activity of the heart muscle to be visualized in the form of a cardiac tension curve. However, in more than half of patients suffering from angina pectoris, the resting ECG is normal.
An ECG shows the activity of the heart muscle © jimmyan8511 | AdobeStock
The exercise ECG, on the other hand, is somewhat more informative. If the doctor suspects cardiac arrhythmia, he or she will recommend a long-term ECG to the patient. The patient is given a portable ECG device to carry with them for 24-48 hours.
During an echocardiogram, the doctor can detect changes in the heart using ultrasound. It is sometimes carried out under physical stress, more often under medical stress (stress echocardiography).
This examination also allows the functionality and condition of the heart valves and ventricles to be assessed. This examination method can be carried out quickly and gently for the patient. It is one of the standard examination options for angina pectoris.
Myocardial perfusion SPECT is the standard procedure for visualizing the blood supply to the heart muscle. This provides the doctor with information on
of the heart muscle.
Other imaging procedures for the examination of angina pectoris are
Theaim of these procedures is to identify the areas of the heart muscle that are not properly supplied with blood. They also make it possible to visualize constricted or blocked vessels.
A coronary catheter examination(coronary angiography) can be used to definitively detect or rule out coronary heart disease. A catheter is advanced through the vascular system into the coronary arteries and the constrictions in the vessels are assessed.
Medication is available to treat an acute attack of angina pectoris. These so-called nitro preparations are taken in the form of sprays or capsules. These nitrates dilate the blood vessels, which relieves the pressure on the heart.
In the event of an emergency, anticoagulants (ASA and heparin) and, if necessary, beta-blockers can also be administered.
Unstable angina pectoris is an acute emergency. There is an increased risk of a heart attack. Therefore, if the patient suffers from chest tightness for the first time or the symptoms are relieved by
or rest, an emergency doctor should be called immediately.
Regardless of the acute emergency, the treatment of angina pectoris consists of
For this purpose, various
are available. These include
Statins or other lipid-lowering drugs (ezetimibe, PCSK9 inhibitors) reduce blood lipid levels. This reduces the risk of increasing vasoconstriction.
In order to permanently alleviate the symptoms, the underlying disease, often coronary heart disease, must be treated. In addition to the aforementioned drug treatment, the focus is on reopening the narrowed or blocked vessels. This allows a sufficient amount of blood to flow through the vessels again (known as revascularization).
There are various methods, depending on the condition of the coronary vessels and any concomitant diseases of the patient:
Lifestyle changes also reduce the risk of complications in patients with coronary heart disease. These include, for example
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