Chest pain or angina pectoris is transient discomfort or pain located in the anterior chest, perceived as a feeling of pressure, tightness or burning.
Angina pectoris occurs when the heart muscle – the myocardium – does not receive enough blood and oxygen. This process is called myocardial ischemia or coronary ischemia. This oxygen deficiency can be the result of an increase in their needs, reduce supply or both. The oxygen requirements of the heart are determined by their level of effort, ie, the frequency and intensity of the heartbeat.
The physical effort and emotions increase heart work, also increasing the demand (need) of oxygen by this Committee. The coronary arteries that have a narrowing, so that blood flow to the myocardium can not be increased to meet an increased need for oxygen, may lead to attacks of angina pectoris.
The main cause of angina is coronary artery disease, ie, the presence of fat (atheroma) signs on the wall of the heart arteries. Angina pectoris may be due to other causes, including hypertensive heart disease (heart disease caused by high blood pressure) and disease of the heart valves, especially the narrowing of the aortic valve (aortic stenosis).
Disease of the heart muscle or mioardiopatias (hypertrophic and dilated types) is other cause of angina pectoris. These diseases are characterized by a dilation and an abnormal thickening of myocardium, respectively, resulting in an increase of the oxygen requirements by this muscle.
Coronary artery spasm (sudden and transient contraction of the muscular layer of the coronary artery), coronary tortuosity (pies coronary arteries) and intramyocardial bridge (abnormal course of coronary artery within the heart muscle, causing a narrowing during heart contraction) are also other possible causes of angina pectoris.
Signs and symptoms
Not all individuals with myocardial ischemia have angina pectoris. This process is called silent myocardial ischemia. Patients often perceive the crises of angina pectoris as a feeling of pressure, tightness or burning in the central region of the chest. Pain can also affect the shoulders or radiate the inner face of the upper limbs, back, neck, jaw or upper abdomen.
Many people describe the feeling more like a discomfort or a pressure than pain itself. Typically, angina is triggered by physical activity, lasts for a few minutes – 3-15 minutes – and goes away with rest or use of nitrates (coronary vasodilators).
The pain of angina is not usually aggravated by breathing or movement of the chest. Emotional stress can also trigger seizures or worsening of angina pectoris.
Forms of presentation
Angina pectoris can be called stable, unstable or variant. A stable angina pectoris is one that always has the same characteristics, ie, the triggering, factor intensity and duration usually always be the same. In unstable angina pectoris, the discomfort is replaced by a higher frequency, intensity or duration, often appearing to rest. The unstable angina pectoris is a medical emergency, it may evolve into a myocardial infarction (heart attack) or death.
The unstable angina pectoris is often a result of rupture of a fatty plaque (atheroma accident) in a coronary artery, leading to formation of a thrombus partially interrupts the flow of blood to an area of the myocardium.
The variant chest angina – also called Prinzmetal’s angina – results from a coronary artery spasm This type of angina is called variant because it is characterized by the occurrence of pain with the individual at rest (usually at night) and not during exercise. Another feature of variant angina is the presence of typical electrocardiographic changes.
Most popular antianginal drug – amlodipine