This document discusses the different types of angina, including stable angina, unstable angina, variant angina, and microvascular angina. Stable angina is the most common type and is triggered by physical activity, with pain relieved by rest. Unstable angina can occur at rest and is more dangerous, as it suggests a heart attack may soon happen. Variant angina is rare and caused by coronary artery spasms, while microvascular angina occurs when the smallest coronary arteries are not working properly. The document also covers the definition, symptoms, causes, pathophysiology, risk factors, and references for further information about angina.

1. ANGINA & ITS TYPES
ABU RAIHAN SHAMS
Pharm.D 4th yr
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2. DEFINITION
 Angina is a type of chest pain caused by reduced blood flow to the
heart.
 Angina pectoris is a clinical syndrome of IHD resulting from transient
myocardial ischemia.
 It is characterized by paroxysmal pain in the substernal or precordial
region of the chest , which is aggrevated by ab increase in the
demand of the heart and relieved by a decrease work of the heart.
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3.  Angina results when there is an imbalance between the heart's
oxygen demand and supply.
 It is a symptom of coronary artery disease.
 Angina, also called angina pectoris, is often described as
squeezing, pressure, heaviness, tightness or pain in chest.
 Often, the pain radiates to the left arm, neck, jaw or right arm.
 It is more common in men past 5th decade of life.
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4. SIGN & SYMPTOMS
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o Angina symptoms include chest pain and discomfort, possibly
described as pressure, squeezing, burning or fullness.
o Pain may be in arms, neck, jaw, shoulder or back.
o Other symptoms that you may have with angina include:
•Dizziness
•Fatigue
•Nausea
•Shortness of breath
•Sweating

5. CAUSE
 Angina is caused by reduced blood flow to heart muscle
 The most common cause of reduced blood flow to your heart
muscle is coronary artery disease (CAD).
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Blood Flow reduction may be due to :-
➢ Narrowing or obstruction of arteries
due to plaque formation
➢ Coronary Vasospasm

6. PATHOPHYSIOLOGY
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Due to any cause
Increase oxygen demand in body
Increase heart work load
Heart need more blood supply
Then coronary artery dilate and supply more blood to heart
But due to any factors , blood supply defected
Heart need more blood demand
Decrease oxygen level in heart and develop condition of ischemia
Start angina (pain) in pectoris ( chest muscles)

7. Types of Angina
o Stable angina
o Unstable angina
o Variant angina & Microvascular angina
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8. Stable Angina
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o It is the most common type of angina
o It is also called classical or typical angina.
o It is usually triggered by physical activity
o It is caused by the reduction of coronary perfusion due to a fixed
obstruction of a coronary artery produced by atherosclerosis.
o It occurs when the heart is working harder than usual.
o Stable angina isn't a heart attack, but it suggests that a heart
attack is more likely to happen in the future.
o In this type of angina pain is relieved by rest.

9. Unstable Angina
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o It is also called angina at rest
o It may occur more often and be more severe than stable angina.
o Unstable angina can be caused by blood clots that block or partially
block your heart's blood vessels.
o Unstable angina also can occur with or without physical exertion, and
rest may not relieve the pain & any episode of this angina is longer
than 20 minutes
o Unstable angina is very dangerous and requires emergency treatment.
o This type of angina is a sign that a heart attack may happen soon.

10. Causes of Unstable Angina
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o Unstable angina is a form of acute coronary syndrome ,which can
result from rupture of an atherosclerotic plaque and partial or
complete thrombosis of a coronary artery.
o Most cases occur from disruption of an atherosclerotic lesion
followed by platelet activation of coagulation cascade that always
result in partial or complete occlusion …
• if this occlusion is untreated ,necrosis ( MI) of the cardiac muscle may
occur.
So, it’s an EMERGENCY situation that requires hospitalization and more
aggressive therapy to prevent myocardial infarction and death.

11. Variant Angina
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o It is also called Prinz metal's angina / non classical angina.
o This type of angina is rare.
o This type of angina is caused by a sudden spasm in a coronary artery,
which temporarily narrows the artery.
o Emotional stress, smoking, medications that tighten blood vessels
(such as some migraine drugs) and use of the illegal drug cocaine
may trigger Prinz metal's angina.
o Variant angina usually occurs at rest, and the pain can be severe.
o It usually happens between midnight and early morning.

12. Microvascular Angina
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o Microvascular angina can occur with coronary microvascular disease
(MVD). This affects the smallest coronary arteries.
o In this type, there is chest pain but no coronary artery blockage. Instead,
it happens because smallest coronary arteries aren’t working, so heart
doesn’t get the blood it needs.
o As well as chest pain, a person may experience:
o fatigue and low energy , sleep problems ,shortness of breath
o Microvascular angina tends to be more persistent than stable angina. It
often lasts longer than 10 minutes and sometimes longer than 30 minutes

13. RISK FACTORS
Angina can develop as a result of:
 Stress
 Unmanaged Diabetes
 Smoking
 Low physical activity
 An unhealthful diet
 High cholesterol levels
 Overweight or obesity
 Some conditions such as heart disease, diabetes, low blood pressure, metabolic
syndrome
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14. REFERANCES
❖https://www.mayoclinic.org/diseases-conditions/angina/symptoms-causes/syc-
20369373
❖https://www.webmd.com/heart-disease/heart-disease-angina#1
❖https://www.medicalnewstoday.com/articles/8886
❖Morrow DA, de Lemos JA. Stable ischemic heart disease. In: Zipes DP, Libby P,
Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease:
A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier;
2019:chap 61
❖KD TRIPATHI “ESSENTIALS OF MEDICAL PHARMACOLOGY” seventh edition ,
Jaypee brothers medical publishers (P) LTD. Page no.539,560
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