Angina pectoris occurs when your heart muscle (myocardium) does not get enough blood and oxygen. Not enough blood supply is called ischemia. Angina can be a symptom of coronary artery disease (CAD). This is when arteries that carry blood to your heart become narrowed and blocked. This can happen because of: Hardening of arteries (atherosclerosis) A blood clot Plaque in an artery that can rupture (unstable plaque) Poor blood flow through a narrowed heart valve Lessened pumping of the heart muscle Coronary artery spasm There are 2 other forms of angina pectoris. They are: Microvascular angina. This used to be called Syndrome X. It causes chest pain with no coronary artery blockage. The pain is caused by from poor function of tiny blood vessels that lead to the heart, arms, and legs. It is more common in women. Variant angina pectoris. This is also called Prinzmetal's angina. It is rare. It occurs almost only at rest, not after exercise or stress. It usually occurs between midnight and 8 a.m. It can be very painful. It is related to spasm of the artery. It is also more common in women.

1. Angina pectoris

2. Angina Pectoris
Commonly known as angina– is the sensation of chest pain, pressure, or
squeezing, often due to ischemia of the heart muscle from obstruction or
spasm of the coronary arteries.[1] While angina pectoris can derive from
anemia, cardiac arrhythmias and heart failure, its main cause is coronary artery
disease (CAD), an atherosclerotic process affecting the arteries feeding the
heart. The term derives from the Latinangere ("to strangle") and pectus ("chest"),
and can, therefore, be translated as "a strangling feeling in the chest".

3. Angina pectoris

4. Classification
• Stable angina
• Unstable angina
• Prinzmetal's angina

5. Stable angina
Also known as effort angina, this refers to the classic type of angina related to
myocardial ischemia. A typical presentation of stable angina is that of chest
discomfort and associated symptoms precipitated by some activity (running,
walking, etc.) with minimal or non-existent symptoms at rest or after
administration of sublingual nitroglycerin.[4] Symptoms typically abate several
minutes after activity and recur when activity resumes. In this way, stable angina
may be thought of as being similar to intermittent claudication symptoms.
Other recognized precipitants of stable angina include cold weather, heavy
meals, and emotional stress.

7. Unstable angina
• Also "crescendo angina"; this is a form of acute coronary syndrome) is
defined as angina pectoris that changes or worsens.[1]
• It has at least one of these three features:
• It occurs at rest (or with minimal exertion), usually lasting 3–5 minutes
• It is severe and of new onset (i.e., within the prior 4–6 weeks)
• It occurs with a crescendo pattern (i.e., distinctly more severe, prolonged, or
frequent than before).

8. (Prinzmetal's angina)
• Occurs in patients with normal coronary arteries or insignificant
atherosclerosis. It is thought to be caused by spasms of the artery. It occurs
more in younger women

9. Major risk factors
• Cigarette smoking, diabetes, high cholesterol, high blood pressure, sedentary
lifestyle, and family history of premature heart disease.

10. Pathophysiology
• Angina results when there is an imbalance between the heart's oxygen
demand and supply. This imbalance can result from an increase in demand
(e.g., during exercise) without a proportional increase in supply (e.g., due to
obstruction or atherosclerosis of the coronary arteries).
• However, the pathophysiology of angina in females varies significantly as
compared to males.[29] Non-obstructive coronary disease is more common in
females.[

11. Diagnosis
• Angina should be suspected in people presenting with tight, dull, or heavy chest discomfort that is:[32]
• Retrosternal or left-sided, radiating to the left arm, neck, jaw, or back.
• Associated with exertion or emotional stress and relieved within several minutes by rest.
• Precipitated by cold weather or a meal.
• Some people present with atypical symptoms, including breathlessness, nausea, or epigastric discomfort or
burping. These atypical symptoms are particularly likely in older people, women, and those with diabetes.[32]
• Anginal pain is not usually sharp or stabbing or influenced by respiration. Antacids and simple analgesia do
not usually relieve the pain. If chest discomfort (of whatever site) is precipitated by exertion, relieved by rest,
and relieved by glyceryl trinitrate, the likelihood of angina is increased

12. Treatment
• The most specific medicine to treat angina is nitroglycerin. It is a potent
vasodilator that makes more oxygen available to the heart muscle. Beta
blockers and calcium channel blockers act to decrease the heart's workload,
and thus its requirement for oxygen. Treatments for angina are balloon
angioplasty, in which the balloon is inserted at the end of a catheter and
inflated to widen the arterial lumen. Stents to maintain the arterial widening
are often used at the same time