Angina
Einstein Health Glossary
ICD 10 - I20
What it is
Angina pectoris is the term used to describe chest pain caused by a lack of blood flow (ischemia) affecting the heart muscle. Angina is almost always related to conditions that cause blockages in the arteries responsible for supplying blood to the heart — the coronary arteries.
Causes
The main cause of angina is a condition known as atherosclerosis, which is the buildup of fatty plaques inside the blood vessels (coronary arteries) responsible for supplying blood to the heart muscle. When the blockage exceeds 70% of the vessel's diameter, the heart, when subjected to increased demand—such as during physical exertion or emotional stress—receives an insufficient supply of oxygen for that demand. This leads to a condition called ischemia, which in turn causes chest angina. Atherosclerosis is multifactorial and is mainly associated with other diseases or risk factors, such as advanced age, hypertension, diabetes, high cholesterol, smoking, family history, and physical inactivity.
Main Symptoms
Angina presents as a sensation of pain or discomfort in the center of the chest, with a poorly defined location, most commonly described as tightness, pressure, suffocation, burning, or strangling.
It is usually triggered by physical exertion, emotional stress, or intense cold and is relieved by rest, occurring in episodes that last from five to fifteen minutes. The pain may radiate to the neck, arm, shoulders, jaw, or, more rarely, to the back.
Symptoms such as nausea, indigestion, cold sweat, shortness of breath, and paleness may accompany the episodes. Pain that is very well localized (pointed to with a fingertip) or fleeting (lasting only a few seconds) is generally not angina.
In cases where the pain is intense, sudden, and very prolonged, the individual is likely experiencing a myocardial infarction—a serious condition indicating a sudden and complete blockage of a heart vessel, requiring immediate medical attention due to the imminent risk of death or severe complications.
Diagnosis
The initial diagnosis is clinical, based on the patient's symptoms and risk factors. After that, several tests are used to investigate the cause and confirm the diagnosis.
Stress tests may be used, such as the exercise stress test, in which the patient undergoes controlled physical exertion on a treadmill while a machine (electrocardiogram) monitors heartbeats and detects signs of ischemia when the heart reaches a certain level of acceleration. Other tests with the same purpose include the stress echocardiogram and nuclear medicine scintigraphy. In certain situations, substances that induce stress on the heart (pharmacological stress) are used for individuals who are unable to exercise.
The test that definitively confirms whether a person has blockages in the coronary arteries is cardiac catheterization. In some cases, coronary computed tomography angiography has recently gained ground. The downside of both of these tests is the use of iodine-based contrast agents.
Treatment
In addition to managing risk factors (such as controlling blood pressure and diabetes, and quitting smoking), there are several medications that can relieve symptoms and even reduce the risk of death or heart attack in patients with angina.
In more severe cases, procedures may be performed to unblock the clogged arteries. One such procedure is angioplasty, in which a balloon is used—via catheterization—to dilate the obstructed vessel, and a metal mesh (stent) is placed to keep the vessel open. Another option is coronary artery bypass surgery, where grafts (vessels taken or redirected from the patient, such as the saphenous vein) are used to create new pathways for blood to reach the heart muscle, bypassing the blockage.
Each procedure has its advantages and disadvantages, which should be discussed on a case-by-case basis with the doctor, patient, and family. It’s important to emphasize that these procedures are ineffective if risk factors are not addressed. There is also no scientific evidence supporting the routine use of these procedures in asymptomatic individuals solely based on the presence of arterial blockage. In all cases, regardless of the treatment approach, individuals with coronary artery obstruction should take acetylsalicylic acid (ASA – Aspirin) indefinitely to prevent clot formation in the coronary arteries and thus reduce the risk of myocardial infarction.
Prevention
Preventing angina involves adopting healthy habits such as maintaining a balanced diet, engaging in regular physical activity, and avoiding smoking. It also includes the early treatment of risk factors, especially diabetes, high blood pressure, and high cholesterol.
Incidence in Brazil
In Brazil, data from the Department of Informatics of the Unified Health System (DATASUS) show that cardiovascular causes account for nearly 30% of all deaths. Epidemiological data from other countries suggest that, after the age of 65, 10 to 15% of people experience angina at some point, and an equal number may have silent ischemia.