Angina Pectoris
Angina pectoris is chest tightness or pressure triggered by the heart not receiving enough oxygen-rich blood. It is a key warning sign of coronary artery disease and requires prompt assessment by a cardiologist.
Chest discomfort can be an early warning sign of heart disease
Angina pectoris is chest discomfort caused by insufficient oxygen supply to the heart muscle, most commonly due to narrowed coronary arteries from plaque buildup. It is not a disease in itself, but a critical warning sign of underlying coronary artery disease that requires prompt specialist evaluation.
Symptoms
The most common symptom is pressure, tightness, or heaviness in the chest, typically triggered by physical exertion or emotional stress and relieved by rest. Pain may radiate to the jaw, neck, shoulders, or arms. Some patients, particularly women, present with atypical symptoms such as unexplained fatigue, shortness of breath, or nausea rather than classic chest pain.
Types of Angina
- Stable angina is the most common form: predictable, exertion-triggered, and relieved by rest or nitrates within minutes.
- Unstable angina occurs at rest or with minimal activity, lasts longer, and does not resolve easily. It is a medical emergency requiring urgent assessment as it may precede a heart attack.
- Variant (Prinzmetal's) angina results from coronary artery spasm rather than fixed blockage, typically occurring at rest or during sleep.
- Microvascular angina involves dysfunction of small coronary vessels and is more prevalent in women, often without visible blockages on standard imaging.
Diagnosis
Diagnosis begins with a clinical history and ECG, followed by stress testing to assess how the heart responds under exertion. Where indicated, cardiac CT coronary angiography or invasive coronary angiography provides definitive anatomical assessment of arterial blockages.
Treatment Options
Treatment is directed at relieving symptoms, improving coronary blood flow, and reducing heart attack risk. Medications, including nitrates, beta blockers, calcium channel blockers, and statins, form the cornerstone of management. Where significant arterial narrowing is confirmed, coronary angioplasty and stenting or bypass surgery may be recommended. For selected patients with refractory angina, Enhanced External Counterpulsation offers a non-invasive option.
When to Seek Emergency Care
Chest pain at rest, pain unrelieved by nitrates, or discomfort accompanied by breathlessness, sweating, or radiation to the jaw or arm requires immediate emergency assessment. These features may indicate unstable angina or acute myocardial infarction.
Experiencing chest tightness or exertional discomfort? Dr. Peter Chang consults at Paragon Medical Centre, Orchard Road. Book a cardiac assessment today.