Angina de pecho: causas, síntomas, diagnóstico y tratamiento

It is known as angina pectoris to the pain that appears in the chest in response to the oxygen shortage in the heart. It is usually an intense, sudden onset pain that is generally described as an oppression and is accompanied by a feeling of shortness of breath. Its duration is variable and limited in a few minutes, with a slow disappearance of symptoms. Appears in response to intense physical activity or emotions , but it is also often not to identify a clear precipitant.

The heart receives the oxygen and nutrients it needs through the coronary arteries. This contribution is not constant, but varies throughout the day in response to their needs, increasing in situations of greater demand, such as climbing a slope, and decreasing in rest situations.

Angina is the result of a transient imbalance between what the heart demands and what coronary arteries provide. It is a serious disease, usually progressive, but many treatments exist today that allow to control its symptomatology.

Causes of angina pectoris

Atherosclerosis or plaque formation within the coronary arteries is the most common cause of angina pectoris. According to specialists in Cardiology , it is a consequence of the progressive deposit of fat and other substances, which slowly reduce the caliber of the vessel and compromising the blood supply.

Heart diseases such as aortic valve stenosis, heart failure, hypertrophy or coronary spasm, and other conditions such as hypertension, hyperthyroidism, anemia, or respiratory failure may be the cause of angina and should be ruled out during the study.

Symptoms of angina

Pain is the most constant symptom. It is usually oppressive, sudden onset, located in the center of the chest and irradiated to the arms, neck, back or jaw. At other times it is of lesser intensity and may not even appear.

Pain characteristics also vary, sometimes manifesting as a burning, stinging or heaviness sensation that can be confused with other pathologies such as hiatal hernia, anxiety or gas. Other symptoms and signs that may appear are the sudden feeling of shortness of breath, sweating, pallor of the skin and nausea. Women and diabetic patients are more prone to a less typical presentation of the disease.

Diagnosis

The description of the pain and the circumstances in which it has manifested can give us the first diagnostic suspicion. Family and personal history, with special attention to vascular risk factors (tobacco, cholesterol, diabetes, hypertension) will let us know if we are facing a patient at high risk for coronary problems.

The physical examination of angina due to atherosclerosis is usually normal, and the electrocardiogram and echocardiography , once the pain has already subsided, usually show no alterations. Measurement of cardiac enzymes in blood (troponins and CPK) allows us to know if there has been damage to the heart muscle, but are negative if the episode has been transient and the heart has returned to normal.

Ischemia tests are used to study patients who have pain suggestive of angina pectoris but in whom initial tests have been normal.

The most common and accessible is the ergometry or stress test , which can be done on tape or bicycle. It consists of performing a progressive physical exercise, which increases the needs of the heart, and reveals situations in which it is not possible to increase the supply of blood through the coronary arteries.

Other tests such as dobutamine echocardiography , stress resonance, or perfusion scintigraphy are also useful in identifying patients with coronary ischemia.

The realization of a coronary CT or a cardiac catheterization allows us to directly visualize, through the administration of contrast, the coronary arteries and to evaluate the presence of stenosis in its path, thus confirming the presence of atherosclerosis plaques.

Which is the treatment?

Treatment should be aimed at reducing and facilitating the work of the heart, as well as improving perfusion through the coronary arteries and controlling vascular risk factors. This includes drugs that act in combination: beta-blockers, calcium antagonists and ivabradine reduce heart rate and contractility and allow blood to flow better in each cardiac cycle; nitrates relax the smooth muscle of the arteries and veins increasing the supply, and ranolazine acts at the cellular level; antiplatelet agents are key to preventing arterial thrombosis and the possibility of a heart attack; drugs that control hypertension, cholesterol, or diabetes can reduce the progression of atherosclerotic disease .

In cases of severe and uncontrolled disease , it may be necessary to intervene at the level of the coronary arteries: stent implants and bypass surgery , in selected cases, allow restoring the flow of the cardiac muscle.

The diagnosis and treatment of angina pectoris is therefore complex. Therefore, it must be supervised and controlled by a specialist in cardiovascular diseases.