6th March 2024

Pathophysiology

Angina pectoris, or stable angina, is often the first warning symptom of underlying coronary artery disease. It occurs when there is an imbalance between the myocardial oxygen supply and the myocardial oxygen demand.  Build-up of fatty plaques within the wall of the coronary artery causes the artery to narrow. During times of increased myocardial oxygen demand, this narrowing or stenosis of the artery prevents adequate myocardial supply, leading to the symptoms of angina. There are several risk factors for developing coronary artery disease. Modifiable ones include smoking, diabetes, hypertension, hypercholesterolemia, and obesity. Unmodifiable risk factors include increasing age, male gender and family history. NICE defines typical anginal pain as (1) a constricting discomfort in the front of the chest or in the neck, shoulders, jaw or arms (2) that is precipitated by exertion and (3) relieved by GTN within about 5 minutes. The presence of two of the features previously mentioned is referred to as atypical anginal pain, whereas the presence of only one or none of the features is referred to as non-anginal chest pain.